Tau-targeting therapies for Alzheimer disease: Current status and future directions
Open accessAbstract
Alzheimer disease (AD) is the most common cause of dementia in older individuals. AD is characterized pathologically by amyloid-β (Aβ) plaques and tau neurofibrillary tangles in the brain, with associated loss of synapses and neurons, which eventually results in dementia. Many of the early attempts to develop treatments for AD focused on Aβ, but a lack of efficacy of these treatments in terms of slowing disease progression led to a change of strategy towards targeting of tau pathology. Given that tau shows a stronger correlation with symptom severity than does Aβ, targeting of tau is more likely to be efficacious once cognitive decline begins. Anti-tau therapies initially focused on post-translational modifications, inhibition of tau aggregation and stabilization of microtubules. However, trials of many potential drugs were discontinued because of toxicity and/or lack of efficacy. Currently, the majority of tau-targeting agents in clinical trials are immunotherapies. In this Review, we provide an update on the results from the initial immunotherapy trials and an overview of new therapeutic candidates that are in clinical development, as well as considering future directions for tau-targeting therapies.
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Tau pathology has a stronger correlation with cognitive deficits than Aβ plaques, indicating treatment benefits from targeting tau may outweigh those from concentrating only on amyloid clearance.
“Research has indicated that tau pathology has a stronger correlation with cognitive deficits than Aβ plaques, indicating that treatment benefits from targeting tau may outweigh those from concentrating only on amyloid clearance [94,95].”
From Recent Advances in Therapeutics for the Treatment of Alzheimer’s Disease (2024) · cites this paper as [94]
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Alzheimer’s disease: insights into pathology, molecular mechanisms, and therapy
Zheng, Q., & Wang, X. (2024) · Protein & Cell · doi:10.1093/procel/pwae026 · Cited by 454 · see citing works
Advance in peptide-based drug development: delivery platforms, therapeutics and vaccines
Xiao, W., Jiang, W., Chen, Z., Huang, Y., Mao, J., Zheng, W., Hu, Y., & Shi, J. (2025) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-024-02107-5 · Cited by 449 · see citing works
Terao, I., & Kodama, W. (2024) · Ageing Research Reviews · doi:10.1016/j.arr.2024.102203 · Cited by 134 · see citing works
Tau in neurodegenerative diseases: molecular mechanisms, biomarkers, and therapeutic strategies
Zhang, X., Wang, J., Zhang, Z., & Ye, K. (2024) · Translational Neurodegeneration · doi:10.1186/s40035-024-00429-6 · Cited by 106 · see citing works
Pathological mechanisms and treatment progression of Alzheimer’s disease
Zhang, J., Kong, G., Yang, J., Pang, L., & Li, X. (2025) · European journal of medical research · doi:10.1186/s40001-025-02886-9 · Cited by 94 · see citing works
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The Enigma of Tau Protein Aggregation: Mechanistic Insights and Future Challenges
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“This section thus presents an overview of tau-targeted therapy, along with a discussion of potential new therapeutic avenues for consideration [156].”
BackgroundInsights into the use of biomarkers in clinical trials in Alzheimer's disease
Pascoal, T. A., Aguzzoli, C. S., Lussier, F. Z., Crivelli, L., Suemoto, C. K., Fortea, J., Rosa‐Neto, P., Zimmer, E. R., Ferreira, P. C. L., & Bellaver, B. (2024) · EBioMedicine · doi:10.1016/j.ebiom.2024.105322 · Cited by 55 · see citing works
Recent Advances in Therapeutics for the Treatment of Alzheimer’s Disease
Thawabteh, A. M., Ghanem, A. W., AbuMadi, S., Thaher, D., Jaghama, W., Karaman, D., & Karaman, R. (2024) · Molecules · doi:10.3390/molecules29215131 · Cited by 56 · see citing works
“Research has indicated that tau pathology has a stronger correlation with cognitive deficits than A β plaques, indicating that treatment benefits from targeting tau may outweigh those from concentrating only on amyloid clearance [94,95].”
