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Hasegawa M, Kitaguchi N, Takechi H, Kawaguchi K, Ito K, Kato T, Kato M, Nii N, Yamada S, Ohashi A, Koide S, Hayashi H, Takahashi K, Inaguma D, Yuzawa Y, Tsuboi N. First-in-human study of blood amyloid β removal from early Alzheimer's disease patients with normal kidney function. Ther Apher Dial 2022; 26:529-536. [PMID: 35294796 DOI: 10.1111/1744-9987.13827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Amyloid β (Aβ) is a brain protein that causes Alzheimer's disease (AD). This study aimed to verify whether hemadsorption using a hexadecyl-alkylated cellulose bead (HexDC) column removes blood Aβ and brain Aβ accumulation in mild cognitive impairment/mild AD cases with normal kidney function. METHODS Two patients with positive Aβ on brain imaging underwent HexDC hemadsorption weekly for 6 months. RESULTS The Aβ removal efficiency of HexDC was 87-99%. Aβ1-40 /Aβ1-42 influx into the blood in one session was 596/56 ng and 489/48 ng for Case A and Case B, respectively. Although brain Aβ accumulation did not clearly change after six months of hemadsorption, cognitive functions measured by the two tests were maintained or slightly improved. CONCLUSION Blood Aβ removal was performed in two early AD patients with normal kidney function without adverse events, and it slightly improved or maintained cognitive function. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine
| | - Nobuya Kitaguchi
- Faculty of Clinical Engineering, Fujita Health University School of Health Sciences
| | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine
| | - Kazunori Kawaguchi
- Faculty of Clinical Engineering, Fujita Health University School of Health Sciences
| | - Kengo Ito
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology
| | - Takashi Kato
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology
| | - Masao Kato
- Center of Blood Purification, Fujita Health University Hospital
| | - Norio Nii
- Center of Blood Purification, Fujita Health University Hospital
| | - Sachie Yamada
- Center of Blood Purification, Fujita Health University Hospital
| | - Atsushi Ohashi
- Faculty of Clinical Engineering, Fujita Health University School of Health Sciences
| | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine
| | - Kazuo Takahashi
- Department of Biomedical Molecular Sciences, Fujita Health University School of Medicine
| | - Daijo Inaguma
- Department of Internal Medicine, Fujita Health University Bantane Hospital
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine
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Kitaguchi N, Kawaguchi K, Sakata M, Aoki H, Yamazaki K, Kaneko M, Kinomura J, Kato M, Hasegawa M, Suzuki N, Mizuno M, Yuzawa Y. Aβ Influx into the Blood Evoked by Different Blood Aβ Removal Systems: A Potential Therapy for Alzheimer's Disease. Neuropsychiatr Dis Treat 2021; 17:2291-2308. [PMID: 34285489 PMCID: PMC8286129 DOI: 10.2147/ndt.s317104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/01/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Amyloid-β (Aβ) is a brain protein that causes Alzheimer's disease. We have revealed that extracorporeal blood Aβ-removal systems evoked a large Aβ influx into the blood. This study investigated the system that is more effective in evoking Aβ influx. METHODS Aβ removal activities were compared between hexadecyl-alkylated cellulose beads (HexDC) and fragments of polysulfone hollow fibers (PSf-HFs) in mini-columns to eliminate the filtration effect. Then, adsorptive filtration systems were adapted for PSf hemodialyzers to enhance Aβ adsorption on micropores in the wall of hollow fibers. Plasma Aβ concentrations of patients with renal failure were analyzed during treatment with PSf hemodialyzers alone for 8 h or tandemly connected HexDC and PSf hemodialyzers for 4 h. RESULTS In the in vitro study, Aβ removal efficiency for HexDC was approximately 100% during the 60 min treatment, whereas the removal efficiency for PSf-HF fragments gradually decreased. However, PSf hemodialyzer in adsorptive filtration systems removed Aβs comparably or more than HexDC. Aβ influx into the blood increases time-dependently. Concomitant use of HexDC and PSf hemodialyzer evoked a larger Aβ1-40 influx than that of PSf hemodialyzer alone. However, Aβ1-42 influx by PSf hemodialyzer alone was similar to or a little larger than influx by the combined system. Both systems evoked almost doubled Aβ influx than estimated Aβs existing in the normal brain during the 4 h treatment. CONCLUSION PSf hemodialyzer alone for a longer period and concomitant use of HexDC and PSf hemodialyzer for a shorter time effectively evoked a larger Aβ influx. To evoke Aβ1-42 influx, PSf hemodialyzer alone was effective enough. These findings of devices and treatment time may lead to optimal clinical settings for therapy and prevention of Alzheimer's disease.
