By Allen P. Green, M.D. April 2026
We just returned to Mill Valley from the American Society for Apheresis annual meeting, held April 22–24 in Denver. This year the ASFA annual meeting was held jointly with the World Apheresis Association, which brought a meaningfully more international audience to the program. It is the gathering where the people who actually perform therapeutic apheresis in the United States meet, present, debate, and get a read on where the field is going. After this year’s program, the answer to where it is going is clearer than it has been at any point in the years we have been attending.
The shorthand version: therapeutic plasma exchange for longevity, microplastics, and forever chemicals is no longer a fringe topic on the apheresis agenda. It is pulling some of the largest crowds in the program.
The Breakfast With The Expert sessions filled past capacity
ASFA’s Breakfast With The Expert format is intentionally intimate. Each session is built around a single table, a single expert, and a small group of registered attendees who get an unhurried hour to ask questions and trade clinical experience. The sessions on laboratory testing, CAR-T treatments, and cell and gene technologies all fit comfortably within that format.
The two sessions on TPE in Integrative Medicine did not. The first ran well past its registered seat count, and a second table had to be added on the spot. The result was effectively a small panel rather than the one-on-one conversation the format was designed for. The two sessions on TPE and Microplastics drew comparable interest. Together, these were pulling one of the largest crowds in the program.
What this means is straightforward. The clinicians who travel to attend the ASFA annual meeting are now asking the same questions our patients are asking, in larger numbers than the program planners anticipated. The “integrative medicine” framing in particular is signaling something about who is starting to perform therapeutic apheresis and what they are hoping it can do.
Microplastics moved from speculation to clinical conversation
The standalone microplastics talk this year covered two threads. The first was the growing body of evidence on what microplastics are doing inside the human body: accumulating in arterial plaque, crossing the blood-brain barrier, showing up in placental tissue, and being implicated in a widening set of inflammatory and cardiovascular endpoints. The second thread was the apheresis question. The speaker discussed two modalities, TPE and double-filtration plasmapheresis (DFPP), and their potential for removing these particles from the plasma compartment. DFPP uses a secondary filter to selectively remove larger molecules while returning plasma proteins to the patient. It is more common in Asia and Europe than in the United States, and several of the international attendees brought clinical experience with it that US-based programs do not yet have.
The discussion was honest about what is known and what is not. No randomized clinical trial has yet demonstrated microplastic reduction in humans through any apheresis modality. There is a growing mechanistic and observational case, and the room was full of physicians treating it as a question worth designing trials around rather than dismissing. That shift in posture, from “interesting if true” to “let’s design the trial,” is the real story.
”Maybe everyone over the age of 40 should be considering TPE”
The most striking single moment of the meeting came during a session titled Current Developments and Research in Apheresis. The presenter discussed the main conclusions of the multi-omics paper Dr. Kiprov co-authored with the Buck Institute, published last year in Aging Cell, with a single summary slide. The paper used 35 epigenetic clocks to characterize biological age, and the biweekly TPE-plus-IVIG arm of the study showed an average reduction of roughly 2.6 years in biological age compared to control.
After running through the headline findings, the lecturer posed the question: “Maybe everyone over the age of 40 should be considering TPE.”
The fact that the question could be posed to a packed room at the field’s flagship US meeting, and that the room treated it as one worth sitting with rather than a fringe one, is itself a signal.
AMBAR continues to deliver
The AMBAR group (Alzheimer Management By Albumin Replacement) presented two new abstracts at this year’s meeting, both extending the original Phase 2b/3 trial findings into real-world populations. The original AMBAR trial enrolled 322 treated patients with mild-to-moderate Alzheimer’s and showed a 52 to 71 percent slowing of cognitive and functional decline in the treatment group compared to placebo. The two abstracts presented in Denver report on real-world patients spanning mild cognitive impairment through moderate Alzheimer’s. Results were positive and consistent with the original trial. The full publications are forthcoming.
For families weighing options for a parent or spouse with cognitive decline, this matters in a specific way. The dominant current conversation in Alzheimer’s care centers on monoclonal antibodies, lecanemab and donanemab, which carry a meaningful risk of ARIA, a class of brain swelling and microbleeds that requires regular MRI surveillance. TPE carries no such risk. It is a decades-old procedure with a well-characterized safety profile, currently classified as ASFA Category III for Alzheimer’s, meaning the evidence is promising but not yet at the level of mainstream first-line recommendation. The new AMBAR abstracts add to the case that this category should be revisited.
What was happening between sessions
The official program was only part of the story. The hallways and the dinners told the rest of it.
In the conversations we had with attendees from academic apheresis programs, biotech companies, and integrative practices, the common note was one of sustained excitement. Several private dinners brought together teams actively working on next-generation apheresis modalities targeted at the longevity space, including DFPP and adsorption-column approaches, neither of which is yet routinely available in US outpatient settings. The investment of professional attention is real, and it is moving faster than the public-facing literature.
We spoke with physicians waiting with bated breath for the next round of clinical-trial readouts. We spoke with researchers whose pre-print pipelines are stacked. We spoke with people who came to the field because of the AMBAR data and others who came because of the plasma-dilution work in GeroScience. They are all in the same room now. That is new.
The roots are starting to bear fruit
Dr. Kiprov has been pioneering therapeutic apheresis in the San Francisco Bay Area since the 1980s and was a founding member of ASFA. For most of those decades, the work that defines this practice’s center of gravity, particularly TPE for neurodegeneration, longevity, and environmental medicine, lived at the edge of the field rather than at its center. ASFA 2026 is the clearest signal we have seen that the center is moving toward that work, not the other way around.
There has not been a better time to be doing this. The roots Dr. Kiprov laid more than four decades ago are starting to bear fruit, and the entire field is benefiting.
A note on Dr. Kiprov
While we were in Denver, Dr. Kiprov was in San Francisco speaking at the World Institute for Regenerative Medicine. By all reports the talk went very well. We will likely write a separate post about it once we have had a chance to debrief.
Allen P. Green, M.D., is Board-Certified in Clinical Pathology and serves as Associate Medical Director at Global Apheresis in Mill Valley, California. He has personally performed over 500 TPE procedures.
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References
Fuentealba M, Kiprov D, et al. Multi-Omics Analysis Reveals Biomarkers That Contribute to Biological Age Rejuvenation by Plasma Exchange. Aging Cell. 2025.
Kim D, Kiprov DD, Luellen C, et al. Old Plasma Dilution Reduces Human Biological Age: A Clinical Study. GeroScience. 2022;44:2701–2720.
Boada M, López OL, Olazarán J, et al. A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer’s disease: Primary results of the AMBAR study. Alzheimer’s & Dementia. 2020;16(10):1412–1425.
American Society for Apheresis. Annual Meeting 2026. Denver, Colorado. April 22–24, 2026.