CNM-Au8 Impacts Neuronal Structural Integrity, Mobile Stroke Units and Direct Transfer to Angiography, Cognitive Impairments Higher in RBD Before Parkinson Disease

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Welcome to this special edition of Neurology News Network. I’m Marco Meglio.

Newly announced findings from the phase 2 VISIONARY-MS study assessing Clene Nanomedicine’s investigational agent CNM-Au8 in patients with relapsing multiple sclerosis (MS) showed that the agent significantly impacted brain neuronal structural integrity, demonstrated by changes in axonal integrity and white matter integrity. Over a 48-week period, investigators observed a least square mean difference in fractional anisotropy change within the whole brain of 0.0029 and fractional anisotropy change within total cerebral white matter of 0.0026. Additionally, at the same time point, there was a 0.0025 least-square mean difference in change within total cerebral normal appearing white matter. Each of these findings, observed through diffusion tensor imaging, highlight improvements in domains of fractional anisotropy, radial diffusivity, and mean diffusivity across all 9 prespecified brain regions and brain white matter tracts for each metric.

Findings from a retrospective chart review comparing patients with emergent large vessel occlusion (ELVO) showed that a direct-to-angiography approach from mobile stroke unit (MSU) was associated with less successful recanalization and increased mortality than opting for additional imaging studies first. These data were presented at the 2023 International Stroke Conference (ISC), held February 8-10, in Dallas, Texas, by senior investigator Shazam Hussain, MD, FRCP, FAHA, director of the Cerebrovascular Center at Cleveland Clinic. The study featured 14 patients with ELVO who went directly to angio (DTA) and 52 patients who underwent additional imaging (CTA), with no differences in age, gender, pre-morbid vascular risk factors or presenting symptoms. At the conclusion of the analysis, the mortality rate was significantly higher in the DTA group (35% vs 9%; P = .028); however, there was no between-group difference in functional outcomes, as assessed using modified Rankin Scale scores between 0-2 (28% vs 17%; P = .45).

Recently published data using participants from the PREDICT-PD study showed that cognitive function is impaired in groups at higher risk of developing Parkinson disease (PD), especially those with REM-sleep behavior disorder. For PREDICT-PD participants, 117 were considered lower risk and 91 were considered higher risk based off their MOCA percentile. For those with RBD, 15 had RBD with level 2 MCI and 10 were cognitively normal. All told, total MOCA scores were worse in the higher risk group compared with the lower risk group (P = .009) and in the RBD group compared with PREDICT-PD participants. Specifically, rates of MCI level 1 were 12.8% in the lower-risk, 21.9% in the higher-risk, and 64% in patients with RBD.

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