Cited by 532Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchNeuroinflammation and Neurodegeneration Mechanisms

Aging-related tau astrogliopathy (ARTAG): Harmonized evaluation strategy

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Kovacs, Gabor G., Ferrer, Isidro, Grinberg, Lea T., Alafuzoff, Irina, Attems, Johannes, Budka, Herbert, Cairns, Nigel J., Crary, John F. +64 more·2016·Acta Neuropathologica

Abstract

Pathological accumulation of abnormally phosphorylated tau protein in astrocytes is a frequent, but poorly characterized feature of the aging brain. Its etiology is uncertain, but its presence is sufficiently ubiquitous to merit further characterization and classification, which may stimulate clinicopathological studies and research into its pathobiology. This paper aims to harmonize evaluation and nomenclature of aging-related tau astrogliopathy (ARTAG), a term that refers to a morphological spectrum of astroglial pathology detected by tau immunohistochemistry, especially with phosphorylation-dependent and 4R isoform-specific antibodies. ARTAG occurs mainly, but not exclusively, in individuals over 60 years of age. Tau-immunoreactive astrocytes in ARTAG include thorn-shaped astrocytes at the glia limitans and in white matter, as well as solitary or clustered astrocytes with perinuclear cytoplasmic tau immunoreactivity that extends into the astroglial processes as fine fibrillar or granular immunopositivity, typically in gray matter. Various forms of ARTAG may coexist in the same brain and might reflect different pathogenic processes. Based on morphology and anatomical distribution, ARTAG can be distinguished from primary tauopathies, but may be concurrent with primary tauopathies or other disorders. We recommend four steps for evaluation of ARTAG: (1) identification of five types based on the location of either morphologies of tau astrogliopathy: subpial, subependymal, perivascular, white matter, gray matter; (2) documentation of the regional involvement: medial temporal lobe, lobar (frontal, parietal, occipital, lateral temporal), subcortical, brainstem; (3) documentation of the severity of tau astrogliopathy; and (4) description of subregional involvement. Some types of ARTAG may underlie neurological symptoms; however, the clinical significance of ARTAG is currently uncertain and awaits further studies. The goal of this proposal is to raise awareness of astroglial tau pathology in the aged brain, facilitating communication among neuropathologists and researchers, and informing interpretation of clinical biomarkers and imaging studies that focus on tau-related indicators.

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  • Primary age-related tauopathy (PART) and aging-related tau astrogliopathy (ARTAG) are independent tau pathologies commonly observed in patients over 80 years of age, and PART may account for a proportion of misdiagnosed clinical AD cases in the elderly.

    “Primary age-related tauopathy (PART) and aging-related tau astrogliopathy (ARTAG) are independent tau pathologies commonly observed in patients over 80 years of age, and PART may account for a proportion of the misdiagnosed clinical AD cases in the elderly [130, 141, 142].”

    From The neuropathological diagnosis of Alzheimer's disease (2019) · cites this paper as [141]

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  • Perivascular, subpial, and periventricular p-tau immunoreactive NFTs and astrocytic tangles in the neocortex have been reported to be characteristic of both primary age-related tauopathy and age-related tau astrogliopathy.

    “Perivascular, subpial, and periventricular p-tau immunoreactive NFTs and astrocytic tangles in the neocortex have been reported to be characteristic of both primary age-related tauopathy (PART) [35] and age-related tau astrogliopathy (ARTAG) [36].”

    From The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features (2017) · cites this paper as [36]

    The Evaluation of ARTAG section (page unavailable) identifies subpial, subependymal and perivascular tau-immunoreactive astrocytes, including examples in cortical regions. But the Introduction distinguishes ARTAG’s astrocytic pathology from neuronal neurofibrillary degeneration, and the paper does not characterize perivascular, subpial and periventricular NFTs in the neocortex as ARTAG lesions. Its subependymal example is at the lateral ventricle, not in the neocortex. (LLM, conf=0.88)

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  • PART and ARTAG appear to be more a manifestation of age than a subtype of neurodegenerative disease.

