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Tauopathies: new perspectives and challenges
Open accessAbstract
Background: Tauopathies are a class of neurodegenerative disorders characterized by neuronal and/or glial tau-positive inclusions. Main body: Clinically, tauopathies can present with a range of phenotypes that include cognitive/behavioral-disorders, movement disorders, language disorders and non-specific amnestic symptoms in advanced age. Pathologically, tauopathies can be classified based on the predominant tau isoforms that are present in the inclusion bodies (i.e., 3R, 4R or equal 3R:4R ratio). Imaging, cerebrospinal fluid (CSF) and blood-based tau biomarkers have the potential to be used as a routine diagnostic strategy and in the evaluation of patients with tauopathies. As tauopathies are strongly linked neuropathologically and genetically to tau protein abnormalities, there is a growing interest in pursuing of tau-directed therapeutics for the disorders. Here we synthesize emerging lessons on tauopathies from clinical, pathological, genetic, and experimental studies toward a unified concept of these disorders that may accelerate the therapeutics. Conclusions: Since tauopathies are still untreatable diseases, efforts have been made to depict clinical and pathological characteristics, identify biomarkers, elucidate underlying pathogenesis to achieve early diagnosis and develop disease-modifying therapies.
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![Fig. 1 MAPT pathological mutations in exons, haplotypes, and alternative splicing. MAPT (microtubule associated protein tau) gene, located on chromosome 17q21.3, has been identified with over 100 mutations, and pathological mutations associated with increased risk for tauopathies are shown above. The difference between H1 and H2 haplotypes is a 900 kb inversion existing in the largest linkage disequilibrium (LD) area in chromosome 17. Besides, H1 and its various sub-haplotypes usually contribute to disease occurrence, while H2 haplotype often act as a protective factor. Alternative splicing is common in neuronal cells which help to increase genetic plasticity and the diversity of proteome under physiological conditions [6]. However, imbalance in the ratio of the 3R and 4R isoforms can give rise to the pathogenesis of tauopathies, as the 4R tau is more efficient in promoting microtubule assembly with an extra repeat domain R2 which hyper-stabilize MT and more free-floating tau leads to aggregates formation [3, 6, 7]](/paper-figures/afc5d0d8007e4d91a18c21d1c51c77d5/tauopathies-new-perspectives-and-challenges-figure-1.jpg)
![Fig. 2 Spatial–temporal distribution of tau lesions in schemes of brains. Deeper color means earlier involvement. A Tau progression in PiD has four stages, shown in medial and lateral views. Stage I, tau affects angular gyrus, limbic and frontotemporal regions. Stage II/III involves white matter tracts, subcortical structures (thalamus, striatum), serotonergic/noradrenergic brainstem nuclei, primary motor cortex and pre-cerebellar nuclei. Stage IV, tau invades visual cortex and cerebellar. Modified from [84]. B Tau progression in AD has six stages. Stage I/II, tau affect transentorhinal area. Stage III/IV, severe involvement of entorhinal, hippocampus and limbic areas happens. Stage V/VI, tau reaches primary and secondary neocortex. Modified from [85, 86]. C Tau progression in PSP has seven stages. Stage 0/I, pallido-luyso-nigral axis shows tau burden. Stage II/III, tau invades basal ganglia, dentate nucleus and pedunculopontine nucleus. Stage IV/V, tau reaches frontoparietal and temporal lobes. Stage VI/VII, occipital cortices, substantia nigra, subthalamic nucleus and globus pallidus are involved. Modified from [55]. D Tau progression in CTE has four stages, shown in coronal view at levels of genu of corpus callosum, mammillary body, and lateral geniculate body. Stage I/II, tau is restricted focally deep in the sulci of cortex, especially frontal lobe, surrounding small vessels and expand to superficial layers. Stage III, tau is widespread to cortices including frontal, temporal, parietal, and insular lobes. Meanwhile, amygdala, hippocampus, and entorhinal cortex are involved. Stage IV, tau affects most regions of cerebral cortex. Modified from [87]. E Tau progression (argyrophilic grains (AGs)) in AGD has four stages, shown in view same as D. Stage I is characterized by AGs in ambient gyrus, hippocampus (CA1), entorhinal and amygdala. Stage II shows involvement of medial temporal lobe and subiculum. Stage III, AGs reaches anterior temporal, cingulate gyrus, rectus gyrus, septum, accumbens nucleus, insular and orbitofrontal cortices, and hypothalamus (CA2 CA3). Stage IV involves neocortex and brainstem (not shown in figures). Modified from [63]](/paper-figures/fb09f8f2f8a8490ca69e9d8bc3c183f9/tauopathies-new-perspectives-and-challenges-figure-2.jpg)


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“Both 3R- and 4R-tau isoforms were detected with no noticeable difference in the 3R to 4R ratio between LOAD and HC 3D-CNs, consistent with the concept that AD is a mixed 3R/4R tauopathy (65, 66) (Fig. 3D).”