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Affiliation(s)
- Nobuya Kitaguchi
- Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Kazunori Kawaguchi
- Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Miwa Sakata
- Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Hiroki Aoki
- Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Kazunori Yamazaki
- Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Megumi Kaneko
- Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Jun Kinomura
- Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Masao Kato
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Midori Hasegawa
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | | | | | - Yukio Yuzawa
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Kitaguchi N, Tatebe H, Sakai K, Kawaguchi K, Matsunaga S, Kitajima T, Tomizawa H, Kato M, Sugiyama S, Suzuki N, Mizuno M, Takechi H, Nakai S, Hiki Y, Kushimoto H, Hasegawa M, Yuzawa Y, Tokuda T. Influx of Tau and Amyloid-β Proteins into the Blood During Hemodialysis as a Therapeutic Extracorporeal Blood Amyloid-β Removal System for Alzheimer's Disease. J Alzheimers Dis 2020; 69:687-707. [PMID: 31156161 DOI: 10.3233/jad-190087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The accumulation of amyloid-β protein (Aβ) and tau in the brain is a major pathological change related to Alzheimer's disease. We have continued to develop Extracorporeal Blood Aβ Removal Systems (E-BARS) as a method for enhancing Aβ clearance from the brain. Our previous report revealed that dialyzers effectively remove blood Aβ and evoke large Aβ influxes into the blood, resulting in a decrease in brain Aβ accumulation after initiating hemodialysis, and that patients who underwent hemodialysis had lower brain Aβ accumulation than those who did not. Here, plasma total tau concentrations from 30 patients undergoing hemodialysis were measured using an ultrasensitive immunoassay and compared to those from 11 age-matched controls. Plasma total tau concentrations were higher in patients with renal failure regardless of whether they underwent hemodialysis, suggesting the involvement of the kidneys in tau degradation and excretion. Hemodialyzers effectively removed blood Aβ but not extracorporeal blood tau. The influx of tau into the blood was observed at around the 1 h period during hemodialysis sessions. However, the influx amount of tau was far smaller than that of Aβ. Furthermore, histopathological analysis revealed similar, not significantly less, cerebral cortex phosphorylated tau accumulation between the 17 patients who underwent hemodialysis and the 16 age-matched subjects who did not, although both groups showed sparse accumulation. These findings suggest that hemodialysis may induce both tau and Aβ migration into the blood. However, as a therapeutic strategy for Alzheimer's disease, it may only be effective for removing Aβ from the brain.
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Affiliation(s)
- Nobuya Kitaguchi
- Faculty of Clinical Engineering, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Harutsugu Tatebe
- Department of Zaitaku (Homecare) Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuyoshi Sakai
- Faculty of Clinical Engineering, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Kazunori Kawaguchi
- Faculty of Clinical Engineering, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Shinji Matsunaga
- Department of Psychiatry, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Tomoko Kitajima
- Department of Psychiatry, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | | | - Masao Kato
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Satoshi Sugiyama
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | | | | | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Shigeru Nakai
- Faculty of Clinical Engineering, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshiyuki Hiki
- Faculty of Clinical Engineering, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | | | - Midori Hasegawa
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Yukio Yuzawa
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Takahiko Tokuda
