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Mechanisms of secretion and spreading of pathological tau protein
Open accessAbstract
Accumulation of misfolded and aggregated forms of tau protein in the brain is a neuropathological hallmark of tauopathies, such as Alzheimer’s disease and frontotemporal lobar degeneration. Tau aggregates have the ability to transfer from one cell to another and to induce templated misfolding and aggregation of healthy tau molecules in previously healthy cells, thereby propagating tau pathology across different brain areas in a prion-like manner. The molecular mechanisms involved in cell-to-cell transfer of tau aggregates are diverse, not mutually exclusive and only partially understood. Intracellular accumulation of misfolded tau induces several mechanisms that aim to reduce the cellular burden of aggregated proteins and also promote secretion of tau aggregates. However, tau may also be released from cells physiologically unrelated to protein aggregation. Tau secretion involves multiple vesicular and non-vesicle-mediated pathways, including secretion directly through the plasma membrane. Consequently, extracellular tau can be found in various forms, both as a free protein and in vesicles, such as exosomes and ectosomes. Once in the extracellular space, tau aggregates can be internalized by neighboring cells, both neurons and glial cells, via endocytic, pinocytic and phagocytic mechanisms. Importantly, accumulating evidence suggests that prion-like propagation of misfolding protein pathology could provide a general mechanism for disease progression in tauopathies and other related neurodegenerative diseases. Here, we review the recent literature on cellular mechanisms involved in cell-to-cell transfer of tau, with a particular focus in tau secretion.
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“Thus, it is suggested that CSF p-tau biomarkers likely indicate an active process of tau secretion, and one that is correlated with cerebral Aβ deposition in early disease.20, 21, 22”
From Cerebrospinal fluid p-tau231 as an early indicator of emerging pathology in Alzheimer's disease (2022) · cites this paper as [22]
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α-Linolenic acid modulates phagocytosis of extracellular Tau and induces microglial migrationPreprint
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Implications of virus-induced stress granules in tauopathies
Sharma, S., Vandenakker, A., Cortes-Pérez, C. M., Milne, S., & Douville, R. N. (2026) · Translational Neurodegeneration · doi:10.1186/s40035-026-00538-4
“The capacity of tau to stabilize microtubules is compromised by its abnormal phosphorylation, which can remove other microtubule-associated proteins (MAP) and exacerbate microtubule destabilisation [21].”
Tau-mediated Mechanisms in Alzheimerʼs Disease Pathogenesis
Narayanappa, T. S., Ananthanarayana, V., & Chinnathambi, S. (2026) · Molecular Neurobiology · doi:10.1007/s12035-026-06057-7
“While small Tau species propagate between cells and seed endogenous Tau in healthy neurons [25, 108, 113, 116, 117] recent studies using size-exclusion chromatography have isolated high molecular mass Tau species from AD brain tissues and CSF, which exhibit strong seeding competence and efficient…”
InfluentialExtracellular Protein Quality Control in Tau Pathology
Bhunia, P. K., Verma, D., Vimal, P., & Kasturi, P. (2026) · Molecular Neurobiology · doi:10.1007/s12035-026-05834-8
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Selective imaging probes for differential detection of pathological tau polymorphs in tauopathies
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Paralisi sopranucleare progressiva
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A non-autonomous protein quality control mechanism targeting tau aggregate propagationPreprint
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“…of seeds caused an approximately 2-fold increase of the FRET signal in acceptor cells, indicating that tau overproduction causes a low level of aggregation (23), while treatment with seeds in the absence of tau overexpression increased the FRET signal by approximately 5-fold in acceptor cells.”
BackgroundParalysie supranucléaire progressive
Grimaldi, S., Koric, L., & Eusebio, A. (2024) · EMC - Neurologia · doi:10.1016/s0246-0378(23)65735-5
Self-assembly of tau fragments as a key pathologic event in tauopathies
Le, L., Lee, J. H., & Lee, M. J. (2024) · Neural Regeneration Research · doi:10.4103/nrr.nrr-d-23-01720
“Initially, four repeats in the microtubule-binding domains, each consisting of 18 amino acids with a Lys-Ile/Cys-Gly-Ser (KxGS) motif, were thought to be sufficient and necessary for the fibrillization of full-length tau (tau-FL) (Brunello et al., 2020).”
BackgroundGlucocorticoid stress hormones stimulate vesicle-free Tau secretion and spreading in the brain
Waites, C., Yu, Q., Du, F., Belli, I., Gomes, P. A., & Sotiropoulos, I. (2023) · Research Square · doi:10.21203/rs.3.rs-3097174/v1
Manthapuri, S. S., & Davis, E. (2021) · Journal of Student Research · doi:10.47611/jsrhs.v10i4.2468
“It is generally agreed that tau inclusions propagate along neuroanatomically connected brain regions, similar to prion diseases [10], [11], [12].”
BackgroundInfluentialIrwin, R., Faust, O., Petrovic, I., Wolf, S., Hofmann, H., & Rosenzweig, R. (2021) · bioRxiv · doi:10.1101/2021.04.11.439324
“In such cases, tau forms large intracellular aggregates, termed neurofibrillary tangles, whose abundance and localization in the brain correlates with cognitive decline (8, 9).”
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Alzheimer's Disease Pathophysiology and Novel Treatment: An Update
Mo, A. (2024) · International Journal of Pharma Medicine and Biological Sciences · doi:10.18178/ijpmbs.13.1.30-38
“In humans, tau is encoded by the MAPT gene, which is situated on chromosome 17 [38].”
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Metadata
- Authors
- Brunello, C. A., Merezhko, M., Uronen, R.-L., & Huttunen, H. J.
- Affiliations
- University of Helsinki (FI)
- Corresponding author
- Huttunen, Henri J.
- Venue
- Cellular and Molecular Life Sciences
- Published
- 2019-10-30
- Volume
- 77
- Issue
- 9
- Pages
- 1721-1744
- ISSN
- 1420-682X (ISSN-L)
- 1420-9071
- PMC
- PMC7190606
- OpenAlex
- W2982627322
- Cited by
- 304
- References
- 267
- Citations by year
- 2026: 36 · 2025: 45 · 2024: 56 · 2023: 38 · 2022: 46 · 2021: 57 · 2020: 25 · 2019: 1
- FWCI
- 3.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Cellular and Molecular Life Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Työväentutkimus Vuosikirja (submittedVersion, cc-by)
- Funders
- Academy of Finland (296409)
- Alfred Kordelinin Säätiö
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Prion Diseases and Protein Misfolding
- Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
- Keywords
- tau protein, tauopathy, tau secretion, cell-to-cell transmission, prion-like propagation, tau aggregation, exosomes, ectosome, vesicular secretion, extracellular tau, endocytosis, phagocytosis, pinocytosis, Alzheimer's disease, frontotemporal lobar degeneration, neurodegeneration
- MeSH terms
- Animals, Humans, tau Proteins, Disease Progression, Tauopathies, Protein Aggregation, Pathological
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