A soluble phosphorylated tau signature links tau, amyloid and the evolution of stages of dominantly inherited Alzheimer's disease.


Journal

Nature medicine
ISSN: 1546-170X
Titre abrégé: Nat Med
Pays: United States
ID NLM: 9502015

Informations de publication

Date de publication:
03 2020
Historique:
received: 11 05 2019
accepted: 30 01 2020
entrez: 13 3 2020
pubmed: 13 3 2020
medline: 9 4 2020
Statut: ppublish

Résumé

Development of tau-based therapies for Alzheimer's disease requires an understanding of the timing of disease-related changes in tau. We quantified the phosphorylation state at multiple sites of the tau protein in cerebrospinal fluid markers across four decades of disease progression in dominantly inherited Alzheimer's disease. We identified a pattern of tau staging where site-specific phosphorylation changes occur at different periods of disease progression and follow distinct trajectories over time. These tau phosphorylation state changes are uniquely associated with structural, metabolic, neurodegenerative and clinical markers of disease, and some (p-tau217 and p-tau181) begin with the initial increases in aggregate amyloid-β as early as two decades before the development of aggregated tau pathology. Others (p-tau205 and t-tau) increase with atrophy and hypometabolism closer to symptom onset. These findings provide insights into the pathways linking tau, amyloid-β and neurodegeneration, and may facilitate clinical trials of tau-based treatments.

Identifiants

pubmed: 32161412
doi: 10.1038/s41591-020-0781-z
pii: 10.1038/s41591-020-0781-z
pmc: PMC7309367
mid: NIHMS1584278
doi:

Substances chimiques

Amyloid 0
tau Proteins 0
Fluorodeoxyglucose F18 0Z5B2CJX4D

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

398-407

Subventions

Organisme : NIA NIH HHS
ID : P30 AG066444
Pays : United States
Organisme : U.S. Department of Health & Human Services | NIH | National Institute of Neurological Disorders and Stroke (NINDS)
ID : R01NS095773
Pays : International
Organisme : NIA NIH HHS
ID : K23 AG046363
Pays : United States
Organisme : NIA NIH HHS
ID : UF1 AG032438
Pays : United States
Organisme : NIA NIH HHS
ID : U19 AG032438
Pays : United States
Organisme : U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging)
ID : UF1AG032438
Pays : International
Organisme : RCUK | Medical Research Council (MRC)
ID : MR/L023784/1
Pays : International
Organisme : RCUK | Medical Research Council (MRC)
ID : MR/009076/1
Pays : International
Organisme : NIA NIH HHS
ID : P50 AG005681
Pays : United States
Organisme : U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging)
ID : MR/L023784/1
Pays : International
Organisme : NIA NIH HHS
ID : R01 AG052550
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS095773
Pays : United States

Investigateurs

Ricardo Allegri (R)
Randy Bateman (R)
Jacob Bechara (J)
Tammie Benzinger (T)
Sarah Berman (S)
Courtney Bodge (C)
Susan Brandon (S)
William Bill Brooks (WB)
Jill Buck (J)
Virginia Buckles (V)
Sochenda Chea (S)
Jasmeer Chhatwal (J)
Patricio Chrem Mendez (P)
Helena Chui (H)
Jake Cinco (J)
Jack Clifford (J)
Carlos Cruchaga (C)
Tamara Donahue (T)
Jane Douglas (J)
Noelia Edigo (N)
Nilufer Erekin-Taner (N)
Anne Fagan (A)
Martin Farlow (M)
Colleen Fitzpatrick (C)
Gigi Flynn (G)
Nick Fox (N)
Erin Franklin (E)
Hisako Fujii (H)
Cortaiga Gant (C)
Samantha Gardener (S)
Bernardino Ghetti (B)
Alison Goate (A)
Jill Goldman (J)
Brian Gordon (B)
Neill Graff-Radford (N)
Julia Gray (J)
Alexander Groves (A)
Jason Hassenstab (J)
Laura Hoechst-Swisher (L)
David Holtzman (D)
Russ Hornbeck (R)
Siri Houeland DiBari (SH)
Takeshi Ikeuchi (T)
Snezana Ikonomovic (S)
Gina Jerome (G)
Mathias Jucker (M)
Celeste Karch (C)
Kensaku Kasuga (K)
Takeshi Kawarabayashi (T)
William Bill Klunk (WB)
Robert Koeppe (R)
Elke Kuder-Buletta (E)
Christoph Laske (C)
Jae-Hong Lee (JH)
Johannes Levin (J)
Ralph Martins (R)
Neal Scott Mason (NS)
Colin Masters (C)
Denise Maue-Dreyfus (D)
Eric McDade (E)
Hiroshi Mori (H)
John Morris (J)
Akem Nagamatsu (A)
Katie Neimeyer (K)
James Noble (J)
Joanne Norton (J)
Richard Perrin (R)
Marc Raichle (M)
Alan Renton (A)
John Ringman (J)
Jee Hoon Roh (JH)
Stephen Salloway (S)
Peter Schofield (P)
Hiroyuki Shimada (H)
Wendy Sigurdson (W)
Hamid Sohrabi (H)
Paige Sparks (P)
Kazushi Suzuki (K)
Kevin Taddei (K)
Peter Wang (P)
Chengjie Xiong (C)
Xiong Xu (X)

