Neuroimaging analyses from a randomized, controlled study to evaluate plasma exchange with albumin replacement in mild-to-moderate Alzheimer's disease : additional results from the AMBAR study
Cuberas-Borrós, Gemma (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Roca, Isabel (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Castell-Conesa, Joan (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Núñez, Laura (Alzheimer's Research Group (Barcelona))
Boada, Mercè (Instituto de Salud Carlos III)
López, Oscar L. (University of Pittsburgh School of Medicine)
Grifols, Carlota (Alzheimer's Research Group (Barcelona))
Barceló Torns, Miquel (Alzheimer's Research Group (Barcelona))
Pareto, Deborah (Hospital Universitari Vall d'Hebron)
Páez, Antonio (Alzheimer's Research Group (Barcelona))
Universitat Autònoma de Barcelona

Data:	2022
Resum:	This study was designed to detect structural and functional brain changes in Alzheimer's disease (AD) patients treated with therapeutic plasma exchange (PE) with albumin replacement, as part of the recent AMBAR phase 2b/3 clinical trial. Mild-to-moderate AD patients were randomized into four arms: three arms receiving PE with albumin (one with low-dose albumin, and two with low/high doses of albumin alternated with IVIG), and a placebo (sham PE) arm. All arms underwent 6 weeks of weekly conventional PE followed by 12 months of monthly low-volume PE. Magnetic resonance imaging (MRI) volumetric analyses and regional and statistical parametric mapping (SPM) analysis on 18 F-fluorodeoxyglucose positron emission tomography (18 FDG-PET) were performed. MRI analyses (n = 198 patients) of selected subcortical structures showed fewer volume changes from baseline to final visit in the high albumin + IVIG treatment group (p < 0. 05 in 3 structures vs. 4 to 9 in other groups). The high albumin + IVIG group showed no statistically significant reduction of right hippocampus. SPM 18 FDG-PET analyses (n = 213 patients) showed a worsening of metabolic activity in the specific areas affected in AD (posterior cingulate, precuneus, and parieto-temporal regions). The high-albumin + IVIG treatment group showed the greatest metabolic stability over the course of the study, i. e. , the smallest percent decline in metabolism (MaskAD), and least progression of defect compared to placebo. PE with albumin replacement was associated with fewer deleterious changes in subcortical structures and less metabolic decline compared to the typical of the progression of AD. This effect was more marked in the group treated with high albumin + IVIG. (AMBAR trial registration: EudraCT#: 2011-001,598-25; ClinicalTrials. gov ID: NCT01561053). The online version contains supplementary material available at 10. 1007/s00259-022-05915-5.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Alzheimer's disease ; Plasmapheresis ; Plasma exchange ; Albumin ; Intravenous immunoglobulin
Publicat a:	European Journal of Nuclear Medicine and Molecular Imaging, Vol. 49 (july 2022) , p. 4589-4600, ISSN 1619-7089

DOI: 10.1007/s00259-022-05915-5
PMID: 35867135

12 p, 1.2 MB

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