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Preeclampsia is a devastating complication of pregnancy. Soluble Fms-like tyrosine kinase-1 (sFlt-1) is an antiangiogenic protein believed to mediate the signs and symptoms of preeclampsia. We conducted an open pilot study to evaluate the safety and potential efficacy of therapeutic apheresis with a plasma-specific dextran sulfate column to remove circulating sFlt-1 in 11 pregnant women (20–38 years of age) with very preterm preeclampsia (23–32 weeks of gestation, systolic BP≥ 140 mmHg or diastolic BP≥ 90 mmHg, new onset protein/creatinine ratio> 0.30 g/g, and sFlt-1/placental growth factor ratio> 85). We evaluated the extent of sFlt-1 removal, proteinuria reduction, pregnancy continuation, and neonatal and fetal safety of apheresis after one (n= 6), two (n= 4), or three (n= 1) apheresis treatments. Mean sFlt-1 levels were reduced by 18%(range 7%–28%) with concomitant reductions of 44% in protein …