Lowering the Cost / Improving Access for Therapeutic Plasma Exchange (Plasmapheresis)

[约瑟夫]

What are the biological markers being measured by Conboy?

[jakexb]

The meme appeal of younger blood being transfused is the reason I think it’s still talked about. But it’s encouraging that the research seems to suggest most of the benefit is removing the “bad stuff” from old blood vs adding special “good stuff” from young blood.

[LaraPo]

What if instead of albumin, saline is injected? Same dilution. Is adding albumin a necessary part of the process?

[RapAdmin]

@drstickler

We are using the latest Haemonetics machine which requires only a single IV access not two.

Thanks for posting. Very interesting. And its good to hear about the good results you’ve been seeing in patients.

Doing a little research on this company (and it may be true for the entire plasmapheresis equipment market), they lock you into their platform and then make very high margins on the “consumables”… this is a common business strategy, but from a customer standpoint is far from ideal as there is no price competition on the “consumables”. This is one strategy to raise the “barriers to entry” for potential competitors in this market, but it can also creates a market opportunity for lower priced, standardized equipment. I wonder if any companies are addressing this market. Years ago a company started manufacturing Hewlett Packard - compatible printer cartridges to get around the same issue / business strategy… this was a big, ongoing battle, I’m not sure how it eventually got resolved: HP is blocking third-party printer ink again - The Verge

As they mentioned in this stock analysis site:

Business Model

Haemonetics designs and manufactures blood collection systems, blood processing systems, devices incorporated in blood transfusions and cell processing, as well as related software. It employs a razor + blade model, where Haemonetics sells its customers’ plasma collection machines and associated consumables.

Competition

Haemonetics’ key competitors include Diagnostica Stago, Fresenius (FMS), Instrumentation Laboratory (Werfen), LivaNova (LIVN), MacoPharma, MAK-System, Medtronic (MDT), MSoft, Sysmex, Terumo (OTCPK:TRUMF), and WellSky.

In the automated plasma collection market, it principally competes with Fresenius’ Fenwal Aurora and Aurora Xi product lines on the basis of speed, plasma yield per donation, quality, reliability, ease of use, services, and technical features of the collection systems and on the long-term cost-effectiveness of equipment and disposables.

In the Blood Center, most donations worldwide are traditional manual whole blood collections and approximately 30% of the Blood Center portfolio competes in this space. There is intense competition in the whole blood business on the basis of quality and price. Main competitors are Fresenius, MacoPharma, and Terumo.

TEG systems compete more directly with other advanced blood test systems, including ROTEM analyzers, VerifyNow System and HemoSonics Quantra. ROTEM and VerifyNow instruments are marketed by Instrumentation Laboratory, a subsidiary of Werfen, and HemoSonics is owned and offered by Diagnostica Stago. In cell salvage, the intraoperative autotransfusion market, competition is based on reliability, ease of use, service, support, and price. For high-volume platforms, each manufacturer’s technology is similar and Haemonetics Cell Saver technology which competes principally with products offered by LivaNova, Medtronic, and Fresenius.

Market Share

In Plasma collection, Haemonetics has the leading market position with 75% of the U.S. market for machines and disposables:

Source: SeekingAlpha: https://archive.ph/rHg6M

Interesting equipment details:

Device Solutions | Haemonetics® Plasma Solutions

Haemonetics Receives FDA Clearance For NexSys PCS® With Persona™ Technology

The FDA 510(k) Summary: https://fda.report/media/142820/BK200498-Summary.pdf

The IMPACT Clinical Trial Validation Study (FDA filing): https://clinicaltrials.gov/ProvidedDocs/23/NCT04320823/Prot_001.pdf

The Research Study published as a result of the above “IMPACT” validation study: https://onlinelibrary.wiley.com/doi/pdf/10.1111/trf.16389

The Hemonetics PCS2 Operators Manual: http://www.frankshospitalworkshop.com/equipment/documents/automated_analyzer/user_manuals/Haemonetics%20PCS2%20-%20Operation%20manual.pdf

Corporate Annual Report: https://stocklight.com/stocks/us/manufacturing/nyse-hae/haemonetics/annual-reports/nyse-hae-2021-10K-21965962.pdf

Company overview presentation for Morgan Stanley: https://haemonetics.gcs-web.com/static-files/b56e06b2-ffa4-4a52-ab7b-9d94322139e8

[RapAdmin]

@Joseph

Which of these is the type of equipment that one might want to purchase for home plasmapheresis?

