Oxidized Albumin Triggers a Cytokine Storm in Leukocytes Through P38 Mitogen-Activated Protein Kinase: Role in Systemic Inflammation in Decompensated Cirrhosis

Hepatology. 2018 Nov;68(5):1937-1952. doi: 10.1002/hep.30135. Epub 2018 Oct 13.


Decompensated cirrhosis is characterized by exuberant systemic inflammation. Although the inducers of this feature remain unknown, the presence of circulating forms of oxidized albumin, namely human nonmercaptalbumin 1 (HNA1) and HNA2, is a common finding in cirrhosis. The aim of this study was to explore the ability of these oxidized albumin forms to induce systemic inflammation by triggering the activation of peripheral leukocytes. We observed significantly higher plasma levels of HNA1 and HNA2 in patients with cirrhosis (n = 256) compared to healthy volunteers (n = 48), which gradually increased during the course from compensated to decompensated to acute-on-chronic liver failure. Plasma HNA1 and HNA2 levels significantly correlated with inflammatory markers (i.e., interleukin-6 [IL-6], IL-1β, tumor necrosis factor-alpha [TNF-α] and IL-8) in patients with cirrhosis. To directly test the inflammatory effects of HNA1 and HNA2 on leukocytes, these oxidized albumin forms were prepared ex vivo and their posttranslational modifications monitored by liquid chromatography (LC)-quadrupole time-of-flight/mass spectrometry (MS). HNA1, but not HNA2, increased IL-1β, IL-6, and TNF-α mRNA and protein expression in leukocytes from both healthy volunteers and patients with cirrhosis. Moreover, HNA1 up-regulated the expression of eicosanoid-generating enzymes (i.e., cyclooxygenase-2 [COX-2] and microsomal prostaglandin E [PGE] synthase 1) and the production of inflammatory eicosanoids (PGE2 , PGF , thromboxane B2 , and leukotriene B4 ), as determined by LC-electrospray ionization-MS/MS. The inflammatory response to HNA1 was more pronounced in peripheral blood mononuclear cells (PBMCs) and marginal in polymorphonuclear neutrophils. Kinome analysis of PBMCs revealed that HNA1 induced the phosphorylation of p38 mitogen-activated protein kinase, the inhibition of which blocked HNA1-induced cytokine and COX-2 induction. Conclusion: HNA1 triggers an inflammatory response in PBMCs, providing a rationale for its removal and replacement by reduced albumin in the prevention of systemic inflammation in patients with advanced liver disease.

Keywords: Albumin; Cirrhosis; Inflammation; Leukocytes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blotting, Western
  • Chromatography, Liquid
  • Cytokines / metabolism*
  • Female
  • Humans
  • Inflammation / metabolism*
  • Leukocytes / metabolism*
  • Liver / metabolism
  • Liver / pathology
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / metabolism*
  • Liver Failure / etiology
  • Liver Failure / metabolism
  • Male
  • Middle Aged
  • Oxidation-Reduction
  • Reactive Oxygen Species / metabolism
  • Real-Time Polymerase Chain Reaction
  • Serum Albumin, Human / metabolism*
  • Tandem Mass Spectrometry
  • p38 Mitogen-Activated Protein Kinases / metabolism*


  • Cytokines
  • Reactive Oxygen Species
  • nonmercaptalbumin
  • p38 Mitogen-Activated Protein Kinases
  • Serum Albumin, Human