    “PART refers to neuronal tau pathology and ARTAG is characterized by astrocytic tau pathology, although they are not mutually exclusive, and appear to be more a manifestation of age than a subtype of neurodegenerative disease.”

    From The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features (2017) · cites this paper as [36]

    The Introduction (page not provided) says PART describes neuronal tau pathology, ARTAG describes astrocytic tau pathology, and both predominantly affect older people. The Summary (page not provided) associates ARTAG mostly with aging, but the paper does not establish that both are manifestations of age rather than neurodegenerative disease: the Introduction also says PART includes NFT-dementia, and the paper notes that ARTAG can coexist with neurodegenerative disorders. (LLM, conf=0.85)

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  • Age-related tau astrogliopathy (ARTAG) is a phenomenon in which p-tau accumulates in astrocytes of various brain regions.

    “Another exemplary phenomenon is age-related tau astrogliopathy (ARTAG), in which p-tau accumulates in astrocytes of various brain regions [79].”
  • The 2016 consensus panel did not include pathology known to be associated with aging (PART and ARTAG) in the a priori criteria for CTE.

    “The panel did not ultimately accept all of the a priori criteria for CTE; they did not include pathology known to be associated with aging (i.e.primary age-related tauopathy [PART] [16] and aging-related tau astrogliopathy [ARTAG] [17]).”

