Ace Alzheimer Center Barcelona, Universitat Internacional De Catalunya, Barcelona, Spain.
Centro De Investigación Y Clínica Memoria, Fundación CITA-Alzheimer Fundazioa, Donostia, San Sebastián, Spain.
Expert Rev Neurother. 2021 Aug;21(8):843-849. doi: 10.1080/14737175.2021.1960823. Epub 2021 Aug 4.
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.
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.
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.
阿尔茨海默病（AD）是一种慢性神经退行性疾病，也是痴呆症最常见的病因。其发病机制复杂，目前尚未完全阐明，多种中枢、全身和环境因素在疾病进展中起着关键作用。了解 AD 的多因素性质对于制定新的治疗方法至关重要。
作者综述了白蛋白对淀粉样β结合、抗氧化和免疫调节特性在 AD 中的作用，以及治疗性血浆置换（PE）在神经病学中的应用。还分析了将 PE 与白蛋白替代疗法联合用于轻中度 AD 患者的阿尔茨海默病管理白蛋白替代疗法（AMBAR）试验的结果。
AMBAR 研究的结果为 AD 的 PE 和白蛋白替代治疗提供了令人鼓舞的结果，特别是在疾病中度阶段的患者中，与安慰剂相比，大多数分析变量的认知能力下降幅度较小。需要进一步的研究来确定这些结果背后的可能作用机制。可能从这种治疗中获益的其他患者群体，如轻度认知障碍或其他类型的痴呆症患者，也可能成为进一步研究的目标。
