Abstract
Background: Reducing the burden of beta-amyloid accumulation and toxic autoimmunity-related proteins, one of the recognized pathophysiological markers of chronic and common neurological disorders such as Alzheimer’s disease (AD) and multiple sclerosis (MS), may be a valid alternative therapy to reduce their accumulation in the brain and thus reduce the progression of these disorders. The objective of this review was to evaluate the efficacy of plasmapheresis (PP) in AD and chronic progressive MS patients (in terms of improving clinical symptoms) and to analyze its safety and protocols. Methods: Articles related to this topic and published without time limitations in the Medline, and Cochrane databases were reviewed. Results: In AD patients, PP reduced amyloid beta (Aβ) levels in the brain, accompanied by a tendency towards cognitive stabilization, and improved language and verbal fluency. In regards to structural and functional brain changes, PP reduced brain volume and favored the stabilization, or absence, of the progression of perfusion. In chronic progressive form of MS patients, PP improved neurological deficits in 20–70% of patients with a chronic progressive form of MS, and restored interferon (IFN) responsiveness, which was not accompanied by any image change in brain plaques. Conclusions: Therapeutic plasmapheresis with albumin replacement is a promising strategy for reducing Aβ mediated toxicity and slowing the progression of the disorder. Some patients with chronic progressive forms of MS show improvement in neurological deficits. The features of AD and MS patients who benefit most from this approach need further research.
Highlights
Neurological disorders are increasingly being recognized as major causes of death and disability worldwide
We summarized the results of this literature review under four headings: (1) protocol of PP tested; (2) the decline in Aβ or auto-immunity mediators after plasmapheresis; (3) the beneficial clinical effects observed after PP; (4) the safety and adverse effects of this technique
The knowledge that the main toxic factors for Alzheimer’s disease (AD) pathology are the accumulation of Aβ in the brain, and circulating Aβ peptides crossing into the brain, and contributing to neurological impairment, led to tests of how PP can reduce the Aβ burden in AD patients in a pioneering study by Boada et al [26]
Summary
Neurological disorders are increasingly being recognized as major causes of death and disability worldwide. There is extensive literature related to the use of plasma exchange in relapsing and remitting multiple sclerosis, and its use as a temporary treatment of acute relapses in steroid-unresponsive MS patients has been recently reviewed [15,16] For this reason, the aim of the review does not include the studies on the relapsing and remitting form of MS (the most common form of the disease). Reducing the burden of beta-amyloid accumulation and toxic autoimmunity-related proteins, one of the recognized pathophysiological markers of chronic and common neurological disorders such as Alzheimer’s disease (AD) and multiple sclerosis (MS), may be a valid alternative therapy to reduce their accumulation in the brain and reduce the progression of these disorders. The features of AD and MS patients who benefit most from this approach need further research
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