Longitudinal Neuroimaging Analysis in Mild-Moderate Alzheimer's Disease Patients Treated with Plasma Exchange with 5 Human Albumin

Gemma Cuberas-Borrós, Isabel Roca, Mercè Boada, Lluís Tárraga, Isabel Hernández, Mar Buendia, Lourdes Rubio, Gustavo Torres, Ángel Bittini, Juan A. Guzmán-De-Villoria, Francesc Pujadas, Mireia Torres, Laura Núñez, Joan Castell, Antonio Páez

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    Abstract

    Background: Recently, modifications of Aβ1-42 levels in CSF and plasma associated with improvement in memory and language functions have been observed in patients with mild-moderate Alzheimer's disease (AD) treated with plasma exchange (PE) with albumin replacement. Objective: To detect structural and functional brain changes in PE-treated AD patients as part of a Phase II clinical trial. Methods: Patients received between 3 and 18 PE with albumin (Albutein 5%, Grifols) or sham-PE (controls) for 21 weeks (divided in one intensive and two maintenance periods) followed by 6-month follow-up. Brain perfusion assessed by SPECT scans using an automated software (NeuroGam) and brain structural changes assessed by MRI were performed at weeks 0 (baseline), 21, and 44 (with additional SPECT at weeks 9 and 33). Statistical parametric mapping (voxel-based analysis, SPM) and Z-scores calculations were applied to investigate changes to baseline. Results: 42 patients were recruited (39 evaluable; 37 analyzed: 18 PE-treated; 19 controls). There was a trend toward decreasing hippocampi and total intracranial volume for both patient groups during the study (p < 0.05). After six months, PE-treated patients had less cerebral perfusion loss than controls in frontal, temporal, and parietal areas, and perfusion stabilization in Brodmann area BA38-R during the PE-treatment period (p < 0.05). SPM analysis showed stabilization or absence of progression of perfusion loss in PE-treated patients until week 21, not observed in controls. Conclusions: Mild-moderate AD patients showed decreased brain volume and impairment of brain perfusion as expected for the progression of the disease. PE-treatment with albumin replacement favored the stabilization of perfusion.
    Original languageEnglish
    Pages (from-to)321-332
    JournalJournal of Alzheimer's Disease
    Volume61
    Issue number1
    DOIs
    Publication statusPublished - 1 Jan 2018

    Keywords

    • Albumin
    • Alzheimer's disease
    • magnetic resonance imaging
    • plasma exchange
    • single-photon emission computed tomography

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  • Cite this

    Cuberas-Borrós, G., Roca, I., Boada, M., Tárraga, L., Hernández, I., Buendia, M., Rubio, L., Torres, G., Bittini, Á., Guzmán-De-Villoria, J. A., Pujadas, F., Torres, M., Núñez, L., Castell, J., & Páez, A. (2018). Longitudinal Neuroimaging Analysis in Mild-Moderate Alzheimer's Disease Patients Treated with Plasma Exchange with 5 Human Albumin. Journal of Alzheimer's Disease, 61(1), 321-332. https://doi.org/10.3233/JAD-170693