A drug that targets a build-up of proteins linked to Parkinson鈥檚 disease could slow the progression of motor symptoms in people with advanced forms of the condition. Although this shows promise to be a disease-modifying treatment for Parkinson鈥檚, it is unclear whether the drug actually clears the proteins from the brain.

The accumulation of a misfolded protein called alpha-synuclein in the brain has long been considered the underlying cause of Parkinson鈥檚. This leads to the loss of neurons that produce the neurotransmitter dopamine, which is involved in motor control.

While some existing treatments aim to ease these symptoms by improving dopamine levels in the brain, their long-term effects are limited. So far, there are no approved disease-modifying therapies that halt or slow the progression of Parkinson鈥檚.

In an effort to combat this, at Swiss pharmaceutical company Roche and his colleagues recruited 316 people who were thought to have early-stage Parkinson鈥檚 disease. Of these individuals, 105 received intravenous infusions of a placebo, while 211 had infusions of the Roche drug prasinezumab at either a low or high dose, administered every four weeks over one year.

Prasinezumab is an antibody that is designed to bind to aggregated clumps of misfolded alpha-synuclein in dopamine-producing neurons. 鈥淚t is hypothesised that prasinezumab may reduce neuronal toxicity, prevent cell-to-cell transfer of pathological alpha-synuclein aggregates and slow disease progression,鈥� says Pagano.

While the results of the trial initially suggested that the antibody had no meaningful impact, the team then realised it may be effective among the trial participants with more severe Parkinson鈥檚.

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These individuals had rapid eye movement sleep behaviour disorder, where people act out intense and often violent dreams, which is common in Parkinson鈥檚; were taking drugs called MAO-B inhibitors to manage their symptoms; or had been rated by their specialist as being at stage two out of five on a symptom scale, with a higher number indicating greater severity.

An additional analysis showed that both low and high doses of the drug had a greater effect among the severe participants specifically than seen in the initial work. Compared with taking a placebo, it significantly reduced the rate at which participants鈥� motor symptoms worsened over the year-long period.

For example, based on a Parkinson鈥檚 disease rating scale for motor symptoms, those on MAO-B inhibitors who then received placebo infusions scored 6.82 at the end of the year, while those taking both the inhibitors and prasinezumab scored 4.15.

鈥淭he results imply that in a faster-progressing population, where the degree of worsening over time is greater, there is an increased likelihood of a potential treatment effect,鈥� says Pagano. This could be because people with more rapidly progressing Parkinson鈥檚 have higher amounts of misfolded alpha-synuclein in their brains, so would probably benefit more from a drug that potentially clears the protein.

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However, Pagano says it wasn鈥檛 possible to assess exactly what was happening in any of the participants鈥� brains because the researchers lacked a biomarker that would have enabled them to monitor how their levels of misfolded alpha-synuclein may be changing.

at the University of Florida Health says a limitation of the study is that it didn鈥檛 assess whether alpha-synuclein was being cleared from the brain. Without this, the results can鈥檛 conclusively show prasinezumab is disease-modifying, she says. Vedam-Mai says she would also like to see longer-term data to better gauge the drug鈥檚 safety and efficacy. No serious adverse events took place in the latest trial.

Researchers could also investigate whether prasinezumab is effective in people with milder Parkinson鈥檚 disease when taken over a longer period, says Pagano.

Drones delivering defibrillators consistently outperform ambulances in the race to get life-saving treatment to people whose hearts have stopped beating, according to a landmark new trial in Sweden.

Time is critical when it comes to reviving patients who have gone into cardiac arrest. Using a defibrillator to apply an .

Yet fewer than 2 per cent of patients receive such treatment before emergency services arrive, with .

To see whether drones could cut the time taken to get defibrillators to collapsed patients, at the Karolinska Institute in Sweden and his colleagues launched a collaborative project with drone operator and emergency services in western Sweden where drones and ambulances were dispatched to each suspected case of cardiac arrest.

Across the 55 cases, drones were quicker than ambulances 67 per cent of the time, and by an average of 3 minutes and 14 seconds.

鈥淒rones can deliver automated external defibrillators in daylight, non-daylight, summertime and wintertime, and before emergency services in a majority of cases,鈥� says Claesson.

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However, he says the benefits also depend on whether there is someone next to the collapsed patient who knows cardiopulmonary resuscitation (CPR) and can use the delivered defibrillator.

Out of 18 cases in the trial in which a patient had actually gone into cardiac arrest, the caller had only managed to use the drove-delivered defibrillator on six occasions.

鈥淲e have shown that [the method of] transportation is really effective,鈥� says Claesson. 鈥淲hat happens after that is dependent on local conditions and CPR knowledge.鈥�

The researchers are now looking to expand the trial, and perhaps use drones to relay video footage of the scene to the ambulance dispatch centre to assist with locating a collapsed person. Claesson also envisages using drones in other emergency scenarios, such as delivering drugs like epinephrine for anaphylactic shock or tourniquets for bleeding.