Expanding Uses of Therapeutic Plasma Exchange: Longevity, PFAS Removal, and Microplastics

Beyond established autoimmune and neurological indications, therapeutic plasma exchange (TPE) is being studied for longevity, environmental toxin burden, and circulating microplastics. This article summarizes emerging evidence in those areas. For Alzheimer’s disease and epigenetic aging in that context, see our companion article on TPE, biological aging, and Alzheimer’s disease.

Longevity and Anti-Aging

One of the most significant recent developments in the field of apheresis is the 2025 randomized, placebo-controlled trial by Fuentealba et al. and other authors including Dr. Kiprov, demonstrating that biweekly TPE combined with IVIG induced biological age rejuvenation across 15 epigenetic clocks (FDR < 0.05) in healthy adults over 50 [1]. This is the first multi-omics study to investigate different TPE therapies on epigenetic biological clocks. The biweekly TPE-IVIG regimen proved to be the most effective, particularly in individuals with poorer initial health status. A 2025 review in Ageing Research Reviews positions TPE as a strategy to target the senescence-associated secretory phenotype (SASP), removing inflammatory cytokines, metabolic waste, and senescence-associated proteins while replenishing rejuvenating factors [2].

A 2026 review in Experimental & Molecular Medicine synthesizes the current understanding, framing blood as both a “mirror and modulator” of aging, with TPE and plasma dilution showing translational promise by reducing pro-aging factors and restoring youthful signaling [3]. A companion 2026 review in the Journal of Advanced Research catalogues five blood-based anti-aging therapies (heterochronic parabiosis, TPE, PRP, extracellular vesicles, and platelet factor transfusion), positioning TPE as the most clinically translatable [4].

A 2025 review in Biomolecules concludes that TPE is underutilized in both preventative and precision medicine, and envisions next-generation TPE involving personalized plasma biomarker feedback and synergistic plasma infusion therapies [5]. For more on how this research relates to clinical interest in aging, see Aging & Longevity Research.

One may wonder how to access TPE, which historically has been a therapy provided in tertiary hospital settings where logistical considerations were paramount. At Plasma Life Center we are positioned to make a novel change to this concept and provide TPE in an outpatient setting in a much more comfortable way.

PFAS Removal

PFAS compounds are ideal candidates for plasma-based removal because they are highly protein-bound (binding to serum albumin and other plasma proteins) with long half-lives: PFOA ~2–5 years, PFOS ~3–6 years, and PFHxS ~3–9 years [6][7]. The landmark randomized clinical trial by Gasiorowski et al. (JAMA Network Open, 2022) in 285 Australian firefighters demonstrated that plasma donation every 6 weeks for 12 months significantly reduced serum PFOS by 2.9 ng/mL (p < 0.001) and PFHxS by 1.1 ng/mL (p < 0.001), with plasma donation outperforming whole blood donation [8]. A case series of phlebotomy in a highly exposed family showed significantly accelerated PFAA clearance compared to natural elimination half-lives [9].

TPE would theoretically be even more effective than plasma donation for PFAS removal because TPE has the capability of exchanging much larger volumes of plasma with one session and can be performed more frequently without causing side effects that may be encountered in donations. The pharmacokinetic profile of PFAS—highly protein-bound, small volume of distribution (~0.2 L/kg), and minimal endogenous metabolism—makes them near-ideal substances for TPE-based clearance [10][6]. Currently, no treatment is recommended by the AAFP or ATSDR to remedy existing PFAS within the body, making this an unmet clinical need [11]. Given the above-mentioned properties of PFAS, TPE might be very effective in removing these substances.

Microplastics and Nanoplastics

Microplastics have been detected in 90% of human blood samples at concentrations of ~2,466 particles/L, with polyethylene being the most abundant polymer [12]. Nanoplastics in blood induce oxidative stress, cytokine release, hemolysis, and immune cell activation, with monocytes showing the highest internalization [13]. A 2025 Nature Reviews Nephrology article highlights that particulate plastics cause oxidative stress, inflammation, and toxic effects on kidney and cardiovascular cells, and are now considered a risk factor for cardiovascular disease [14].

While no published study has directly examined TPE for microplastic/nanoplastic removal, the theoretical basis is strong. Microplastics circulating in plasma—particularly those bound to plasma proteins via protein corona formation—would be removed along with the exchanged plasma [15]. Nanoplastics that remain in the plasma compartment (rather than internalized in cells) would similarly be cleared. However, particles already internalized by white blood cells or deposited in tissues would not be accessible to TPE, and rebound equilibration from tissue stores is a known limitation of TPE for any substance with significant extravascular distribution [10].

Additionally, a recent paper by Stanford researchers points to microplastics as a contributor to five carcinogenic pathways (oxidative stress, DNA damage, epigenetic reprogramming, immune dysregulation, cell cycle disruption) which overlap substantially with the pro-aging pathways that TPE has been shown to modulate [16]. The 2025 Fuentealba et al. RCT demonstrated that TPE reverses age-related changes in JAK-STAT, MAPK, TGF-β, and NF-κB signaling—the same pathways activated by air pollution and microplastics [1]. The 2025 Ageing Research Reviews paper on apheresis for senescence specifically targets the SASP, which includes the same inflammatory cytokines (IL-6, TNF-α) that air pollution and microplastics upregulate [2].

Cancer Prevention

The Vu et al. paper [16] provides a rationale for positioning TPE as a potential cancer risk reduction strategy by reducing the circulating burden of environmental carcinogens and their downstream molecular effects. This is supported by the Fuentealba et al. finding that TPE restored pro-regenerative and anti-cancer regulators while reducing cellular senescence and DNA damage markers [1]. Having said that, more data is needed to look into this more longitudinally. The TPE effect on cancer prevention, removal of toxins, and removal of microplastics warrants further investigation.

Patients interested in discussing environmental exposure or preventive applications may review our chronic conditions overview or request a consultation.

Conclusion

TPE is expanding from traditional indications into longevity science, environmental toxicology, and preventive medicine. Evidence for biological age rejuvenation and PFAS reduction is strengthening; microplastic clearance and cancer-risk modification remain theoretical but biologically plausible. As with all emerging applications, candidacy and protocol should be determined individually under physician supervision.