BackgroundThe evolving landscape of Alzheimer’s disease therapy: From Aβ to tau
Courade, J., Zetterberg, H., Höglinger, G. U., & Dewachter, I. (2025) · Cell · doi:10.1016/j.cell.2025.11.033 · Cited by 52 · see citing works
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Tau degradation in Alzheimer's disease: Mechanisms and therapeutic opportunities
Wang, L., Banesh, S., Kumar, R., Schedin‐Weiss, S., Tjernberg, L. O., & Winblad, B. G. (2025) · Alzheimer s & Dementia · doi:10.1002/alz.70048 · Cited by 45 · see citing works
A Nanozyme-Boosted MOF-CRISPR Platform for Treatment of Alzheimer’s Disease
Yang, J., Qin, G., Liu, Z., Zhang, H., Du, X., Ren, J., & Qu, X. (2024) · Nano Letters · doi:10.1021/acs.nanolett.4c02272 · Cited by 42 · see citing works
Myelin dysfunction in aging and brain disorders: mechanisms and therapeutic opportunities
Huang, Z., Zhang, Y., Zou, P., Zong, X., & Zhang, Q. (2025) · Molecular Neurodegeneration · doi:10.1186/s13024-025-00861-w · Cited by 42 · see citing works
BACE1 Inhibitors for Alzheimer’s Disease: Current Challenges and Future Perspectives
Coimbra, J. R. M., Resende, R., Custódio, J. B., Salvador, J. A. R., & Santos, A. (2024) · Journal of Alzheimer's Disease · doi:10.3233/jad-240146 · Cited by 33 · see citing works
Roles of TREM2 in the Pathological Mechanism and the Therapeutic Strategies of Alzheimer's Disease
Lin, M., Yu, J., Zhang, W., Lao, F., & Huang, H. (2024) · The Journal of Prevention of Alzheimer s Disease · doi:10.14283/jpad.2024.164 · Cited by 41 · see citing works
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Biomarkers of synaptic degeneration in Alzheimer’s disease
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The roles of intrinsically disordered proteins in neurodegeneration
Utami, K. H., Morimoto, S., Mitsukura, Y., & Okano, H. (2025) · Biochimica et Biophysica Acta (BBA) - General Subjects · doi:10.1016/j.bbagen.2025.130772 · Cited by 34 · see citing works
Chemical Synthesis Reveals Pathogenic Role of N-Glycosylation in Microtubule-Associated Protein Tau
Powell, W. C., Jing, R., Herlory, M., Holland, P., Poliyenko, D., Ebmeier, C. C., Stowell, M. H. B., & Walczak, M. A. A. (2025) · Journal of the American Chemical Society · doi:10.1021/jacs.4c17873 · Cited by 32 · see citing works
Exploring CAR-macrophages in non-tumor diseases: Therapeutic potential beyond cancer
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Advancements and challenges in mouse models of Alzheimer’s disease
Qian, Z., Li, Y., & Ye, K. (2024) · Trends in Molecular Medicine · doi:10.1016/j.molmed.2024.10.010 · Cited by 28 · see citing works
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Targeted protein degradation in CNS disorders: a promising route to novel therapeutics?
