Therapeutic Plasma Exchange
TPE / plasmapheresis · established medical procedure; healthy-aging use is off-label
What it is + mitochondrial link
An apheresis machine separates blood cells from plasma; the plasma is discarded and replaced, usually with 5% albumin. A session generally takes 2–3 hours, and one plasma-volume exchange removes roughly 60% of circulating macromolecules. The proposed mitochondrial benefit is indirect: removing inflammatory mediators, autoantibodies, oxidized lipids and age-elevated proteins may reduce oxidative stress that impairs mitochondrial function.
What the evidence shows
TPE has decades of established use for conditions such as Guillain–Barré syndrome, myasthenia gravis and thrombotic thrombocytopenic purpura. Mouse plasma-dilution studies improved tissue repair and cognition. A 42-person randomized, sham-controlled 2025 study found mid-trial biological-age shifts—largest with TPE plus IVIG—but no significant group differences at later follow-up. A separate 2025 plasmapheresis trial found no epigenetic rejuvenation. The only direct human mitochondrial-endpoint study was small, non-randomized and limited to acute fatty liver of pregnancy.
Risks + bottom line
Reported risks include citrate-related hypocalcemia and tingling, low blood pressure, fatigue, medication removal, coagulation changes, and catheter-related infection or thrombosis. Albumin replacement lacks clotting factors. TPE has not been shown to extend lifespan or durably improve mitochondrial function in healthy people; epigenetic clocks remain surrogate markers.