Miquel Lozano, MD, PhD, Hospital Clínic de Barcelona, Barcelona, Spain, discusses the use of plasma exchange plus albumin replacement as an innovative treatment for Alzheimer´s disease. The rationale behind this procedure is based on the peripheral sink hypothesis which assumes amyloid beta exists in an equilibrium between the cerebral spinal fluid (CSF) and peripheral blood. Plasma albumin in patients with Alzheimer’s has a reduced ability to bind amyloid beta. Thus, albumin replacement may increase sequestration of amyloid beta in the blood, altering the equilibrium and provoking CSF amyloid to move out into the plasma. Recently reported data from the Phase II/III AMBAR trial assessing the clinical benefits of this treatment in patients with mild/moderate Alzheimer’s showed that patients treated with plasma exchange showed 52% less decline than those receiving placebo, based on change from baseline of Alzheimer’s Disease Cooperative Study–Activities of Daily Living (ADCS-ADL) scores. This interview took place during the European Academy of Neurology 2021 congress.
