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Extracorporeal apheresis therapy for Alzheimer disease-targeting lipids, stress, and inflammation.

Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany. stefan.bornstein@ukdd.de. Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK. stefan.bornstein@ukdd.de. Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, University Hospital, Zürich, Switzerland. stefan.bornstein@ukdd.de. Zentrums für Apherese- und Hämofiltration am INUS Tagesklinikum, Cham, Germany. Facharzt für Nervenheilkunde, Facharzt Psychiatrie und Psychotherapie, Paulmannshöher Strasse 17, 58515, Lüdenscheid, Germany. Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany. Lee Kong Chian School of Medicine, NTU Nanyang Technological University, Singapore, Singapore. Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Center for Regenerative Therapies Dresden (CRTD), Technische Universität Dresden, 01307, Dresden, Germany. German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307, Dresden, Germany. Department of Neurology University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany. University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece. State University of New York Upstate Medical University, Syracuse, NY, USA. Departments of Pathology, Department of Medicine, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA. Veterans Affairs Medical Center, Miami, FL, USA.

Molecular psychiatry. 2020;(2):275-282
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Abstract

Current therapeutic approaches to Alzheimer disease (AD) remain disappointing and, hence, there is an urgent need for effective treatments. Here, we provide a perspective review on the emerging role of "metabolic inflammation" and stress as a key factor in the pathogenesis of AD and propose a novel rationale for correction of metabolic inflammation, increase resilience and potentially slow-down or halt the progression of the neurodegenerative process. Based on recent evidence and observations of an early pilot trial, we posit a potential use of extracorporeal apheresis in the prevention and treatment of AD. Apolipoprotein E, lipoprotein(a), oxidized LDL (low density lipoprotein)'s and large LDL particles, as well as other proinflammatory lipids and stress hormones such as cortisol, have been recognized as key factors in amyloid plaque formation and aggravation of AD. Extracorporeal lipoprotein apheresis systems employ well-established, powerful methods to provide an acute, reliable 60-80% reduction in the circulating concentration of these lipid classes and reduce acute cortisol levels. Following a double-membrane extracorporeal apheresis in patients with AD, there was a significant reduction of proinflammatory lipids, circulating cytokines, immune complexes, proinflammatory metals and toxic chaperones in patients with AD. On the basis of the above, we suggest designing clinical trials to assess the promising potential of such "cerebropheresis" treatment in patients with AD and, possibly, other neurodegenerative diseases.

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Publication Type : Review

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