Cited by 1,113Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchNeuroinflammation and Neurodegeneration Mechanisms

The DOI matches its Crossref record; 232 of the 235 references it cites were found in a registry or an index; 13 of the 230 sources its claims cite were checked for support.

Tau-targeting therapies for Alzheimer disease

Open access
Congdon, Erin E., Sigurdsson, Einar M.·2018·Nature Reviews Neurology

Abstract

Alzheimer disease (AD) is the most common form of dementia. Pathologically, AD is characterized by amyloid plaques and neurofibrillary tangles in the brain, with associated loss of synapses and neurons, resulting in cognitive deficits and eventually dementia. Amyloid-β (Aβ) peptide and tau protein are the primary components of the plaques and tangles, respectively. In the decades since Aβ and tau were identified, development of therapies for AD has primarily focused on Aβ, but tau has received more attention in recent years, in part because of the failure of various Aβ-targeting treatments in clinical trials. In this article, we review the current status of tau-targeting therapies for AD. Initially, potential anti-tau therapies were based mainly on inhibition of kinases or tau aggregation, or on stabilization of microtubules, but most of these approaches have been discontinued because of toxicity and/or lack of efficacy. Currently, the majority of tau-targeting therapies in clinical trials are immunotherapies, which have shown promise in numerous preclinical studies. Given that tau pathology correlates better with cognitive impairments than do Aβ lesions, targeting of tau is expected to be more effective than Aβ clearance once the clinical symptoms are evident. With future improvements in diagnostics, these two hallmarks of the disease might be targeted prophylactically.Interest in tau-targeting strategies for Alzheimer disease is increasing, in part because of the failure of various amyloid-β-targeting treatments in clinical trials. Congdon and Sigurdsson review the current status of tau-targeting therapies, including anti-tau drugs and immunotherapies.Key pointsTherapies for Alzheimer disease in clinical trials are gradually shifting from amyloid-β (Aβ)-targeting to tau-targeting approaches.Early anti-tau therapies were based mainly on inhibition of kinases or tau aggregation, or on stabilization of microtubules, but most of these approaches have been discontinued because of toxicity and/or lack of efficacy.Most of the tau-targeting approaches that are currently in clinical trials are immunotherapies.Tau is likely to be a better target than Aβ once cognitive deficits manifest because the tau burden correlates better with clinical impairments than does the Aβ burden.Eventually, with continued improvements in diagnostics, both Aβ and tau are likely to be targeted prophylactically for clearance.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes tau-targeting therapies for Alzheimer disease, covering tau pathological mechanisms and clinical-stage drugs. It concludes that after Aβ-targeting failures and discontinuation of many early anti-tau approaches, tau immunotherapies now dominate clinical trials and show promise, though human efficacy remains to be established.

Key findings

Tau pathology correlates better with cognitive impairment and neuron loss than Aβ lesions, so targeting tau is expected to be more effective than Aβ clearance once symptoms are evident. Most tau-targeting therapies in clinical trials are immunotherapies; earlier kinase inhibitors, aggregation inhibitors, and microtubule stabilizers were mostly discontinued because of toxicity and/or lack of efficacy. In reported trials, tideglusib produced no significant improvement in the full AD cohort but showed cognitive improvement and reduced CSF β-secretase in a mild AD subgroup; LMTX showed no significant benefits in two phase III trials; AADvac1 phase I elicited IgG in 29 of 30 patients, with no encephalitis or oedema but two withdrawals due to adverse reactions. MK-8719 increased O-GlcNAcylated proteins dose-dependently in healthy individuals, was well tolerated, and received FDA orphan drug status for PSP.

Methods

Narrative review of tau-targeting therapies for AD and other tauopathies, focusing on mechanisms such as post-translational modifications, cytoskeletal dysfunction, tau aggregation, and impaired protein degradation. Synthesizes preclinical and clinical literature, including published trial results and ClinicalTrials.gov registrations; no primary data collection or systematic search is described. Discusses active and passive immunotherapies and other drug classes, with tables of ongoing, completed, and discontinued trials.

Limitations

The paper states that preclinical success in animal models has often failed to translate into human benefit; clinical data on methylene blue derivatives are not very promising, and curcumin is limited by bioavailability and has not demonstrated efficacy in humans with tauopathy. It also notes that some trial results are unpublished or awaited, that LMTX subgroup claims were widely questioned over statistics and unsuitable controls, that decreasing CSF tau with AD progression may impede detection of drug-induced reductions, and that it is unclear how closely tau seeding/spread is linked to tau toxicity. Evident from the text: this is a narrative review without systematic search or quantitative synthesis, and its 2018 publication date means the clinical trial landscape described is now dated.

