Therapeutic apheresis: An effective strategy for a combined targeting of circulating lipoproteins, inflammatory markers, PFAS, and microplastics in cardiometabolic and neurodegenerative disease?

Lipoprotein apheresis is a highly effective and well-established extracorporeal therapy designed to remove lipoproteins from human circulation on a large scale, particularly in patients with progressive cardiovascular diseases when conventional treatments fail to achieve adequate lipoprotein reduction. Beyond its lipid-lowering capabilities, therapeutic apheresis is used to eliminate pathogenic substances, such as autoantibodies and immune complexes, and to exert immunomodulatory effects. Recent research highlights its potential to reduce inflammatory mediators, making it a promising intervention for conditions associated with systemic inflammation, including neurodegenerative diseases and post-infectious syndromes. In addition to its established applications, therapeutic apheresis is being explored as a novel approach to address emerging environmental health challenges, such as the accumulation of per- and polyfluoroalkyl substances (PFAS) and micro- and nanoplastics (MNPs) in living organisms. These pollutants, which are increasingly pervasive in the environment, pose significant health risks, including metabolic disruption, carcinogenesis, and neuroinflammation. Recognizing the urgency of this issue, institutions such as the US Department of Health and Human Services have initiated research programs to develop methods to monitor and remove these contaminants from the human body. Here, our preliminary findings suggest that therapeutic apheresis may represent a promising approach for reducing environmental toxins, alongside its established role in lowering lipoproteins and inflammatory biomarkers, and warrants further systematic clinical investigation. This is based on the hypothesis that PFAS and MNPs form aggregates with lipids and proteins, suggesting that therapeutic apheresis could be an ideal method for clearance. In the initial results, we observed decreases in both PFAS and MNP levels in patient blood and sequestered plasma following double filtration plasmapheresis, although responses varied across individuals and analytes. Tissue and in vitro studies using imaging and functional bioassays may be suitable for demonstrating the potential of apheresis to remove PFAS and MNPs, as well as for assessing the impact of MNPs on cell viability, inflammation, and secretome profiles. These findings could serve as clinical surrogates to guide treatment frequency and evaluate the sustainability of therapeutic apheresis in mitigating health risks associated with environmental pollutants. While larger, well-designed clinical trials are needed to confirm these benefits, these early results could lay the groundwork for future research and clinical applications.