Therapeutic plasma exchange with albumin: a new approach to treat Alzheimer’s disease

Abstract

Introduction: Alzheimer's disease (AD) is a chronic neurodegenerative disease and the most common cause of dementia. It has a complex pathophysiology that is not yet completely understood, where multiple central, systemic, and environmental factors play a key role in disease progression. Understanding the multifactorial nature of AD is paramount to formulate new therapies. Areas covered: The authors reviewed the role of the amyloid-β-binding, antioxidant, and immunomodulatory properties of albumin in AD and the use of therapeutic plasma exchange (PE) in neurology. The results from the Alzheimer Management By Albumin Replacement (AMBAR) trial that combined the use of PE with albumin replacement in patients with mild-to-moderate AD, are also analyzed. Expert opinion: Findings from the AMBAR study provide encouraging results in the treatment of AD with PE and albumin replacement, especially in patients at the moderate stage of the disease, who showed less cognitive decline from baseline compared with placebo in most of the variables analyzed. Further research is warranted to ascertain the possible mechanisms of action underlying these results. Different cohorts of patients that may also benefit from this treatment, such as those with mild cognitive impairment or other types of dementia, could also be the target of additional studies.

Inhibition of toxic metal-alpha synuclein interactions by human serum albumin

“…Overall, our study not only emphasizes the importance of fatty acid binding and age-related posttranslational modications such as glycation for the neuroprotective mechanisms of HSA, but also highlights the potential of aSyn as a viable NMR-based sensor to investigate HSA-metal ions interactions. The concepts presented here are also relevant to understand the mechanism of action of albumin as a biotherapeutic [92][93][94] for neurodegeneration.…”

Geroscience and Alzheimer’s Disease Drug Development

“…The goal of plasma exchange is to reduce systemic and brain chemokines and cytokines that may exacerbate brain inflammation in AD. Plasma exchange may also affect amyloid dynamics, and replacement albumin may have antioxidant effects ( 51 ).…”

Translating blood biomarkers into clinical practice for Alzheimer's disease: Challenges and perspectives

“…34 Therefore, human albumin replacement with plasma exchange has been used to remove albumin-bound Aβ from plasma and subsequently clear Aβ in the brain. 35 This approach has shown beneficial efficacy in AD patients in phase 2 clinical trials. 36,37 Third, the sources of pathological proteins in the blood include both the brain and the periphery.…”

“…In AD patients, the albumin‐bound Aβ levels were reduced, possibly due to a decreased capacity of albumin to bind Aβ 34 . Therefore, human albumin replacement with plasma exchange has been used to remove albumin‐bound Aβ from plasma and subsequently clear Aβ in the brain 35 . This approach has shown beneficial efficacy in AD patients in phase 2 clinical trials 36,37 …”