Références

Goedert, M., Spillantini, M. G., Jakes, R., Rutherford, D. & Crowther, R. A. Multiple isoforms of human microtubule-associated protein tau: sequences and localization in neurofibrillary tangles of Alzheimer’s disease. Neuron 3, 519–526 (1989).
pubmed: 2484340
Grundke-Iqbal, I. et al. Abnormal phosphorylation of the microtubule-associated protein τ (tau) in Alzheimer cytoskeletal pathology. Proc. Natl Acad. Sci. USA 83, 4913–4917 (1986).
pubmed: 3088567
Kimura, T., Sharma, G., Ishiguro, K. & Hisanaga, S. Phospho-tau bar code: analysis of phosphoisotypes of tau and its application to tauopathy. Front. Neurosci. 12, 44 (2018).
pubmed: 29467609 pmcid: 5808175
Crowther, R. A. Straight and paired helical filaments in Alzheimer disease have a common structural unit. Proc. Natl Acad. Sci. USA 88, 2288–2292 (1991).
pubmed: 1706519
Fitzpatrick, A. W. P. et al. Cryo-EM structures of tau filaments from Alzheimer’s disease. Nature 547, 185–190 (2017).
pubmed: 28678775 pmcid: 5552202
Price, J. L., Davis, P. B., Morris, J. C. & White, D. L. The distribution of tangles, plaques and related immunohistochemical markers in healthy aging and Alzheimer’s disease. Neurobiol. Aging 12, 295–312 (1991).
pubmed: 1961359
Qian, J., Hyman, B. T. & Betensky, R. A. Neurofibrillary tangle stage and the rate of progression of Alzheimer symptoms: modeling using an autopsy cohort and application to clinical trial design. JAMA Neurol. 74, 540–548 (2017).
pubmed: 28288263 pmcid: 5547572
McDade, E. et al. Longitudinal cognitive and biomarker changes in dominantly inherited Alzheimer disease. Neurology 91, e1295–e1306 (2018).
pubmed: 30217935 pmcid: 6177272
Bateman, R. J. et al. Clinical and biomarker changes in dominantly inherited Alzheimer’s disease. N. Engl. J. Med. 367, 795–804 (2012).
pubmed: 22784036 pmcid: 3474597
Fagan, A. M. et al. Cerebrospinal fluid tau/β-amyloid
pubmed: 17210801
Vandermeeren, M. et al. Detection of tau proteins in normal and Alzheimer’s disease cerebrospinal fluid with a sensitive sandwich enzyme-linked immunosorbent assay. J. Neurochem. 61, 1828–1834 (1993).
pubmed: 8228996
Mori, H. et al. Tau in cerebrospinal fluids: establishment of the sandwich ELISA with antibody specific to the repeat sequence in tau. Neurosci. Lett. 186, 181–183 (1995).
pubmed: 7777192
Schindler, S. E. et al. Emerging cerebrospinal fluid biomarkers in autosomal dominant Alzheimer’s disease. Alzheimers Dement. 15, 655–665 (2019).
pubmed: 30846386
Toledo, J. B., Xie, S. X., Trojanowski, J. Q. & Shaw, L. M. Longitudinal change in CSF Tau and Aβ biomarkers for up to 48 months in ADNI. Acta Neuropathol. 126, 659–670 (2013).
pubmed: 23812320
Jack, C. R. Jr. et al. NIA-AA research framework: toward a biological definition of Alzheimer’s disease. Alzheimers Dement. 14, 535–562 (2018).
pubmed: 29653606 pmcid: 5958625
Jack, C. R. Jr. et al. A/T/N: an unbiased descriptive classification scheme for Alzheimer disease biomarkers. Neurology 87, 539–547 (2016).
pubmed: 27371494 pmcid: 4970664
Hu, W. T. et al. Reduced CSF p-Tau181 to Tau ratio is a biomarker for FTLD-TDP. Neurology 81, 1945–1952 (2013).
pubmed: 24174584 pmcid: 3843382
Hampel, H. et al. Measurement of phosphorylated tau epitopes in the differential diagnosis of Alzheimer disease: a comparative cerebrospinal fluid study. Arch. Gen. Psychiatry 61, 95–102 (2004).
pubmed: 14706948
La Joie, R. et al. Associations between AV1451 tau PET and CSF measures of tau pathology in a clinical sample. Neurology 90, e282–e290 (2018).
pubmed: 29282337 pmcid: 5798657
Mattsson, N. et al.
pubmed: 28743782 pmcid: 5582410
Gordon, B. A. et al. Tau PET in autosomal dominant Alzheimer’s disease: relationship with cognition, dementia and other biomarkers. Brain 142, 1063–1076 (2019).
pubmed: 30753379
Jack, C. R. Jr. et al. The bivariate distribution of amyloid-β and tau: relationship with established neurocognitive clinical syndromes. Brain 142, 3230–3242 (2019).
