You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Albumin Synthesis Rates Are Not Decreased in Hypoalbuminemic Cachectic Cancer Patients With an Ongoing Acute-Phase Protein Response

Fearon, Kenneth C. H. M.D.*; Falconer, J. Stuart M.B.Ch.B.*; Slater, Christine M.Ph.†; McMillan, Donald C. Ph.D.‡; Ross, James A. Ph.D.*; Preston, Tom Ph.D.†

Annals of Surgery:
Advances in Surgical Technique
Abstract

Objective: To determine whether suppression of albumin synthesis contributes to the hypoalbuminemia observed in weight-losing cancer patients with evidence of an ongoing acute-phase protein response (APPR).

Background Data: Proinflammatory cytokines such as tumor necrosis factor (TNF) and interleukin 6 (IL-6) are known to downregulate albumin synthesis and increase acute-phase protein production in isolated hepatocytes. However, whether albumin synthesis is suppressed in hypoalbuminemic cancer patients with evidence of an ongoing acute-phase response is unknown.

Methods: Albumin synthesis rates were determined in six healthy controls and in six weight-losing pancreatic cancer patients with an ongoing APPR using a flooding dose technique with [2H5]-phenylalanine. The presence of an APPR was defined as a serum C-reactive protein concentration > 10 mg/L. Serum cytokines (TNF, IL-6) and soluble TNF receptors (sTNF-R 55 and 75), along with serum cortisol and insulin, were also measured in both groups.

Results: Cancer patients had reduced serum albumin (median 32 [range, 23-36] vs. 42 g/L [40-45]; p < 0.01) and increased serum C-reactive protein concentrations (72 [23-126] vs. <5 mg/L; p < 0.01) when compared with controls. TNF was not detected in either group. sTNF-R 55 levels were significantly elevated in the cancer patients (3.8 [1.9-8.1] vs. 1.2 pg/mL [0.9-2.2]; p < 0.01). Circulating IL-6, insulin, and cortisol concentrations were not significantly different between the groups. The intravascular albumin mass was lower (88 [56-93] vs. 133 g [105-177]; p < 0.01), but the intravascular albumin fractional synthetic rate was higher (13.9 [13.5-18.5] vs. 10.3%/d [71-11.3]; p < 0.01) in the cancer patients compared with the controls. The total intravascular albumin synthetic rate was, however, similar between the two groups (12.7 [7.7-15.7] vs. 11.7 g/d [8.5-18.7]; p NS).

Conclusions: In weight-losing pancreatic cancer patients with evidence of an ongoing APPR, hypoalbuminemia is not caused by a decreased rate of albumin synthesis.

Author Information

From the University Department of Surgery, Royal Infirmary, Edinburgh, United Kingdom;* the Isotope Biochemistry Laboratory, SURRC, East Kilbride, Glasgow, United Kingdom;† and the University Department of Surgery, Royal Infirmary, Glasgow, United Kingdom‡

Supported in part by The Scottish Office Home and Health Department Grant K/MRS/50/C1922 and by the Cancer Research Campaign.

Reprints are not available. Address for correspondence: Dr. K. C. H. Fearon, University Department of Surgery, Royal Infirmary, Edinburgh EH3 9JW, United Kingdom.

Accepted for publication October 16, 1996.

© Lippincott-Raven Publishers.