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Integrity signals

Registry

Crossref · 10.1038/s41582-018-0013-z

Cites

232 of 232 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

99 Not checked yet · 20 Own interpretation · 9 No basis given · 3 Partly supported · 2 Supported so far · 2 Own method · 2 Own result · accuracy not yet measured

Verify all 217 references — free account

Show all 74 claims

  • It may state two separate claims as one. 57
  • Probably not a substantial claim. 7
  • The quote only partly states this claim. 1
63 of 63
  • The paper relies on this without support.

    Attempts to alter the disease course of AD by removing Aβ or reducing its production have been largely unsuccessful.

    “Unfortunately, attempts to alter the disease course by removing Aβ or reducing its production have been largely unsuccessful.”
  • The paper relies on this without support.

    Aβ is not a confounding variable in the non-AD tauopathies.

    “Aβ is not a confounding variable in the non-AD tauopathies”
  • The paper relies on this without support.

    Elicitation of antibodies against a native protein carries the risk of adverse immune reactions and detrimental targeting of the normal protein.

    “However, elicitation of antibodies against a native protein always carries the risk of adverse immune reactions and detrimental targeting of the normal protein.”
  • The paper relies on this without support.

    The pathogenesis of tauopathies is likely to differ.

    “Although the pathological epitopes seen in AD are common to most if not all of the tauopathies, the pathogenesis of these conditions is likely to differ.”
  • The paper relies on this without support.

    Solanezumab did not alter tau levels in treated individuals in any of the trials.

    “Likewise, solanezumab did not alter tau levels in treated individuals in any of the trials.”
5 of 5

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Citations

Cites

Items 201–232 of 232

Research works printed but not linked: 6

  1. Fagan, T. In first phase 3 trial, the tau drug LMTM did not work. Period. Alzforum http://www.alzforum.org/news/conference-coverage/first-phase-3-trial-tau-drug-lmtm-did-not-work-period#show-more (2016).
  2. Fagan, T. Tau inhibitor fails again — subgroup analysis irks clinicians at CTAD. Alzforum http://www.alzforum.org/news/conference-coverage/tau-inhibitor-fails-again-subgroup-analysis-irks-clinicians-ctad (2016).
  3. [No authors listed.] Biogen licenses phase 2 anti-tau antibody from Bristol-Myers Squibb. Biogen http://media.biogen.com/press-release/corporate/biogen-licenses-phase-2-anti-tau-antibody-bristol-myers-squibb (2017).
  4. West, T. et al. Safety, tolerability and pharmacokinetics of ABBV-8E12, a humanized anti-tau monoclonal antibody, in a Phase I, single ascending dose, placebo-controlled study in subjects with progressive supranuclear palsy. J. Prev. Alzheimers Dis. 3, 285 (2016).
  5. Rogers, M. B. Treating tau: finally, clinical candidates are stepping into the ring. Alzforum http://www.alzforum.org/news/conference-coverage/treating-tau-finally-clinical-candidates-are-stepping-ring (2017).
  6. Rogers, M. B. To block tau’s proteopathic spread, antibody must attack its mid-region. Alzforum https://www.alzforum.org/news/conference-coverage/block-taus-proteopathic-spread-antibody-must-attack-its-mid-region (2018).

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Metadata

Authors
Congdon, E. E., & Sigurdsson, E. M.
Affiliations
New York University (US)
Corresponding author
Sigurdsson, Einar M.
Venue
Nature Reviews Neurology
Published
2018-06-12
Volume
14
Issue
7
Pages
399-415
ISSN
  • 1759-4758 (ISSN-L)
  • 1759-4766
OpenAlex
W2808028315
Cited by
1,113
References
235
Citations by year
2026: 70 · 2025: 134 · 2024: 154 · 2023: 141 · 2022: 179 · 2021: 168 · 2020: 161 · 2019: 82 · 2018: 22
FWCI
14.47
Type
journal article
Language
en
Open access
Locations
  • Nature Reviews Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Michael J. Fox Foundation for Parkinson's Research
  • H. Lundbeck A/S
  • National Institutes of Health
  • National Institute on Aging (R01AG032611)
  • National Institute of Neurological Disorders and Stroke (R01NS077239)
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
Alzheimer's disease, tau protein, tau immunotherapy, amyloid-beta, neurofibrillary tangles, tau aggregation, kinase inhibition, microtubule stabilization, clinical trial failure
MeSH terms
Alzheimer Disease, Animals, Humans, tau Proteins

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