Therapeutic plasmapheresis and experience in Alzheimer's disease

Background and study development. Therapeutic apheresis is a treatment strategy aimed at removing and eliminating from blood those substances that are considered pathogenically responsible for a disease or its clinical manifestations. In a therapeutic plasmapheresis (plasma exchange), a volume of circulating plasma is extracted and usually substituted by a 5% albumin solution or, exceptionally, by fresh plasma. Beta-amyloid peptide (A beta) is the main proteinaceous component of the extracellular senile plaque found in the brain parenchyma involved in memory function. Both extracellular senile plaque and neurofibrillar tangles are characteristic of Alzheimer's disease (AD). Considering that 90% of circulanting AI is linked to albumin, a mobilization of plasma A beta after plasmapheresis could induce a mobilization of brain A beta and, as a consequence, the decline of cognitive functions in AD patients could be prevented. With this objective, a clinical program was developed to investigate the feasibility of plasmapheresis with Human Albumin Grifols (R) 5% in patients with AD. Conclusions. Plasmapheresis is feasible in this complex patient population in terms of treatment, safety and tolerability. Moreover, a trend towards plasma A beta mobilization associated with an improvement in neuropsychological evaluation was observed.