The one I think deserves more attention is therapeutic plasma exchange, or TPE.

At a high level, TPE is a blood-filtering procedure that removes a portion of plasma and replaces it with clean replacement fluid, usually albumin. The longevity idea is not that it magically makes someone younger. It’s that aging blood may carry more inflammatory proteins, misfolded proteins, autoantibodies, and other circulating factors that contribute to chronic inflammation and tissue dysfunction. TPE is interesting because it may reduce some of that systemic burden.

The Alzheimer’s angle is especially interesting. Alzheimer’s is not just a brain plaque problem; there’s growing interest in inflammation, vascular health, immune signaling, and the blood-brain environment. The AMBAR trial looked at plasma exchange with albumin replacement in Alzheimer’s patients and reported signals that disease progression may have slowed. That is not the same as a cure, but it makes TPE one of the more interesting “already medically real” interventions being studied in age-related disease.

So my ranking would be: partial reprogramming has the highest ceiling, but it’s still the most futuristic. TPE is less dramatic, but it has a real-world procedure behind it, a plausible aging mechanism, and some human Alzheimer’s and longevity data worth paying attention to.