Anaya Fernando
Hospital General Universitario, Gregorio Maranon, 28007 Madrid, Espana.
Rev Neurol. 2010 Mar 16;50 Suppl 5:S5-8.
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 (Alphabeta) 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 Alphabeta is linked to albumin, a mobilization of plasma Ass after plasmapheresis could induce a mobilization of brain Alphabeta 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 5% in patients with AD.
Plasmapheresis is feasible in this complex patient population in terms of treatment, safety and tolerability. Moreover, a trend towards plasma Alphabeta mobilization associated with an improvement in neuropsychological evaluation was observed.
背景与研究进展：治疗性血液成分单采是一种治疗策略，旨在从血液中去除和消除那些被认为是导致疾病或其临床表现的致病物质。在治疗性血浆置换（血浆交换）中，抽取一定量的循环血浆，通常用5%白蛋白溶液替代，特殊情况下用新鲜血浆替代。β-淀粉样肽（Aβ）是脑实质中参与记忆功能的细胞外老年斑的主要蛋白质成分。细胞外老年斑和神经原纤维缠结都是阿尔茨海默病（AD）的特征。鉴于90%循环中的Aβ与白蛋白结合，血浆置换后血浆Aβ的动员可能会促使脑内Aβ的动员，因此，AD患者认知功能的下降可能会得到预防。基于这一目标，开展了一项临床项目，以研究用5%基立福人血白蛋白进行血浆置换治疗AD患者的可行性。
就治疗、安全性和耐受性而言，血浆置换在这类复杂患者群体中是可行的。此外，观察到血浆Aβ动员的趋势与神经心理学评估的改善相关。
