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Aging-related tau astrogliopathy (ARTAG): harmonized evaluation strategy
Open accessAbstract
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 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 (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]
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“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]
Experimental — accuracy not yet measuredIn the citing paper
“Another exemplary phenomenon is age-related tau astrogliopathy (ARTAG), in which p-tau accumulates in astrocytes of various brain regions [79].”
From DNA repair deficiency and senescence in concussed professional athletes involved in contact sports (2019) · cites this paper as [79]
In the citing paper
“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]).”
From Mild Chronic Traumatic Encephalopathy Neuropathology in People With No Known Participation in Contact Sports or History of Repetitive Neurotrauma (2019) · cites this paper as [17]
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Citations
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“Finally, tufted astrocytes in PSP, astrocytic plaques in CBD, globular astrocytic inclusions in GGT, and ramified astrocytes in PiD are distinct from tau-immunoreactive astrocytes in the gray matter in ARTAG (see Table 1).”
InfluentialMesial Temporal Astrocyte Tau Pathology in the MRC-CFAS Ageing Brain Cohort
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White Matter Hypoperfusion and Damage in Dementia: Post‐Mortem Assessment
Love, S., & Miners, J. S. (2014) · Brain Pathology · doi:10.1111/bpa.12223 · Cited by 44 · cited 1×
“Potential etiologies are not known, although defective function of the blood–brain barrier [57], metabolic encephalopathy, neurodegenerative pathologies, hypoperfusion associated with aging, AD, or vascular dementia [39, 64], and even repeated minor trauma with possible genetic risk factors may play a role.”
Familial Behavioral Variant Frontotemporal Dementia Associated With Astrocyte-Predominant Tauopathy
Ferrer, I., Legati, A., García‐Moncó, J. C., Gómez-Beldarrain, M., Carmona, M., Blanco, R. E., Seeley, W. W., & Coppola, G. (2015) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0000000000000180 · Cited by 44 · cited 1×
“Interestingly, prominent tau astrogliopathy may be seen in familial disorders without MAPT mutation [20].”
Schultz, C., Ghebremedhin, E., Braak, E., & Braak, H. (1999) · Experimental Neurology · doi:10.1006/exnr.1999.7185 · Cited by 39 · cited 1×
“In aged individuals sex-dependent tau pathology, developing independently from AD has been also described in the hypothalamus [16, 54, 56].”
Patterns of Hippocampal Tau Pathology Differentiate Neurodegenerative Dementias
Milenković, I., Petrov, T., & Kovács, G. G. (2014) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000365548 · Cited by 36 · cited 1×
“Mathematical modeling of hippocampal tau immunolabeling patterns suggested that some forms of tau astrogliopathy in the elderly involve hippocampal subregions in a different pattern from that of primary tauopathies [44].”
Glial fibrillary tangles and argyrophilic threads: Classification and disease specificity
Ikeda, K. (1996) · Neuropathology · doi:10.1111/j.1440-1789.1996.tb00158.x · Cited by 32 · cited 2×
“In comparison to the tufted astrocytes of PSP, TSA showed more voluminous perinuclear cytoplasm and their processes are often thicker and shorter [27].”
A comparison of Aβ amyloid pathology staging systems and correlation with clinical diagnosis
Boluda, S., Toledo, J. B., Irwin, D. J., Raible, K. M., Byrne, M., Lee, E. B., Lee, V. M. ‐., & Trojanowski, J. Q. (2014) · Acta Neuropathologica · doi:10.1007/s00401-014-1308-9 · Cited by 31
López‐González, I., Carmona, M., Blanco, R., Luna‐Muñoz, J., Martínez‐Mandonado, A., Mena, R., & Ferrer, I. (2013) · Brain Pathology · doi:10.1111/j.1750-3639.2012.00627.x · Cited by 28 · cited 4×
“Other antibodies that may prove useful in the characterization of ARTAG include those specific for tau phosphorylated at Thr181, Ser202, Ser214, Ser396, Ser422, N-terminus region epitopespecific, 4R tau isoform-specific, and some conformation-dependent antibodies such as Alz50 (but not MC-1) [21, 35, 38].”
InfluentialTuft-shaped astrocytes in Lewy body disease
Hishikawa, N., Hashizume, Y., Yoshida, M., Niwa, J.-I., Tanaka, F., & Sobue, G. (2005) · Acta Neuropathologica · doi:10.1007/s00401-004-0967-3 · Cited by 26 · cited 14×
“Finally, tufted astrocytes in PSP, astrocytic plaques in CBD, globular astrocytic inclusions in GGT, and ramified astrocytes in PiD are distinct from tau-immunoreactive astrocytes in the gray matter in ARTAG (see Table 1).”
InfluentialSakai, K., Piao, Y.-S., Kikugawa, K., Ohara, S., Hasegawa, M., Takano, H., Fukase, M., Nishizawa, M., Kakita, A., & Takahashi, H. (2006) · Acta Neuropathologica · doi:10.1007/s00401-006-0093-5 · Cited by 26
Yamazaki, M., Nakano, I., Imazu, O., & Terashi, A. (1995) · Acta Neuropathologica · doi:10.1007/bf00294456 · Cited by 22
Spinal cord tau pathology in cervical spondylotic myelopathy
Shimizu, H., Kakita, A., & Takahashi, H. (2007) · Acta Neuropathologica · doi:10.1007/s00401-007-0321-7 · Cited by 19 · cited 1×
“In a study on cervical spondylotic myelopathy, AT8 immunohistochemistry revealed tau-positive, neuropil threads, astrocytic foot-like perivascular or subpial structures, and glial cells with short and thick processes, which the authors termed TSA [58].”