You mentioned there are different machines for “collection” of blood / plasma, so there must be one for the “distribution” (replacement?) of the plasma. Can you help us identify what equipment is the “plasma replacement” products from these manufacturers?

haemonetics for sale | eBay

[RapAdmin]

Baxter’s TPE Educational Presentations (videos and pdfs of slides below):

Part 1: TPE Part I: Methods, Goals & Guidelines

Part 2: TPE Part II: Treatment Considerations

TPE_Customer_Presentation_Pt1_2.pdf (612.0 KB)

TPE_Customer_Presentation_Pt2_0.pdf (622.4 KB)

[约瑟夫]

FWIW
I prefer/have used{on my self] Ringer’s lactate solution, you may as well add some other compounds/molecules; magnesium chloride, vitamin C, just about any compounds/molecules is available in a form for IV use. The one’s that are not, you can have compound by a pharmacy.{Pharmacy than make IV compounds]

Would cost you less than $100.00 per infusion, depending on what you put in the IV solution.

[约瑟夫]

A quick reply, the “cell saver” are used{designed to be used] for collecting a patient own blood during surgery as to not use “blood donation” for replacement. The cell save is used to collect the blood, wash the blood and reinfuse.

Any piece of of equipment can be reconfigured for other use, “off label/approved” use.

[LaraPo]

I also used Ringers solution. It’s the only one I can use having transplanted kidney. How critical is albumin when diluting blood (for anti-aging purpose)?

[约瑟夫]

@LaraPo

…" How critical is albumin when diluting blood (for anti-aging purpose)?"…

This question should be addressed to RapAdmin {the people where he is in the trial] and or Conboy.

[Elizabeth_Kirby]

MHO, the main issue is that we don’t actually understand what is happening. Like as not, there are only a few molecules that matter in the plasma. It’s inefficient & potentially dangerous to just dump someone else’s plasma into one’s body, leaving aside the difficulty of getting it.

In other words, I think the big target is the science. What is added, what is removed, why does it make a difference? If we knew that, we would be in a much better position to design a system to apply a meaningful therapy.

[KarlT]

I was hoping that Dr Harold Katcher’s work would result in a way to avoid all of this, but I haven’t seen any updates from him in a long time.

[medaura]

I’m a bit confused as to why there’s still such lack of certainty about what is ideal — young blood transfusion or plasma dilution. This study from 2020 is what first got me started down the life extension rabbit hole and what really tickled my fancy was the conclusion that there’s nothing superior about young blood, but rather it was all a matter of flushing out old blood.

Rejuvenation of three germ layers tissues by exchanging old blood plasma with...

Diluting blood plasma rejuvenates tissue, reverses aging in mice

So why are we still debating which is better? Also all was needed was saline with 5% albumin so the cost of the consumables should be negligible. The only issue would be access to the machinery and training as a nurse to self inject.

Am I missing anything?

In the study, the team found that replacing half of the blood plasma of old mice with a mixture of saline and albumin — where the albumin simply replaces protein that was lost when the original blood plasma was removed — has the same or stronger rejuvenation effects on the brain, liver and muscle than pairing with young mice or young blood exchange. Performing the same procedure on young mice had no detrimental effects on their health.

This discovery shifts the dominant model of rejuvenation away from young blood and toward the benefits of removing age-elevated, and potentially harmful, factors in old blood.

