Navarro-Martínez Rut, Cauli Omar
Haematology Department, Hospital General Universitario, 46014 Valencia, Spain.
Department of Nursing, University of Valencia, 46010 Valencia, Spain.
Pharmaceuticals (Basel). 2020 Feb 12;13(2):28. doi: 10.3390/ph13020028.
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.
Articles related to this topic and published without time limitations in the Medline, and Cochrane databases were reviewed.
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.
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.
减少β-淀粉样蛋白积累以及与毒性自身免疫相关蛋白的负担，这些蛋白是诸如阿尔茨海默病（AD）和多发性硬化症（MS）等慢性常见神经疾病公认的病理生理标志物之一，可能是一种有效的替代疗法，可减少它们在大脑中的积累，从而减缓这些疾病的进展。本综述的目的是评估血浆置换（PP）对AD和慢性进展性MS患者的疗效（在改善临床症状方面），并分析其安全性和方案。
对Medline和Cochrane数据库中无时间限制发表的与该主题相关的文章进行了综述。
在AD患者中，PP降低了大脑中的淀粉样β蛋白（Aβ）水平，同时伴有认知稳定的趋势，并改善了语言和言语流畅性。关于大脑结构和功能的变化，PP减少了脑容量，并有利于灌注进展的稳定或无进展。在慢性进展型MS患者中，PP使20%-70%的慢性进展型MS患者的神经功能缺损得到改善，并恢复了干扰素（IFN）反应性，且脑斑块未出现任何影像学变化。
用白蛋白替代进行治疗性血浆置换是一种有前景的策略，可减少Aβ介导的毒性并减缓疾病进展。一些慢性进展型MS患者的神经功能缺损有所改善。最能从这种方法中获益的AD和MS患者的特征需要进一步研究。