Arima, K., Izumiyama, Y., Nakamura, M., Nakayama, H., Kimura, M., Ando, S., Ikeda, K., & Takahashi, K. (1998) · Acta Neuropathologica · doi:10.1007/s004010050762 · Cited by 18 · cited 1×
“Few studies reported tau immunopositivity in glial cells in AD cases with prolonged duration of the disease [5, 48, 68].”
Primary progressive aphasia with focal glial tauopathy
Wakabayashi, K., Shibasaki, Y., Hasegawa, M., Horikawa, Y., Soma, Y., Hayashi, S., Morita, T., Iwatsubo, T., & Takahashi, H. (2000) · Neuropathology and Applied Neurobiology · doi:10.1046/j.1365-2990.2000.00266-2.x · Cited by 11
Uchikado, H., Fujino, Y., Lin, W., & Dickson, D. W. (2007) · Springer eBooks · doi:10.1007/978-0-387-72076-0_39 · Cited by 2
Dugger, B. N., Uchikado, H., Ahmed, Z., & Dickson, D. W. (2008) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2008.05.2219 · Cited by 1
Cited by
Sorted by citations
The neuropathological diagnosis of Alzheimer's disease
DeTure, M. A., & Dickson, D. W. (2019) · Molecular Neurodegeneration · doi:10.1186/s13024-019-0333-5 · Cited by 3,329
“gies 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].”
BackgroundPathology of Neurodegenerative Diseases
Dugger, B. N., & Dickson, D. W. (2017) · Cold Spring Harbor Perspectives in Biology · doi:10.1101/cshperspect.a028035 · Cited by 1,665
“Tau pathology in chronic traumatic encephalopathy (CTE) (A,B) and aging-related tau astrogliopathy (ARTAG) (C,D).”
BackgroundInfluentialSelf-citationLewy pathology in Parkinson’s disease consists of crowded organelles and lipid membranes
Shahmoradian, S. H., Lewis, A. J., Genoud, C., Hench, J., Moors, T. E., Navarro, P. P., Castaño‐Díez, D., Schweighauser, G., Graff-Meyer, A., Goldie, K. N., et al. (2019) · Nature Neuroscience · doi:10.1038/s41593-019-0423-2 · Cited by 1,017
Structure-based classification of tauopathies
Shi, Y., Zhang, W., Yang, Y., Murzin, A. G., Falcon, B., Kotecha, A., van Beers, M., Tarutani, A., Kametani, F., Garringer, H. J., et al. (2021) · Nature · doi:10.1038/s41586-021-03911-7 · Cited by 878
“To expand our knowledge of the diversity of tau filaments in human disease, we determined the structures of tau filaments from the brains of individuals with typical and atypical PSP, GGT (Types I and II), AGD, ARTAG and MAPT intron 10 mutations (+3 and +16), as well as from the brains of individuals with FBD and FDD…”
InfluentialArendt, T., Stieler, J. T., & Holzer, M. (2016) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2016.08.018 · Cited by 609
Metadata
- 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.
- ORCID
- Grinberg, Lea T.
- Alafuzoff, Irina
- Attems, Johannes
- Budka, Herbert
- Cairns, Nigel J.
- Crary, John F.
- Duyckaerts, Charles
- Ghetti, Bernardino
- Halliday, Glenda M.
- Ironside, James W.
- Love, Seth
- Mackenzie, Ian R.
- Murray, Melissa E.
- Nelson, Peter T.
- Takahashi, Hitoshi
- Trojanowski, John Q.
- Ansorge, Olaf
- Arzberger, Thomas
- Beach, Thomas G.
- Bieniek, Kevin F.
- Bigio, Eileen H.
- Dugger, Brittany N.
- Feany, Mel
- Giaccone, Giorgio
- Hatanpaa, Kimmo J.
- Heale, Richard
- Hof, Patrick R.
- Hofer, Monika
- Hortobágyi, Tibor
- Jellinger, Kurt
- Jicha, Gregory A.
- Ince, Paul
- Kofler, Julia
- Kril, Jillian J.
- Mann, David M.
- McKee, Ann C.
- McLean, Catriona
- Montine, Thomas J.
- Murayama, Shigeo
- Lee, Edward B.
- Rodriguez, Roberta D.
- Rozemüller, Annemieke
- Schneider, Julie A.
- Schultz, Christian
- Seeley, William
- Seilhean, Danielle
- Smith, Colin
- Tagliavini, Fabrizio
- Takao, Masaki
- Thal, Dietmar Rudolf
- Toledo, Jon B.
- Tolnay, Markus
- Troncoso, Juan C.
- Vinters, Harry V.
- Weis, Serge
- Wharton, Stephen B.
- White, Charles L.
- Woulfe, John M.
- Yamada, Masahito
- Dickson, Dennis W.
- Venue
- Acta Neuropathologica
- Published
- 2015-12-10
- Volume
- 131
- Issue
- 1
- Pages
- 87-102
- ISSN
- 0001-6322 (ISSN-L)
- 1432-0533
- PMC
- PMC4879001
- 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
- green
- pure.amsterdamumc.nl
- Licence
- 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
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › 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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