Kuemper, S., Cairns, A. G., Birchall, K., Yao, Z., & Large, J. M. (2024) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2024.1370509 · Cited by 27 · see citing works
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Alzheimer’s Disease Immunotherapy: Current Strategies and Future Prospects
Aljassabi, A., Zieneldien, T., Kim, J., Regmi, D., & Cao, C. (2024) · Journal of Alzheimer s Disease · doi:10.3233/jad-231163 · Cited by 25 · see citing works
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Modulation of Tau Pathology in Alzheimer’s Disease by Dietary Bioactive Compounds
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Nrf2/Bach1 signaling axis: A promising multifaceted therapeutic strategy for Alzheimer's disease
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Molecular Therapeutics in Development to Treat Alzheimer’s Disease
Tartaglia, M. C., & Ingelsson, M. (2024) · Molecular Diagnosis & Therapy · doi:10.1007/s40291-024-00738-6 · Cited by 22 · see citing works
An Anti-tau Therapeutic Antibody Etalanetug (E2814)
Rawal, S., Wildsmith, K. R., Aluri, J., Yagi, T., Chang, M., Niu, H., Zhou, J., Horie, K., Takahashi, E., Boyd, P., et al. (2025) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000680 · Cited by 21 · see citing works
PROTAC: a revolutionary technology propelling small molecule drugs into the next golden age
Cai, J., Chen, C., Wang, J., Zhang, X., Cui, Y., Zhu, Q., & Sun, H. (2025) · Frontiers in Oncology · doi:10.3389/fonc.2025.1676414 · Cited by 21 · see citing works
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Neuronal Vulnerability of the Entorhinal Cortex to Tau Pathology in Alzheimer’s Disease
Zhang, S., Crossley, C. A., & Yuan, Q. (2024) · British Journal of Biomedical Science · doi:10.3389/bjbs.2024.13169 · Cited by 20 · see citing works
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The Role of Amyloid-β and Tau PET in the New Era of Alzheimer Disease Therapies
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Immunological aspects of central neurodegeneration
Niso‐Santano, M., Fuentes, J. M., & Galluzzi, L. (2024) · Cell Discovery · doi:10.1038/s41421-024-00666-z · Cited by 16 · see citing works
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Peptide-based inhibitors and nanoparticles: Emerging therapeutics for Alzheimer’s disease
Mojarad-Jabali, S., & Roh, K. (2024) · International Journal of Pharmaceutics · doi:10.1016/j.ijpharm.2024.125055 · Cited by 17 · see citing works
Advancements in autophagy perturbations in Alzheimer’s disease: Molecular aspects and therapeutics
Dhapola, R., Kumari, S., Sharma, P., Vellingiri, B., & HariKrishnaReddy, D. (2025) · Brain Research · doi:10.1016/j.brainres.2025.149494 · Cited by 17 · see citing works
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Plasma phosphorylated-tau217 is increased in Niemann–Pick disease type C
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Lysine lactylation in diseases: beyond histone lactylation
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Single-domain antibody-based protein degrader for synucleinopathies
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Protective Effects of Bifidobacterium Breve MCC1274 as a Novel Therapy for Alzheimer’s Disease
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- Authors
- Congdon, E. E., Ji, C., Tetlow, A. M., Jiang, Y., & Sigurdsson, E. M.
- Affiliations
- New York University (US)
- NYU Langone Health (US)
- Corresponding author
- Sigurdsson, Einar M.
- Venue
- Nature Reviews Neurology
- Published
- 2023-10-24
- Volume
- 19
- Issue
- 12
- Pages
- 715-736
- ISSN
- 1759-4758 (ISSN-L)
- 1759-4766
- PMC
- PMC10965012
- OpenAlex
- W4387904363
- Cited by
- 371
- References
- 380
- Citations by year
- 2026: 125 · 2025: 170 · 2024: 74 · 2023: 1 · 2021: 1
- FWCI
- 13.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Nature Reviews Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Alzheimer's Association (AG032611, AARF-22-924783)
- National Institutes of Health (NS120488)
- National Institute on Aging (R21AG069475, R01AG032611, T32AG052909)
- National Institute of Neurological Disorders and Stroke (RF1NS120488, R01NS120488, R01NS077239)
- 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
- Alzheimer's disease, tau protein, tau immunotherapy, tau aggregation, microtubule stabilization, post-translational modification, amyloid plaques, neurofibrillary tangles, clinical trials, drug candidates
- MeSH terms
- Aged, Alzheimer Disease, Humans, Immunotherapy, Amyloid beta-Peptides, Neurofibrillary Tangles, tau Proteins, Plaque, Amyloid
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