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Diabetes drug shows promise against Parkinson’s

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On 8 April, researchers will get an unprecedented view of the Sun’s outer wispy atmosphere: the corona. The solar eclipse visible in parts of North America will coincide with a solar maximum — a period of extreme activity that occurs every 11 years. One research team will chase the eclipse from a jet, adding 90 more seconds of observation time to the maximum of 4 minutes and 30 seconds seen by observers on the ground. One question they’re hoping to answer: why the corona is so much hotter than the solar surface. That, says solar physicist James Klimchuk, is like walking away from a campfire — but finding that instead of cooling down, you get warmer.

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A diabetes drug called lixisenatide has shown promise in slowing the progression of Parkinson’s disease. Lixisenatide is in the family of GLP-1 receptor agonists, such as Ozempic, that have made headlines as weight-loss drugs. In the latest clinical trial, lixisenatide was given to people with mild to moderate Parkinson’s who were already receiving a standard treatment for the condition. After a year they saw no worsening of their symptoms, unlike a control group whose condition did worsen. Further work is needed to reduce the drug’s side effects, such as nausea and vomiting, and to determine whether its benefits last. “We’re all cautious. There’s a long history of trying different things in Parkinson’s that ultimately didn’t work,” says neurologist David Standaert.

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Reference: The New England Journal of Medicine paper

The Bill & Melinda Gates Foundation, one of the world’s top biomedical research funders, will from next year require grant holders to make their research publicly available as preprints, which are not peer reviewed. It will also no longer pay article-processing charges (APCs) to publishers in order to secure open access, in which the peer-reviewed version of the paper is free to read. The change follows criticism that APCs create inequities because of the costs they push onto researchers and funders. “We’ve become convinced that this money could be better spent elsewhere,” said a Gates representative.

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Diabetes drug slows development of Parkinson’s disease

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A diabetes drug related to the latest generation of obesity drugs can slow the development of the symptoms of Parkinson’s disease, a clinical trial suggests1. Participants who took the drug, called lixisenatide, for 12 months showed no worsening of their symptoms — a gain in a condition marked by progressive loss of motor control.

Further work is needed to control side effects and determine the best dose, but researchers say that the trial marks another promising step in the decades-long effort to tackle the common and debilitating disorder.

“This is the first large-scale, multicentre clinical trial to provide the signs of efficacy that have been sought for so many years,” says Olivier Rascol, a Parkinson’s researcher at Toulouse University Hospital in France, who led the study.

The diabetes connection

Lixisenatide is a glucagon-like peptide-1 (GLP-1) receptor agonist, making it part of a large family of similar compounds used to treat diabetes and, more recently, obesity. (The weight-loss drug semaglutide, sold under the brand name Wegovy, is a GLP-1 compound.)

Many studies have shown a link between diabetes and Parkinson’s2. People with diabetes are around 40% more likely to develop Parkinson’s. And people who have both Parkinson’s and diabetes often see more rapid progression of symptoms than do those who have only Parkinson’s.

Animal studies3 have suggested that some GLP-1 drugs, which influence levels of insulin and glucose, can slow the symptoms of Parkinson’s. Smaller trials, published in 20134 and 20175, suggested that the GLP-1 molecule exenatide, another diabetes drug, could do the same in people.

Progression halted

In the latest, larger study, the French researchers investigated lixisenatide in 156 people with mild to moderate Parkinson’s symptoms, all of whom were already taking the standard Parkinson’s drug levodopa or other drugs. Half got the GLP-1 drug for a year and the others received a placebo.

After 12 months, those in the control group showed a worsening of their symptoms. Specifically, their score had increased by three points on a scale used to assess the severity of Parkinson’s that measures how well people can perform tasks including speaking, eating and walking.

Those taking the drug had no change in their scores on this scale. But the treatment did induce side effects. Nausea occurred in nearly half, and vomiting in 13%, of people on the medication. The results are published in The New England Journal of Medicine.

Not a miracle drug

David Standaert, a neurologist at the University of Alabama at Birmingham, who was not involved in the trial, says it’s important to know whether the effect will last beyond a year.

“We’re all cautious. There’s a long history of trying different things in Parkinson’s that ultimately didn’t work,” he says. A difference of three points in the rating score is a small change — one that many people with Parkinson’s would struggle to notice, he says. “What happens at 5 years? Is it 15 points then, or is it still 3? If it’s still 3, then this is not worth it.”

Lixisenatide as a diabetes treatment was pulled from the US market last year by its Paris-based manufacturer Sanofi for commercial reasons. But Standaert says that this would not have affected development of a possible treatment for Parkinson’s, because other GLP-1 drugs are available.

“I view this as a study of the class. I don’t know if this particular one is the right answer,” he says. Newer GLP-1 drugs (lixisenatide was developed in the 2000s) could offer fewer and milder side effects or work at lower doses, he adds.

Another question that needs further consideration is just how some GLP-1 drugs might protect against Parkinson’s. The compounds are known to reduce inflammation, which has led some researchers to suggest that they prevent the steady loss of dopamine-producing neurons that drives the condition. That would offer a significant benefit over existing treatments such as levodopa, which mask the symptoms but don’t address the underlying cause. But this trial and others haven’t assessed neuron loss.

Researchers are now waiting for the results of a large clinical trial examining the effects of a two-year course of exenatide in people with Parkinson’s disease. Those data will be available in the second half of this year, according to Tom Foltynie, a neurologist at University College London, in comments provided to the UK Science Media Centre.

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