“There are two main interpretations of our original experiments: The first is that, in the mouse joining experiments, rejuvenation was due to young blood and young proteins or factors that become diminished with aging, but an equally possible alternative is that, with age, you have an elevation of certain proteins in the blood that become detrimental, and these were removed or neutralized by the young partners,” said Irina Conboy, a professor of bioengineering at UC Berkeley who is the first author of the 2005 mouse-joining paper and senior author of the new study . “As our science shows, the second interpretation turns out to be correct. Young blood or factors are not needed for the rejuvenating effect; dilution of old blood is sufficient.”

Has Conboy since reversed course?

[argonaut]

You’re right. The two notions, (1) dilution of plasma and (2) replacement of old plasma with young plasma have gotten a little mixed up in this thread. I think the Conboys are still betting on dilution - replacement of plasma with saline and a little albumin, adding nothing else. The trial RapAdmin was in did it this way.

However, there’s Harold Katcher’s isolation of some plasma factors that have been conserved across species. Using adolescent pig’s blood as the source of these factors, he has increased the health and lifespan of rats - no dilution was involved in his procedure.

As I’ve heard others speculate, maybe a combination of plasma dilution and addition of Katcher’s factors would work better than either alone.

[medaura]

But Katcher’s factors are not commercially available so whether or not they would work synergistically with plasma dilution is a bit of a moot point. It seems to me the root issue is the achievement of an acceptable cost for the average consumer of plasma dilution with saline and albumin. It becomes much simpler to problem solve when you remove the variable of commercial availability of young blood.

@RapAdmin penny for your thoughts?

What I’m seeing here so far is that at a cost in the ~$6,000 neighborhood it might be much more feasible to shop it around overseas. I’m an immigrant from Eastern Europe and will check in the mother country this summer. I’m reasonably sure I can obtain the treatment for hundreds of dollars, not thousands, and the challenge will be just explaining the need for it to the would be practitioner, as a healthy youngish adult.

If we’re to go the skunk works route, let’s see what kind of equipment is involved and what it costs on EBay / alibaba. Because saline + 5% albumin is not gonna break the bank.

[RapAdmin]

@argonaut

The two notions, (1) dilution of plasma and (2) replacement of old plasma with young plasma have gotten a little mixed up in this thread.

Yes - I’ve included both in this discussion because the research is good on both of them, they are very similar, and the researchers that are the leaders in the areas (the Conboys at UC Berkeley and Tony Wyss-Coray at Stanford) have been looking at both and have found both effective.

The issue about which is more effective seems to be somewhat still undecided as yet - but both are available now as commercial services and something many of us may be interested in.

Katchers work is interesting, but I’ve seen no indication that its a serious commercial venture yet and so its not something we need to consider at this point. Last I heard they had injected and tested on a half doze rats… this is far from a validated, commercial product right now. I wish them well.

As @medaura has suggested, the 5% albumin plasmapheresis is likely the most cost effective approach today given the limited availability of young blood plasma (they call it “fresh frozen plasma” in the commercial market).

Fresh frozen plasma

As Dr. Stickler suggested in his above comment, prices for TPE / plasmapheresis seem to be in the $2500 (Dr. Stickler’s clinic) to $6,000 per liter range (Dobri Kiprov’s clinic from what I’ve heard).

Off-shore is one approach. I’m personally a little reluctant in that area just because I find it so hard to evaluate the quality and expertise of the clinicians, products and services being provided, but at some level that is still an issue in the US or other developed countries. But perhaps we should get a list together of perceived high quality clinics and pricing just to be aware and people can make their own choices.

I actually like the idea of the skunk works approach better as I have some control over things and its easier to judge the quality of the equipment and supplies (e.g. the albumin you purchase). I know the quality of the (used) equipment I might be buying (we can research all the market share leaders). We have access (or potential access) to knowledgeable experts at academic centers of excellence here in the US, we can talk to the researchers and follow their protocols, we might be able to tap into experienced independent phlebotomists that we could consult or hire to help set up our home lab and do our initial plasmapheresis treatments (after all, if we can equipment from medical auction sites / ebay, etc. at low cost … e.g. $5,000, and get a prescription for the 5% albumin, the variable cost gets down to a range where it may make sense to do the protocol weekly or monthly, etc.

