Dr. Neil Paulvin

New research at the intersection of environmental medicine and therapeutic apheresis: onlinelibrary.wiley.com/doi/epdf/10.10… A paper just published in the Journal of Clinical Apheresis (Weinstein et al., 2026) reports the first deliberate attempt to remove circulating microplastics from human blood using therapeutic plasma exchange (TPE). Across 174 procedures in 114 patients, the results showed that TPE can significantly reduce circulating microplastic burden, but only in patients who start with higher levels (≥20 particles/100µL). This is a novel finding and, to the best of my knowledge, the first demonstration of a technology that effectively reduces microplastic burden in people with high exposure. We've known since 2022 (Leslie et al., Environment International) that microplastics circulate in most people's blood, and additional studies (e.g. Marfella et al. NEJM 2924) have suggested a potential connection between microplastics and cardiovascular disease, coagulation, and chronic inflammation. Importantly, we don’t yet know the extent to which microplastics contribute to disease pathology, the levels of exposure necessary to cause pathology, and which individuals are at highest risk. Nonetheless, it seems reasonable that reducing exposure and lowering circulating levels of microplastics should be beneficial, or at least net neutral, for future health risks. In that light, the TPE results here are encouraging for patients presenting with high circulating microplastics burden. For those starting at ≥30 particles/100µL, the mean level dropped from ~52 to ~21 - a large, statistically significant reduction. But there’s a critical caveat that also deserves attention: patients who started with *low* microplastic levels (0–9/100µL) ended the procedure with *more* microplastics in their blood than they started with. The plastic apheresis tubing and saline bags were leaching particles into the circulation during treatment. Again, we don’t know whether this exposure from the TPE itself is meaningful or not, from a health perspective. But it is a finding that should be taken into consideration if considering TPE as a routine "detox" for people without a demonstrated high burden. One underappreciated implication: if TPE can reduce circulating microplastics, it likely has similar potential for other lipophilic or plasma-bound environmental toxins, such as persistent organic pollutants, heavy metals, PFAS, and other endocrine-disrupting compounds that accumulate over a lifetime. The plasma exchange mechanism is not specific to microplastics. This opens an interesting research agenda that goes well beyond plastics alone. **Where I land** I would characterize this paper as an important proof of concept, not a treatment protocol. I personally tried TPE about a year ago through @CirculateHealth . My microplastic burden going in was 1 particle / 100 uL, and it was 5 particles / 100 uL coming out. So, I’m not surprised by these results. I’m also not concerned that my circulating microplastic levels went up a bit from the procedure, as I’m not doing TPE or other i.v. procedures frequently. We need larger studies with outcome data to understand whether reducing microplastic burden actually moves the needle on health. For people carrying a genuinely high environmental toxin burden, TPE is a plausible and increasingly evidence-supported tool. It’s also worth noting that there is early, but very intriguing, evidence that TPE may offer broader benefits beyond reducing circulating environmental toxins. I’m particularly interested in the effects of TPE in patients with autoimmunity/high chronic inflammation, ME/CFS, and those at high risk for dementia. I recently had a chance to record an episode for @longevityscipod with Dr. Dobri Kiprov and one of his patients at his clinic in Mill Valley, CA. That video should drop next week: @mkaeberlein" target="_blank" rel="nofollow noopener">youtube.com/@mkaeberlein. Worth watching. Full disclosure: The new study was funded by Circulate Health, and I am a Scientific Advisor for Circulate Health.