pubmed: 31501889 pmcid: 6763736
Johnson, K. A. et al. Tau positron emission tomographic imaging in aging and early Alzheimer disease. Ann. Neurol. 79, 110–119 (2016).
pubmed: 26505746
Mattsson, N. et al. Predicting diagnosis and cognition with
pubmed: 30639421
Quiroz, Y. T. et al. Association between amyloid and Tau accumulation in young adults with autosomal dominant Alzheimer disease. JAMA Neurol. 75, 548–556 (2018).
pubmed: 29435558 pmcid: 5885174
Fleisher, A. S. et al. Associations between biomarkers and age in the presenilin 1 E280A autosomal dominant Alzheimer disease kindred: a cross-sectional study. JAMA Neurol. 72, 316–324 (2015).
pubmed: 25580592 pmcid: 4355261
Toledo, J. B., Xie, S. X., Trojanowski, J. Q. & Shaw, L. M. Longitudinal change in CSF Tau and Aβ biomarkers for up to 48 months in ADNI. Acta Neuropathol. 126, 659–670 (2013).
pubmed: 23812320
Fagan, A. M. et al. Longitudinal change in CSF biomarkers in autosomal-dominant Alzheimer’s disease. Sci. Transl. Med. 6, 226ra230 (2014).
Price, J. L. & Morris, J. C. Tangles and plaques in nondemented aging and “preclinical” Alzheimer’s disease. Ann. Neurol. 45, 358–368 (1999).
pubmed: 10072051
Ittner, L. M. et al. Dendritic function of Tau mediates amyloid-β toxicity in Alzheimer’s disease mouse models. Cell 142, 387–397 (2010).
pubmed: 20655099
Cohen, A. D. et al. Early striatal amyloid deposition distinguishes Down syndrome and autosomal dominant Alzheimer’s disease from late-onset amyloid deposition. Alzheimers Dement. 14, 743–750 (2018).
pubmed: 29477284 pmcid: 5994364
Maia, L. F. et al. Changes in amyloid-β and Tau in the cerebrospinal fluid of transgenic mice overexpressing amyloid precursor protein. Sci. Transl. Med. 5, 194re192 (2013).
Sato, C. et al. Tau kinetics in neurons and the human central nervous system. Neuron 98, 861–864 (2018).
pubmed: 29772204 pmcid: 6192252
Schelle, J. et al. Prevention of tau increase in cerebrospinal fluid of APP transgenic mice suggests downstream effect of BACE1 inhibition. Alzheimers Dement. 13, 701–709 (2017).
pubmed: 27750032
Zempel, H., Thies, E., Mandelkow, E. & Mandelkow, E. M. Aβ oligomers cause localized Ca
pubmed: 20826658 pmcid: 6633549
Saman, S. et al. Exosome-associated Tau is secreted in tauopathy models and is selectively phosphorylated in cerebrospinal fluid in early Alzheimer disease. J. Biol. Chem. 287, 3842–3849 (2012).
pubmed: 22057275
Jin, M. et al. Soluble amyloid β-protein dimers isolated from Alzheimer cortex directly induce Tau hyperphosphorylation and neuritic degeneration. Proc. Natl Acad. Sci. USA 108, 5819–5824 (2011).
pubmed: 21421841
Gordon, B. A. et al. Spatial patterns of neuroimaging biomarker change in individuals from families with autosomal dominant Alzheimer’s disease: a longitudinal study. Lancet Neurol. 17, 241–250 (2018).
pubmed: 29397305 pmcid: 5816717
Ryman, D. C. et al. Symptom onset in autosomal dominant Alzheimer disease: a systematic review and meta-analysis. Neurology 83, 253–260 (2014).
pubmed: 24928124 pmcid: 4117367
Morris, J. C. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 43, 2412–2414 (1993).
pubmed: 8232972
Medina, M. & Avila, J. Further understanding of tau phosphorylation: implications for therapy. Expert Rev. Neurother. 15, 115–122 (2015).
pubmed: 25555397
Benzinger, T. L. et al. Regional variability of imaging biomarkers in autosomal dominant Alzheimer’s disease. Proc. Natl Acad. Sci. USA 110, E4502–E4509 (2013).
pubmed: 24194552
Quiroz, Y. T. et al. Cortical atrophy in presymptomatic Alzheimer’s disease presenilin 1 mutation carriers. J. Neurol. Neurosurg. Psychiatry 84, 556–561 (2013).
pubmed: 23134660
Ridha, B. H. et al. Tracking atrophy progression in familial Alzheimer’s disease: a serial MRI study. Lancet Neurol. 5, 828–834 (2006).
