RapAdmin
#176
Dr. Kiprov’s latest lecture and the preliminary results of the plasmapheresis clinical trial for aging, which was presented at the A4M Longevity Fest last week in Las Vegas.
I was in group A or B (they haven’t told me which one).
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It seems that plasmapheresis may do something beneficial for people. The key issue in terms of cost justification will be how long the benefits last, and how frequently it needs to be done to maintain the benefits.
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Neo
#178
His said it impacts cholesterol markers, did you notice anything on that?
Do you have any epigentic test data over the period, said it positively impacted that too
And also SASP, but they is difficult to know, but perhaps look at inflammation markers?
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RapAdmin
#179
I don’t know right now. Will go in for full blood test suite this coming week. My data will be confounded because I restarted statins just before the clinical study…
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Ulf
#180
@davidjhp , I applaud your effort. I will travel to Florida, Texas or wherever for a more reasonably priced TPE. No big money left for me after four of those treatments at Kiprov’s clinic.
I met with the Conboys at Berkeley, who thought that a second TPE just two days after the first is of questionable benefit. So I cancelled my treatment nr 2 of that round scheduled for next day, upsetting them all. Got that TPE recently a year later, instead. Too seldom to have an effect?
I have poured over those blue- and redcolored protein markers from the original six-person trial but it’s hard to get a real handle on the magnitude of the benefits of the procedure. In particular, as rapadmin notes, on how long benefits last. Hopefully there will be some independent review of the recent trial.
In any case, a decent price allowing more frequent treatments would be a huge boost.
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RapAdmin
#181
Ulf - I’m curious, did you get a discount on the 4 treatments? I think the normal price at Kiprov’s clinics is around $6,000 per treatment, is that correct?
Related Readings on TPE:
Here: Plasma Dilution appears to rejuvenate humans
Here: Questions about parabiosis
TPE in Russia: Plasma Dilution
Here: Old plasma dilution reduces human biological age
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Ulf
#182
RapAdmin,
No discount. Exactly $6000 for each TPE. A huge subsidy to the clinic. The cost must go down, as you have written about.
Do you have any idea if TPE with most plasma removed is available in Russia, from the communication a few years ago with the biohackers? The plasma dilution done in Russia as per the recent thread seems to be below the volume threshold needed to be effective.
Yes, the volume was low as @DrT has reported getting TPE in Russia (a little easier for him since it sounds like he lives there). Not sure if Americans or Europeans will be venturing to Russia for any sort of medical treatments any time soon given the relationship currently, and the war in Ukraine right now - but it could open up at some point.
But, I suspect another problem is going to become evident and that is the issue of medical supplies from western companies, for western Plasmapheresis equipment. Since these companies operate on a “razors and razorblades” type of business model, they make their money off the tubing and related supplies that are used for each TPE treatment. I suspect these supplies are getting hard to find, and more expensive in Russia. Increasingly they will likely turn to Chinese suppliers for this type of thing, but I don’t believe there are any Chinese companies who have much marketshare in this segment of the market … so this could be an ongoing issue.
See here for DrT’s experience of Plasmapheresis in Russia: Plasma Dilution
I reached out to the Biohackers in Russia who did the TPE by way of Leon Peshkin at Harvard. Leon is a helpful and positive guy, and said he’d forward the message to the Russian biohackers - but I never did hear back from them.
Perhaps our resident Russian doctor (@DrT ) can reach out to the biohackers and see if they are moving forward with doing more of the TPE routines with more frequency and more data?
@DrT here is the thread and contact info for the Russian TPE biohackers: Irina Conboy Plasmapheresis Webinar - #41 by RapAdmin
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DrT
#184
Yeah, I’m aware of the “Biohackers”. They seem to keep everyone at arm’s length. I checked in on their website and it looks like there hasn’t been much activity for a while. Certainly no reply to any questions about the plasma dilution for a couple of years. Quite frankly, I couldn’t be bothered chasing secretive people.
There may well be a clinic in Moscow that offers such services to “The Elites” but it wouldn’t be easy to find, unless you are one of “The Elites.
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davidjhp
#185
Dobri Kiprov charges $6000. What price would be reasonable for you?
José
#186
FWIW
The disposable cost are less than $600.00 per treatment.
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DrT
#187
Nice markup, if you can get it!
Cheeze Louize!!
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Ulf
#188
I would feel comfortable paying two thousand dollars for TPE and would do this as often as I find it beneficial. For three thousand I would have to think about the frequency.
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I just learned new information about plasmapheresis. Phthalates can leach from the IV fluid bags. Is this of concern?
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José
#190
FWIW
This is not new, in everything purchased, used and consumed.
