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This study, part of the AMBAR phase 2b/3 clinical trial, investigated the effects of therapeutic plasma exchange (PE) with albumin replacement on brain structure and function in patients with mild-to-moderate Alzheimer’s disease (AD). Patients were divided into four groups: three received PE with varying doses of albumin (some with intravenous immunoglobulin, IVIG), while the fourth group received a placebo.

Key Findings:

• MRI analyses (198 patients) showed that patients in the high albumin+IVIG group had fewer brain volume changes in selected subcortical structures compared to other groups, with no significant volume reduction in the right hippocampus.
• PET scans (213 patients) indicated that the high albumin+IVIG group had the least decline in brain metabolism in AD-affected areas (posterior cingulate, precuneus, and parieto-temporal regions), showing greater metabolic stability compared to placebo.

Conclusion: PE with albumin replacement appeared to slow down structural and metabolic brain changes typical of AD progression, with the high albumin+IVIG group showing the most marked benefits. These findings suggest potential therapeutic effects of PE with albumin and IVIG in managing AD.