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This study, part of the AMBAR phase 2b/3 clinical trial, investigated structural and functional brain changes in Alzheimer’s disease (AD) patients treated with therapeutic plasma exchange (PE) with albumin replacement. The trial included mild-to-moderate AD patients randomized into four groups: three receiving PE with varying doses of albumin (with or without intravenous immunoglobulin, IVIG) and a placebo group.

Key Findings:

• MRI Results: Among 198 patients, those in the high albumin+IVIG group showed fewer volume reductions in selected subcortical brain structures compared to other groups. This group also had no significant reduction in the right hippocampus, suggesting better preservation of brain structure.
• PET Results: 18FDG-PET scans of 213 patients revealed typical AD-related metabolic decline in brain areas like the posterior cingulate, precuneus, and parieto-temporal regions. However, the high albumin+IVIG group showed the least metabolic decline and the greatest stability in these areas, indicating reduced progression of metabolic defects.

Conclusion: PE with albumin, particularly in the high albumin+IVIG group, was associated with less deterioration in brain structure and metabolic activity. These findings suggest that this treatment approach may slow structural and metabolic decline in AD patients.