Anyway, I view this as an ongoing project with which we hopefully can pull together some viable approaches for a lower cost TPE / Young plasma solutions. This isn’t something we’ll likely figure out in the short term… but perhaps over the next year of input from many people here on the site we can slowly cobble together some approaches that may work.

[约瑟夫]

@RapAdmin

…“after all, if we can equipment from medical auction sites / ebay, etc. at low cost … e.g. $5,000, and get a prescription for the 5% albumin, the variable cost gets down to a range where it may make sense to do the protocol weekly or monthly, etc”.

You are hot to trot on equipment, I will post it again equipment is the least of the issue.

As I posted above.

Lowering the Cost / Improving Access for Therapeutic Plasma Exchange (Plasmapheresis)

We are not speaking about insurance paying for this. We are speaking about off label, longevity use, expermential use, pay out of pocket/self pay. Such as biohack this as a do it your self. The easiest way/least expenssive way; Remove 1 unit{500ml is a unit of blood] of whole blood.{this would also reduce your iron level, a side benefit] Then infuse 500ml of 5% albumin, by gravity feed, you do not require a pumping system. All standard off the shelf equipment/disposables and off the shelf 5% albumin. You will achieve diluting your whole systemic blood supply. All for less than $500.00{500ml 5% albumin, evacuated bottle to remove blood, infusion line set, catheter/winged infusion set, blood removed line] as a do it yourself biohack. Yes, “clinics” charging $2,500.00 per treatment…

What are the current biological markers being measured?

Approximately how much “plasma” is being removed in the trial you are in?

Did they tell you what size filter is being used or are they using a centrifuge system in you trial?

[约瑟夫]

“Fresh frozen plasma (FFP) is a blood product”

My issue is the same.

Lowering the Cost / Improving Access for Therapeutic Plasma Exchange (Plasmapheresis)

FWIW My biggest issue with any blood product is foreign particulate material{not just virus], material that are known {known to science] and unknown. Example viruses can not be “filtered” out. Even with testing, particles are there, just not detectable. The risk potential{unknown] reward is more risk than potential reward.

Remove whole blood and or plasma, OK

Infuse a “blood product” based on a unknown/potential benefit it “may extend lifespan” with totally unknown risk{current or in the future] not for me.

Diluting your whole systemic blood supply with a clean fluid{adding compounds to the fluid. OK

[medaura]

@Joseph

The easiest way/least expenssive way;

Remove 1 unit{500ml is a unit of blood] of whole blood.{this would also reduce your iron level, a side benefit]

Then infuse 500ml of 5% albumin,
by gravity feed, you do not require a pumping system.

All standard off the shelf equipment/disposables and off the shelf 5% albumin.

You will achieve diluting your whole systemic blood supply.

All for less than $500.00{500ml 5% albumin, evacuated bottle to remove blood, infusion line set,
catheter/winged infusion set, blood removed line] as a do it yourself biohack.

Explain this to me please like I’m 9. I don’t quite understand it. And as badly as I understand it, it doesn’t seem like the exact equivalent of what they’ve done in the studies. Is this like blood dumping as opposed to blood donation? And didn’t Conway say she doesn’t advise increased donation frequency as it’s not the same? The idea was to dilute 50% of plasma. I don’t see how dumping one unit of blood achieves that, so maybe I am missing something and don’t understand it.

[Kebossit]

I tried that last year and noticed no change in bloodwork or how I felt. I donated twice weekly for a month (8 total donations). Subsequently, I heard Irina in a talk state how that does not work because one needs to rid the body of enough of the aging molecules to tip the scales toward youth and a single donation at a time won’t do it. Plus, I also came across a post that the type of apherisis machine makes a critical difference. Evidently there are 2 kinds and one doesn’t extract the necessary components.