Forever chemicals fell after lipid apheresis

Clinical takeaway: Patients worried about their own pollutant exposure are asking a fair question. Plasma PFAS dropped after single apheresis sessions in small groups, an investigational use that needs repeated-session and outcome data before it means much.

A lipid panel drawn right after apheresis looks like it is from a different patient. That drop is real but it is also quite specific, since it captures cholesterol in the blood but not what is stored in liver, kidney, or fat. According to a recent study, the same rationale can also apply to removing pollutants.

Per- and polyfluoroalkyl substances (PFAS) turn up in the blood of more than 99% of Americans. Roughly 200 million have been exposed through contaminated drinking water. Half-lives run about five to nine years, so an exposure in a patient's thirties is still measurable in their forties.

Medicine has no tools to shorten that, which leaves clinicians fielding unanswerable questions. The new data come from adults receiving clinically indicated apheresis for refractory lipid disorders or autoimmune disease.

The compounds that fell in plasma turned up in the discarded fraction, which is the difference between removal and a number that dropped for other reasons. Across 14 patients at a certified reference laboratory, the four PFAS measured fell by up to 25%.

A second laboratory tested four other patients after one session and found even larger average drops, 44% to 76%. Polyethylene fell in all four patients tested and polyvinyl chloride in three. Polypropylene fell in one, rose in two, and was undetectable in the fourth.

The concern is not theoretical. Exposure tracks with higher LDL cholesterol, metabolic syndrome, endocrine disruption, and cancers of the kidney and testis. Most of that evidence rests on two compounds, perfluorooctanoic acid and perfluorooctane sulfonic acid, the two detected most often in American blood and the two the International Agency for Research on Cancer flagged in 2023 as carcinogenic and possibly carcinogenic to humans. For follow-up, the National Academies tie decisions to the summed level of seven PFAS rather than any single one.

Nothing yet indicates that apheresis is meaningful beyond the bloodstream. The next experiment is built to test that directly: expose large animals to labeled plastic particles, image them by PET and MRI, then look again after apheresis. Only then would repeated-session studies in patients be worth running, and those are what would show whether levels stay down or refill from tissue.

All of it comes from one Dresden center, the world's largest apheresis program, in patients treated for reasons unrelated to pollutants. There was no control group and no follow-up beyond the session, the plastics assays are exploratory in a field with no validated methods, and different patients contributed to different panels, so the authors state they cannot claim a shared clearance mechanism. Several authors hold advisory roles or equity in the apheresis companies whose devices were used.

"We have not demonstrated that apheresis removes plastic already bound in tissue, and whether it can reach those deposits, perhaps through exosomes or other flux mechanisms, is the key question in front of us," said Stefan Bornstein, first and corresponding author, of the Department of Internal Medicine III at University Hospital Carl Gustav Carus, Technische Universität Dresden.

He continued, "None of this displaces the first priority, which remains preventing exposure. Cleaning up afterwards is the harder and more expensive way to solve the problem. And this is not a disease of poverty. Some of the highest levels are carried by the people who can afford the expensive fish."

Source: Bornstein SR, et al (2026 Aug 4). Brain Health. Therapeutic apheresis: An effective strategy for a combined targeting of circulating lipoproteins, inflammatory markers, PFAS, and microplastics in cardiometabolic and neurodegenerative disease?