pubmed: 16987729
Arriagada, P. V., Growdon, J. H., Hedley-Whyte, E. T. & Hyman, B. T. Neurofibrillary tangles but not senile plaques parallel duration and severity of Alzheimer’s disease. Neurology 42, 631–639 (1992).
pubmed: 1549228
Okonkwo, O. C. et al. Cerebrospinal fluid profiles and prospective course and outcome in patients with amnestic mild cognitive impairment. Arch. Neurol. 68, 113–119 (2011).
pubmed: 21220682 pmcid: 3058271
Bateman, R. J. et al. The DIAN-TU Next Generation Alzheimer’s prevention trial: adaptive design and disease progression model. Alzheimers Dement. 13, 8–19 (2017).
pubmed: 27583651
Yanamandra, K. et al. Anti-tau antibody administration increases plasma tau in transgenic mice and patients with tauopathy. Sci. Transl. Med. 9, eaal2029 (2017).
pubmed: 28424326 pmcid: 5727571
He, Z. et al. Amyloid-β plaques enhance Alzheimer’s brain tau-seeded pathologies by facilitating neuritic plaque tau aggregation. Nat. Med. 24, 29–38 (2018).
pubmed: 29200205
Buerger, K. et al. CSF phosphorylated tau protein correlates with neocortical neurofibrillary pathology in Alzheimer’s disease. Brain 129, 3035–3041 (2006).
pubmed: 17012293
Ittner, A. et al. Site-specific phosphorylation of tau inhibits amyloid-β toxicity in Alzheimer’s mice. Science 354, 904–908 (2016).
pubmed: 27856911
Potter, R. et al. Increased in vivo amyloid-β42 production, exchange, and loss in presenilin mutation carriers. Sci. Transl. Med. 5, 189ra177 (2013).
Yamada, K. et al. In vivo microdialysis reveals age-dependent decrease of brain interstitial fluid tau levels in P301S human tau transgenic mice. J. Neurosci. 31, 13110–13117 (2011).
pubmed: 21917794 pmcid: 4299126
Van der Kant, R. et al. Cholesterol metabolism is a druggable axis that independently regulates tau and amyloid-β in iPSC-derived Alzheimer’s disease neurons. Cell Stem Cell 24, 363–375.e9 (2019).
pubmed: 30686764 pmcid: 6414424
Morris, J. C. et al. Developing an international network for Alzheimer research: the Dominantly Inherited Alzheimer Network. Clin. Investig. (Lond.) 2, 975–984 (2012).
Storandt, M., Balota, D. A., Aschenbrenner, A. J. & Morris, J. C. Clinical and psychological characteristics of the initial cohort of the Dominantly Inherited Alzheimer Network (DIAN). Neuropsychology 28, 19–29 (2014).
pubmed: 24219606
Lim, Y. Y. et al. BDNF Val66Met moderates memory impairment, hippocampal function and tau in preclinical autosomal dominant Alzheimer’s disease. Brain 139, 2766–2777 (2016).
pubmed: 27521573 pmcid: 5815565
McKhann, G. et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34, 939–944 (1984).
pubmed: 6610841
Patterson, B. W. et al. Age and amyloid effects on human central nervous system amyloid-beta kinetics. Ann. Neurol. 78, 439–453 (2015).
pubmed: 26040676 pmcid: 4546566
Del Campo, M. et al. Recommendations to standardize preanalytical confounding factors in Alzheimer’s and Parkinson’s disease cerebrospinal fluid biomarkers: an update. Biomark. Med. 6, 419–430 (2012).
pubmed: 22917144
Barthelemy, N. R. et al. Tau protein quantification in human cerebrospinal fluid by targeted mass spectrometry at high sequence coverage provides insights into its primary structure heterogeneity. J. Proteome Res. 15, 667–676 (2016).
pubmed: 26742856
Su, Y. et al. Partial volume correction in quantitative amyloid imaging. Neuroimage 107, 55–64 (2015).
pubmed: 25485714
Luo, J., D’Angelo, G., Gao, F., Ding, J. & Xiong, C. Bivariate correlation coefficients in family-type clustered studies. Biom. J. 57, 1084–1109 (2015).
pubmed: 26360805 pmcid: 4741284
Xiong, C. et al. Longitudinal relationships among biomarkers for Alzheimer disease in the Adult Children Study. Neurology 86, 1499–1506 (2016).
pubmed: 27009258 pmcid: 4836885
Benjamini, Y. & Hochberg, Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J. R. Stat. Soc. B 57, 289–300 (1995).