And it is not good
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dhm
#191
I obtained the following info from a Haemonetics specialist:
The PCS2 is being discontinued. Likely within 12 months from now, they will stop servicing them, and stop manufacturing consumables (tubing kits, citrate, bags etc). All PCS2 units in the field are being replaced with the newer NexSys PCS. Also they wouldn’t be selling the consumables directly to individuals; they would have to carry out extensive due dilligence to make sure the individual who takes the responsibility is adequately trained in the risks, etc. at which point the bureaucracy becomes too impractical.
It seems that knock off disposable kits compatible with PCS2 are available from Chinese manufacturers, but would carry a risk of improper sterilisation (which can cause contamination) and technical faults (which can cause hemolysis, air embolism).
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dhm
#192
With some social engineering, I managed to convince someone at Haemonetics to disclose the typical price of the consumables for the PCS2. For a complete single-use kit, the price is $115.
However, one program on the PCS2 is not enough to remove 1-1.5 volumes of plasma, as per the Conboys protocol. The PCS2 was not designed for that; the program supports up to 600mL, which is the legal limit for plasma donation. So to use the PCS2 for therapeutic apheresis, the program would have to be run 5 times (in a row), requiring 5 kits. It’s an unusual way to use the PCS2, but doable.
There is also the issue of replacing the albumin. Hypoalbuminemia is not a risk up to 20mL/kg, so the PCS2 is again not designed to accommodate this scenario. Replacement albumin is not included with the consumables supplied by Haemonetics. It would have to be procured from a different source and spiked manually into the saline+citrate replacement fluid.
(The thread seems to have died. Does anyone still care about this, or just me?)
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Good detective methods. I’m still interested. I agree with Ulf also, it would be good to get TPE down to $2K. Or, they should consider sliding scale. First $3K, then, 2, 1, etc.
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dhm
#194
Finished studying about replacement albumin. Here are my notes.
- For more than 20mL/kg of exchanged plasma, albumin should be added in the replacement fluid, to avoid hypoalbuminemia; crystalloid solutions (i.e saline alone) are cost-effective, but they are only recommended if the volume is lower than this [3].
- Albumin is available in 500mL bottles, as 5% purified human serum albumin in normal saline. Widely available on the market; one common brand name: Albuminar-5. Can be stored at room temperature [5].
- In limited supply and expensive: the NHS (who gets bulk discounts) pays £35.05 per 500mL [6] (remember the goal is up to 2.5L plasma exchanged). This is actually close to the prices on indiamart.
- Alternatives:
- Colloid: gelofusine. Price paid by NHS (who gets bulk discounts): £2.11 per 500mL [6]. Again, a similar price to indiamart. In periods of albumin shortage, it has been used successfully in 50:50 ratio with 5% albumin [6]. Well tolerated, with a small risk of severe allergic reaction: incidence up to 0.115%, severe reactions only 0.038% [7] (another trial found 0.345% incidence of anaphylaxis, 3x higher compared to albumin [8]). It is more dangerous in patients with known history of allergy and asthma.
- 1:2 ratio of saline to 5% albumin (e.g only 2L of 5% albumin, instead of 3L). In a small trial of 23 patients, no difference in outcomes [10].
- one trial in Russia is investigating replacing 1 volume of plasma with saline only (results not published yet) [9]. This is also a trial that investigates apheresis for aging biomarkers.
Note that these are all licenced medical products, so you need to be an approved medical professional to procure them. The takeaway is that even by cutting corners (i.e substituting up to half of the replacement fluid with a colloidal alternative or saline and procuring everything from indiamart), the price hovers around $100-150.
Refs.
[3] https://doi.org/10.2450%2F2009.0094-09
[4] https://doi.org/10.1111/j.1525-139X.2011.01026.x
[5] https://labeling.cslbehring.com/pi/us/albuminar5/en/albuminar5-prescribing-information.pdf
[6] https://www.bbts.org.uk/downloads/2017_-_bbts_presentations/1315_wed_boisdale2_manson.pdf
[7] Redirecting
[8] Redirecting
[9] ClinicalTrials.gov
[10] https://doi.org/10.1002/jca.21385 - Conference abstract 28 (Ping et al. Using normal saline as part ofreplacement fluid in therapeuticplasma exchange procedures – a pilotstudy.)
This is the feedback from one person who had Plasmapheresis / TPT done at the Maxwell Clinic:
I was finally able to get my hands on some old communications with MaxWell Clinic regarding the vitamins and minerals they add during the artificial plasma exchange procedure:
we gave you 100mL of Normal Saline infused with Vitamin C, B6, B12, Magnesium Sulfate, B5, Calcium Gluconate, and trace elements Zinc, Manganese, Copper, and Selenium during the plasma exchange. We have found that this fluid notably decreases side effects such as tingling or nausea during the procedure.
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