- Department of Molecular Pathobiology of Brain Diseases, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Stracke S, Lange S, Bornmann S, Kock H, Schulze L, Klinger-König J, Böhm S, Vogelgesang A, von Podewils F, Föel A, Gross S, Wenzel K, Wallukat G, Prüss H, Dressel A, Kunze R, Grabe HJ, Langner S, Dörr M. Immunoadsorption for Treatment of Patients with Suspected Alzheimer Dementia and Agonistic Autoantibodies against Alpha1a-Adrenoceptor-Rationale and Design of the IMAD Pilot Study. J Clin Med 2020; 9:jcm9061919. [PMID: 32575439 PMCID: PMC7356934 DOI: 10.3390/jcm9061919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND agonistic autoantibodies (agAABs) against G protein-coupled receptors (GPCR) have been linked to cardiovascular disease. In dementia patients, GPCR-agAABs against the α1- and ß2-adrenoceptors (α1AR- and ß2AR) were found at a prevalence of 50%. Elimination of agAABs by immunoadsorption (IA) was successfully applied in cardiovascular disease. The IMAD trial (Efficacy of immunoadsorption for treatment of persons with Alzheimer dementia and agonistic autoantibodies against alpha1A-adrenoceptor) investigates whether the removal of α1AR-AABs by a 5-day IA procedure has a positive effect (improvement or non-deterioration) on changes of hemodynamic, cognitive, vascular and metabolic parameters in patients with suspected Alzheimer's clinical syndrome within a one-year follow-up period. METHODS the IMAD trial is designed as an exploratory monocentric interventional trial corresponding to a proof-of-concept phase-IIa study. If cognition capacity of eligible patients scores 19-26 in the Mini Mental State Examination (MMSE), patients are tested for the presence of agAABs by an enzyme-linked immunosorbent assay (ELISA)-based method, followed by a bioassay-based confirmation test, further screening and treatment with IA and intravenous immunoglobulin G (IgG) replacement. We aim to include 15 patients with IA/IgG and to complete follow-up data from at least 12 patients. The primary outcome parameter of the study is uncorrected mean cerebral perfusion measured in mL/min/100 gr of brain tissue determined by magnetic resonance imaging with arterial spin labeling after 12 months. CONCLUSION IMAD is an important pilot study that will analyze whether the removal of α1AR-agAABs by immunoadsorption in α1AR-agAAB-positive patients with suspected Alzheimer's clinical syndrome may slow the progression of dementia and/or may improve vascular functional parameters.
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Affiliation(s)
- Sylvia Stracke
- Department for Internal Medicine A, Nephrology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
- Correspondence: (S.S.); (M.D.); Tel.: +49-(0)-3834-86-80752 (S.S.); +49-(0)-3834-86-80510 (M.D.); Fax: +49-(0)-3834-86-6662 (S.S.); +49-(0)-3834-86-80502 (M.D.)
| | - Sandra Lange
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany; (S.L.); (S.L.)
| | - Sarah Bornmann
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (S.B.); (A.V.); (F.v.P.); (A.F.)
| | - Holger Kock
- Strategic Research Management, University Medicine Greifswald, 17475 Greifswald, Germany;
| | - Lara Schulze
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17475 Greifswald, Germany; (L.S.); (J.K.-K.); (H.J.G.)
| | - Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17475 Greifswald, Germany; (L.S.); (J.K.-K.); (H.J.G.)
| | - Susanne Böhm
- Coordinating Centre for Clinical Trials, University Medicine Greifswald, 17475 Greifswald, Germany;
| | - Antje Vogelgesang
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (S.B.); (A.V.); (F.v.P.); (A.F.)
| | - Felix von Podewils
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (S.B.); (A.V.); (F.v.P.); (A.F.)
| | - Agnes Föel
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany; (S.B.); (A.V.); (F.v.P.); (A.F.)
- German Center for Neurodegenerative Diseases (DZNE), 17475 Rostock/Greifswald, partner site Greifswald, Germany
| | - Stefan Gross
- Department of Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany;
- German Centre for Cardiovascular Research (DZHK), 17475 Greifswald, Germany
| | - Katrin Wenzel
- Berlin Cures GmbH, 13125 Berlin, Germany; (K.W.); (G.W.)
| | - Gerd Wallukat
- Berlin Cures GmbH, 13125 Berlin, Germany; (K.W.); (G.W.)
| | - Harald Prüss
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117 Berlin, Germany;
- Department of Neurology and Experimental Neurology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Alexander Dressel
- Department of Neurology, Carl-Thiem-Klinikum, 03048 Cottbus, Germany;
| | - Rudolf Kunze
- Science Office, Hessenhagen 2, 17268 Flieth-Stegelitz, Germany;
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17475 Greifswald, Germany; (L.S.); (J.K.-K.); (H.J.G.)
- German Center for Neurodegenerative Diseases (DZNE), 17475 Rostock/Greifswald, partner site Greifswald, Germany
| | - Sönke Langner
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany; (S.L.); (S.L.)
- Institute of Diagnostic and Interventional Radiology, University Medicine Rostock, 18057 Rostock, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany;
- German Centre for Cardiovascular Research (DZHK), 17475 Greifswald, Germany
- Correspondence: (S.S.); (M.D.); Tel.: +49-(0)-3834-86-80752 (S.S.); +49-(0)-3834-86-80510 (M.D.); Fax: +49-(0)-3834-86-6662 (S.S.); +49-(0)-3834-86-80502 (M.D.)