Auteurs

Nicolas R Barthélemy (NR)

Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA.

Yan Li (Y)

Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA.
Division of Biostatistics, Washington University School of Medicine, Saint Louis, MO, USA.

Nelly Joseph-Mathurin (N)

Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.

Brian A Gordon (BA)

Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.

Jason Hassenstab (J)

Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA.

Tammie L S Benzinger (TLS)

Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.

Virginia Buckles (V)

Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA.

Anne M Fagan (AM)

Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA.

Richard J Perrin (RJ)

Department of Pathology, Washington University School of Medicine, Saint Louis, MO, USA.

Alison M Goate (AM)

Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

John C Morris (JC)

Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA.

Celeste M Karch (CM)

Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA.

Chengjie Xiong (C)

Division of Biostatistics, Washington University School of Medicine, Saint Louis, MO, USA.

Ricardo Allegri (R)

Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI) Instituto de Investigaciones Neurológicas Raúl Correa, Buenos Aires, Argentina.

Patricio Chrem Mendez (PC)

Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI) Instituto de Investigaciones Neurológicas Raúl Correa, Buenos Aires, Argentina.

Sarah B Berman (SB)

University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Takeshi Ikeuchi (T)

Niigata University, Niigata, Japan.

Hiroshi Mori (H)

Osaka City University, Osaka, Japan.

Hiroyuki Shimada (H)

Osaka City University, Osaka, Japan.

Mikio Shoji (M)

Hirosaki University, Hirosaki, Japan.

Kazushi Suzuki (K)

Tokyo University, Tokyo, Japan.

James Noble (J)

Columbia University, College of Physicians and Surgeons, New York, NY, USA.

Martin Farlow (M)

Department of Neurology, Indiana University, Indianapolis, IN, USA.

Jasmeer Chhatwal (J)

Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Neill R Graff-Radford (NR)

Department of Neurology, Mayo Clinic Jacksonville, Jacksonville, FL, USA.

Stephen Salloway (S)

Butler Hospital, Providence, RI, USA.
Brown University, Providence, RI, USA.

Peter R Schofield (PR)

Neuroscience Research Australia, Sydney, New South Wales, Australia.
School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.

Colin L Masters (CL)

The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
University of Melbourne, Melbourne, Victoria, Australia.

Ralph N Martins (RN)

Edith Cowan University, Perth, Western Australia, Australia.

Antoinette O'Connor (A)

Dementia Research Centre, Institute of Neurology, University College London, London, UK.

Nick C Fox (NC)

Dementia Research Centre, Institute of Neurology, University College London, London, UK.

Johannes Levin (J)

German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany.
Department of Neurology, Ludwig-Maximilians Universität München, Munich, Germany.
Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.

Mathias Jucker (M)

German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.

Audrey Gabelle (A)

Laboratoire de Biochimie et Protéomique Clinique and CRB, INSERM-UM, CHU Montpellier, Montpellier, France, Montpellier, France.

Sylvain Lehmann (S)

Laboratoire de Biochimie et Protéomique Clinique and CRB, INSERM-UM, CHU Montpellier, Montpellier, France, Montpellier, France.

Chihiro Sato (C)

Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA.

Randall J Bateman (RJ)

Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA. batemanr@wustl.edu.

Eric McDade (E)

Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA. ericmcdade@wustl.edu.

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