Therapeutic plasma exchange (TPE, plasmapheresis)
Therapeutic plasma exchange (TPE, plasmapheresis) is an extracorporeal blood purification technique designed for the removal of large molecular weight substances from the plasma (eg, pathogens, autoantibodies, immune complexes, pro-inflammatory cytokines, cryoglobulins, endotoxins, cholesterol-containing lipoproteins) and this may help in autoimmune disease and immune dysregulation.
Treatment of Therapeutic Plasma Exchange Provides
- Removal of Harmful Substances: TPE helps eliminate abnormal proteins, toxins, or antibodies from the blood, which can be beneficial in conditions like autoimmune diseases, certain neurological disorders, and metabolic dysregulation.
- Reduction of Inflammation: By removing inflammatory mediators and immune system components, TPE can help reduce inflammation and associated symptoms and be useful for chronic illness and longevity.
- Improvement in Disease Symptoms: Many patients experience significant improvements in symptoms and overall health, such as reduced pain, better organ function, and improved quality of life.
- Immune System Modulation: TPE can help modulate the immune system, which is useful in treating conditions where the immune system is overactive or misdirected, like in autoimmune disorders and long COVID studies have shown:
- Stimulated Proliferation of B cells and plasma cells
- Removal of immunocomplexes enhancing macrophage/monocyte function
- Removal of Cytokines
- Correction of altered T helper cell types Th1/Th2 balance
- Increased T regulatory cells and T Suppresor cells
- Prevention: TPE can prevent complications and disease progression, improving long-term health outcomes.
- Restoration of Function: In cases where TPE helps restore normal function to organs or systems affected by disease, it can contribute to a more balanced and healthier state.
In addition to TPE, we recommend maximizing the benefits by having autologous stem cells or exosome therapies.
Once harmful substances are removed from your blood and the immune system is better regulated with TPE, it is an excellent opportunity to potentially enhance your cellular communication with these regenerative therapies.
Schedule an appointment or reach out to me to get started!
Research and References:
Immune Modulation
The use of TPE may also modulate cellular immunity by altering the ratio of T-helper type-1 (Th1) and type 2 (Th2) cells in peripheral blood. Th2 cells are known to facilitate the humoral immune response by facilitating antibody production by B cells. It is likely, therefore, that Th2 play an important role in autoimmune disorders due to autoantibody production. A small study found that in two out of three patients with neuroimmunological disease, TPE altered the Th1/Th2 cytokine ratio. In another study, patients with Miller Fisher Syndrome (MFS) were found to have an imbalance of Th1/Th2 cells with a predominance of Th2 cells; TPE shifted the Th1/Th2 balance in these patients to a Th1 dominant pattern.
Jean-Marc Léger, Luis Querol, Mazen M Dimachkie., The immunomodulatory Role of Theapeutic Plasma Exhange in Peripheral Nervous Sytstem and Neuromusclular Diseases., eb 2nd 2017European Neurological Review, 2017;12(Suppl. 1):2-7
Goto H, Matsuo H, Nakane S, et al., Plasmapheresis affects T helper type-1/T helper type-2 balance of circulating peripheral lymphocytes, Ther Apher, 2001;5:494-6
Kambara C, Matsuo H, Fukudome T, et al., Miller Fisher syndrome and plasmapheresis, Ther Apher, 2002;6:450-3.
Reversal of Biomarkers of Aging
The results on biological age are strongly supported by the data, which demonstrates that rounds of therapeutic plasma exchange (TPE) promote a global shift to a younger systemic proteome, including youthfully restored pro-regenerative, anticancer, and apoptotic regulators and a youthful profile of myeloid/lymphoid markers in circulating cells, which have reduced cellular senescence and lower DNA damage.
Kim D, Kiprov DD, Luellen C, Lieb M, Liu C, Watanabe E, Mei X, Cassaleto K, Kramer J, Conboy MJ, Conboy IM. Old plasma dilution reduces human biological age: a clinical study. Geroscience. 2022 Dec;44(6):2701-2720. doi: 10.1007/s11357-022-00645-w. Epub 2022 Aug 24. Erratum in: Geroscience. 2024 Apr;46(2):2795. doi: 10.1007/s11357-023-00997-x. PMID: 35999337; PMCID: PMC9398900.