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Saito Y, Sakata M, Kobayakawa M, Kawachi H, Kawaguchi K, Hiki Y, Kato M, Mori M, Hasegawa M, Ohashi N, Yuzawa Y, Kitaguchi N. Removal of Aβ Oligomers from the Blood: A Potential Therapeutic System for Alzheimer's Disease. Neuropsychiatr Dis Treat 2020; 16:607-627. [PMID: 32210564 PMCID: PMC7064818 DOI: 10.2147/ndt.s241074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/14/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Amyloid-β protein (Aβ) is one of the causative proteins of Alzheimer's disease. We have been developing extracorporeal blood Aβ-removal systems as a method for enhancing Aβ clearance from the brain. We reported previously that medical adsorbents and hemodialyzers removed Aβ monomers from peripheral blood, which was associated with influx of Aβ monomers from the brain into the bloodstream. Our intent here was to develop a method to promote clearance of Aβ oligomers and to provide an estimate of the molecular size of intact Aβ oligomers in plasma. METHODS Two hollow-fiber devices with different pore sizes (Membranes A and B) were evaluated as removers of Aβ oligomers with human plasma in vitro. The concomitant removal of Aβ oligomers and monomers was investigated by using Membrane B and hexadecyl alkylated cellulose beads or polysulfone hemodialyzers. Double-filtration plasmapheresis with Membrane A was investigated as an approach for the removal of plasma Aβ oligomers in humans. RESULTS Aβ oligomers were effectively removed by both Membranes A and B. The increase of Aβ oligomers in plasma was observed just after the removal of plasma Aβ oligomers in humans. The intact molecular size of major Aβ oligomers in the plasma was estimated to be larger than albumin at approximately 60 kDa or more. Additionally, the concomitant removal of Aβ monomers and oligomers evoked dissociation of larger Aβ oligomers into smaller ones and monomers. CONCLUSION Aβ oligomers were cleared from plasma both in vitro and in human subjects by using hollow-fiber membranes with large pores, indicating that their intact sizes were mostly larger than 60 kDa. Aβ oligomers in peripheral circulation were increased after some clearances in human. Further investigation will determine whether the Aβ oligomers detected in circulation after clearance were via influx from the brain.
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Affiliation(s)
- Yuta Saito
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan.,Graduate School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan.,Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Miwa Sakata
- Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Moe Kobayakawa
- Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | | | - Kazunori Kawaguchi
- Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshiyuki Hiki
- Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Masao Kato
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Mayuko Mori
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan.,Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Midori Hasegawa
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | | | - Yukio Yuzawa
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Nobuya Kitaguchi
- Faculty of Clinical Engineering, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan
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Kitaguchi N, Kato T, Matsunaga S, Hirano K, Iwata K, Kawaguchi K, Fujita K, Takechi H, Hasegawa M, Yuzawa Y, Ito K. Removal of blood amyloid-β with hemodialysis reduced brain amyloid-β, confirmed by brain imaging: a case report. Neuropsychiatr Dis Treat 2018; 14:2931-2937. [PMID: 30464477 PMCID: PMC6219271 DOI: 10.2147/ndt.s186118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The accumulation of amyloid-β protein (Aβ) in the brain signifies a major pathological change of Alzheimer's disease (AD). Extracorporeal blood Aβ removal system (E-BARS) has been under development as a tool for enhancing the clearance of Aβ from the brain. Previously, we revealed that dialyzers remove blood Aβs effectively, evoking substantial Aβ influx into the blood during hemodialysis sessions as one form of blood Aβ removal by E-BARS, and that postmortem brains of hemodialysis patients exhibited lower Aβ accumulation. Here, we present a case report of a 77-year-old male patient with end-stage renal failure whose Aβ accumulation in the brain declined by initiating and continuing hemodialysis for 6 months. This report suggests that blood Aβ removal by E-BARS could be an effective therapeutic method for AD.
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Affiliation(s)
- Nobuya Kitaguchi
- School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan,
| | - Takashi Kato
- Department of Brain Science and Molecular Imaging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Shinji Matsunaga
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Kyoko Hirano
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Kaori Iwata
- Department of Brain Science and Molecular Imaging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Kazunori Kawaguchi
- School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan,
| | - Kiyoshi Fujita
- Okehazama Hospital, Fujita Kokoro Center, Seisinkai, Toyoake, Aichi, Japan
| | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Midori Hasegawa
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Yukio Yuzawa
- Department of Nephrology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Kengo Ito
- Department of Brain Science and Molecular Imaging, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
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