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Authors
Kovacs, G. G., Ferrer, I., Grinberg, L. T., Alafuzoff, I., Attems, J., Budka, H., Cairns, N. J., Crary, J. F., Duyckaerts, C., Ghetti, B., Halliday, G. M., Ironside, J. W., Love, S., Mackenzie, I. R., Munoz, D. G., Murray, M. E., Nelson, P. T., Takahashi, H., Trojanowski, J. Q., Ansorge, O., Arzberger, T., Baborie, A., Beach, T. G., Bieniek, K. F., Bigio, E. H., Bodi, I., Dugger, B. N., Feany, M., Gelpi, E., Gentleman, S. M., Giaccone, G., Hatanpaa, K. J., Heale, R., Hof, P. R., Hofer, M., Hortobágyi, T., Jellinger, K., Jicha, G. A., Ince, P., Kofler, J., Kövari, E., Kril, J. J., Mann, D. M., Matej, R., McKee, A. C., McLean, C., Milenkovic, I., Montine, T. J., Murayama, S., Lee, E. B., Rahimi, J., Rodriguez, R. D., Rozemüller, A., Schneider, J. A., Schultz, C., Seeley, W., Seilhean, D., Smith, C., Tagliavini, F., Takao, M., Thal, D. R., Toledo, J. B., Tolnay, M., Troncoso, J. C., Vinters, H. V., Weis, S., Wharton, S. B., White, C. L., Wisniewski, T., Woulfe, J. M., Yamada, M., & Dickson, D. W.
Affiliations
  • Universidade de São Paulo (BR)
  • Uppsala University (SE)
  • Newcastle University (GB)
  • University Hospital Zurich (CH)
  • Washington University in St. Louis (US)
  • Icahn School of Medicine at Mount Sinai (US)
  • Sorbonne Université (FR)
  • Indiana University School of Medicine (US)
  • UNSW Sydney (AU)
  • University of Edinburgh (GB)
  • Southmead Hospital (GB)
  • University of British Columbia (CA)
  • Mayo Clinic (US)
  • University of Kentucky (US)
  • Brain Research Institute, Niigata University (JP)
  • University of Pennsylvania (US)
  • John Radcliffe Hospital (GB)
  • Institut für Neuropathologie (DE)
  • Walton Centre (GB)
  • Banner Sun Health Research Institute (US)
  • Northwestern University (US)
  • University of California, San Francisco (US)
  • Brigham and Women's Hospital (US)
  • Imperial College London (GB)
  • Fondazione IRCCS Istituto Neurologico Carlo Besta (IT)
  • The University of Texas Southwestern Medical Center (US)
  • University of Debrecen (HU)
  • University of Sheffield (GB)
  • University of Pittsburgh (US)
  • The University of Sydney (AU)
  • University of Manchester (GB)
  • Boston University (US)
  • The Alfred Hospital (AU)
  • University of Washington (US)
  • Tokyo Metropolitan Institute of Gerontology (JP)
  • Vienna General Hospital (AT)
  • Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
  • Rush University Medical Center (US)
  • Heidelberg University (DE)
  • Saitama International Medical Center (JP)
  • Universität Ulm (DE)
  • University Hospital of Basel (CH)
  • Johns Hopkins University (US)
  • University of California, Los Angeles (US)
  • Johannes Kepler University of Linz (AT)
  • University of Ottawa (CA)
  • Kanazawa University (JP)
Corresponding author
Dickson, Dennis W.
Venue
Acta Neuropathologica
Published
2015-12-10
Volume
131
Issue
1
Pages
87-102
ISSN
  • 0001-6322 (ISSN-L)
  • 1432-0533
OpenAlex
W2195527239
Cited by
532
References
69
Citations by year
2026: 37 · 2025: 49 · 2024: 66 · 2023: 48 · 2022: 57 · 2021: 56 · 2020: 54 · 2019: 51 · 2018: 49 · 2017: 38 · 2016: 25 · 2015: 1
FWCI
27.47
Type
journal article
Language
en
Open access
Locations
  • Acta Neuropathologica (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, other-oa)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Explore Bristol Research (publishedVersion, other-oa)
  • PubMed Central (acceptedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
  • Bristol Research (University of Bristol) (submittedVersion, other-oa)
  • University of Debrecen Electronic Archive (University of Debrecen) (submittedVersion, other-oa)
  • University of Debrecen Electronic Archive (University of Debrecen) (submittedVersion)
  • Lirias (submittedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
  • Purdue University Indianapolis (Indiana University) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Newcastle University ePrints (Newcastle Univesity)
Funders
  • FP7 EU Project (Develage No. 278486)
  • National Institutes of Health (NIH P30 AG10133, R01 AG040311, P01 AG019724-03, P50 AG023501, AG010124, AG017586, P50 AG005138, AG028383, P50AG05146, grants P50 AG05136 and P50 NS062684, P50 AG016574 and P50 NS072187)
  • NIA Grant (P50 AG05681, P01 AG03991)
  • Nelson Family Foundation
  • Alzheimer’s Research UK
  • Alzheimer's Society, National Institute for Health Research
  • Medical Research Council (G0400074, MR/L016400/1, MR/L016400/1 Edinburgh Brain Bank)
  • National Health and Medical Research Council of Australia (Senior Principal Research Fellow (#630434))
  • Grant Agency of Ministry of Health of Czech Republic (IGA NT12094-5)
  • NIA P50 (P50 AG005133)
  • National Institute of Neurological Disorders and Stroke (1U01NS086659-01)
  • National Institute of Aging Boston University Alzheimer’s Disease Center (P30AG13846; supplement 0572063345–5)
  • MRC (MC-PC-13044)
  • National Brain Research Program, Hungary (KTIA_13_NAP-A-II/7)
  • Grant-in-Aid (KAKEN 26250017)
  • NIH (P30AG12300)
  • DFG Grant (SFB 1134/A03)
  • Alzheimer's Disease Core Center (P30AG008051-26)
  • Grant (AG13854)
  • JSPS KAKENHI (26430060)
  • Italian Ministry of Health
  • Vienna KIN-Neurobiobank and VITA–study
  • France Alzheimer, France Parkinson, Fondacion ARSEP and CSC (GIE NeuroCEB)
  • Neuroscience Research Australia and the University of New South Wales (Sydney Brain Bank)
  • Sheffield and Cambridge Brain Banks (Brain Banks)
  • Parkinson's UK (Parkinson's UK Tissue Bank at Imperial College)
Topics
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
Keywords
tau phosphorylation, astrocytes, glia limitans, white matter, gray matter, primary tauopathies, nomenclature, brain aging, clinical biomarkers
MeSH terms
Aging, Animals, Astrocytes, Brain, Humans, Neuroglia, tau Proteins, Tauopathies

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