Therapeutic Plasma Exchange and Long-Covid
Extracorporeal apheresis has the potential to improve symptoms of Long-Covid. Consistent with the clinical experience of several centers that have administered this treatment in a cohort of more than 1000 patients, 70% of patients with ME/CFS, including Long-Covid patients, reported a significant improvement in their symptoms. In the current study, they analyzed those biomarkers that play a role in the pathogenesis of postinfectious syndromes, such as Long-Covid, in 27 patients who showed clinical improvement after extracorporeal therapeutic apheresis and found that the biomarkers were significantly reduced after the treatment.
Achleitner M, Steenblock C, Dänhardt J, Jarzebska N, Kardashi R, Kanczkowski W, Straube R, Rodionov RN, Bornstein N, Tselmin S, Kaiser F, Bucher R, Barbir M, Wong ML, Voit-Bak K, Licinio J, Bornstein SR. Clinical improvement of Long-COVID is associated with reduction in autoantibodies, lipids, and inflammation following therapeutic apheresis. Mol Psychiatry. 2023 Jul;28(7):2872-2877. doi: 10.1038/s41380-023-02084-1. Epub 2023 May 2. PMID: 37131073; PMCID: PMC10152027.
The addition of TPE significantly reduced mortality in hospitalized patients with moderate-to-critical COVID-19. Plasma exchange therapy should be considered for COVID-19, especially in critically ill patients.
Qin J, Wang G, Han D. Benefits of plasma exchange on mortality in patients with COVID-19: a systematic review and meta-analysis. Int J Infect Dis. 2022 Sep;122:332-336. doi: 10.1016/j.ijid.2022.06.014. Epub 2022 Jun 14. PMID: 35709964; PMCID: PMC9192121.
Plasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS)
The current study was designed to evaluate the effect of plasmapheresis on systemic cytokine and immune cell levels in severe COVID-19 patients with ARDS. Therapeutic plasmapheresis in critically ill patients with COVID-19 reduced excess pro-inflammatory cytokine, liver function, and acute phase protein levels which could help to support vital organ function. In addition, plasmapheresis improved oxygenation status and lymphocyte subset counts.
Hashemian SM, Shafigh N, Afzal G, Jamaati H, Tabarsi P, Marjani M, Malekmohammad M, Mortazavi SM, Khoundabi B, Mansouri D, Moniri A, Hajifathali A, Roshandel E, Mortaz E, Adcock IM. Plasmapheresis reduces cytokine and immune cell levels in COVID-19 patients with acute respiratory distress syndrome (ARDS). Pulmonology. 2021 Nov-Dec;27(6):486-492. doi: 10.1016/j.pulmoe.2020.10.017. Epub 2020 Dec 4. PMID: 33358260; PMCID: PMC7834188.
Therapeutic Plasma Exchange and Alzheimer’s Disease
This phase 3 trial in October 2020 examined the effects of plasma exchange on 496 patients with mild to moderate Alzheimer’s disease. This trial suggests that therapeutic plasma exchange with albumin replacement could slow cognitive and functional decline in Alzheimer’s disease, showing 52% less decline on activities of daily living and 66% less decline in Alzheimer’s Cognitive subscale, although further studies are warranted.
Boada M, López OL, Olazarán J, Núñez L, Pfeffer M, Paricio M, Lorites J, Piñol-Ripoll G, Gámez JE, Anaya F, Kiprov D, Lima J, Grifols C, Torres M, Costa M, Bozzo J, Szczepiorkowski ZM, Hendrix S, Páez A. A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer’s disease: Primary results of the AMBAR Study. Alzheimers Dement. 2020 Oct;16(10):1412-1425. doi: 10.1002/alz.12137. Epub 2020 Jul 27. PMID: 32715623; PMCID: PMC7984263.
Mechanisms of Action of Plasma Exchange
The therapeutic effects of TPE could include the removal of pathological substances from the blood, such as monoclonal paraproteins and autoantibodies, as well as the replacement of deficient plasma components when plasma is used as a replacement fluid. Beyond these potential mechanisms, other possible mechanisms include possible alterations in lymphocyte proliferation and function that could sensitize these cells to immunosuppressant and chemotherapeutic agents and alterations in the immune system including changes in B and T cell numbers and activation, increased T suppressor function, and alteration in T-helper cell type 1/2 (Th1/Th2) ratio.
Reeves HM, Winters JL, The mechanisms of action of plasma exchange, Br J Haematol, 2014;164:342-51.
Bosch T, Current status in extracorporeal immunomodulation: immune disorders, Artif Organs, 1996;20:902-5.
Fantastic experience with Dr. Squires! The regenerative injection therapy really helped me!