From Modeling late-onset Alzheimer’s disease neuropathology via direct neuronal reprogramming (2024) · cites this paper as [66]
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Additional file 6 of Tau protein profiling in tauopathies: a human brain study
Lantero‐Rodriguez, J., Camporesi, E., Montoliu‐Gaya, L., Gobom, J., Piotrowska, D., Olsson, M., Matečko‐Burmann, I., Becker, B., Brinkmalm, A., Burmann, B. M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26751392
Additional file 5 of Tau protein profiling in tauopathies: a human brain study
Lantero‐Rodriguez, J., Camporesi, E., Montoliu‐Gaya, L., Gobom, J., Piotrowska, D., Olsson, M., Matečko‐Burmann, I., Becker, B., Brinkmalm, A., Burmann, B. M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26751389
Nuñez‐Diaz, C., Andersson, E., Schultz, N., Pocevičiūtė, D., Hansson, O., Nilsson, K. P. R., & Wennström, M. (2024) · Figshare · doi:10.6084/m9.figshare.24934682
Additional file 1 of The therapeutic landscape of tauopathies: challenges and prospects
Cummings, J. L., González, M. I., Pritchard, M. C., May, P. C., Toledo‐Sherman, L., & Harris, G. A. (2024) · Figshare · doi:10.6084/m9.figshare.26623807
Additional file 3 of Tau protein profiling in tauopathies: a human brain study
Lantero‐Rodriguez, J., Camporesi, E., Montoliu‐Gaya, L., Gobom, J., Piotrowska, D., Olsson, M., Matečko‐Burmann, I., Becker, B., Brinkmalm, A., Burmann, B. M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26751383
Additional file 8 of Tau protein profiling in tauopathies: a human brain study
Lantero‐Rodriguez, J., Camporesi, E., Montoliu‐Gaya, L., Gobom, J., Piotrowska, D., Olsson, M., Matečko‐Burmann, I., Becker, B., Brinkmalm, A., Burmann, B. M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26751398
Additional file 1 of Tau protein profiling in tauopathies: a human brain study
Lantero‐Rodriguez, J., Camporesi, E., Montoliu‐Gaya, L., Gobom, J., Piotrowska, D., Olsson, M., Matečko‐Burmann, I., Becker, B., Brinkmalm, A., Burmann, B. M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26333190
Additional file 7 of Tau protein profiling in tauopathies: a human brain study
Lantero‐Rodriguez, J., Camporesi, E., Montoliu‐Gaya, L., Gobom, J., Piotrowska, D., Olsson, M., Matečko‐Burmann, I., Becker, B., Brinkmalm, A., Burmann, B. M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26751395
Additional file 2 of Tau protein profiling in tauopathies: a human brain study
Lantero‐Rodriguez, J., Camporesi, E., Montoliu‐Gaya, L., Gobom, J., Piotrowska, D., Olsson, M., Matečko‐Burmann, I., Becker, B., Brinkmalm, A., Burmann, B. M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26333445
Nuñez‐Diaz, C., Andersson, E., Schultz, N., Pocevičiūtė, D., Hansson, O., Nilsson, K. P. R., & Wennström, M. (2024) · Figshare · doi:10.6084/m9.figshare.24934406
Additional file 1 of Tau reduction attenuates autism-like features in Fmr1 knockout mice
Zhao, S., Jiang, X., Han, L., Jiang, Y., Wang, Y., Meng, J., Zhu, X., Zhang, X., Luo, H., & Zhang, Y.-W. (2023) · Figshare · doi:10.6084/m9.figshare.24522666
Self-citationAdditional file 4 of Tau protein profiling in tauopathies: a human brain study
Lantero‐Rodriguez, J., Camporesi, E., Montoliu‐Gaya, L., Gobom, J., Piotrowska, D., Olsson, M., Matečko‐Burmann, I., Becker, B., Brinkmalm, A., Burmann, B. M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26751386
Gee, M. S., Kwon, E., Song, M., Jeon, S. H., Kim, N., Lee, J. K., & Koo, T. (2024) · Figshare · doi:10.6084/m9.figshare.25596330
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Chinnathambi, S., & Rangappa, N. (2025) · Advances in protein chemistry and structural biology · doi:10.1016/bs.apcsb.2025.10.014
FAM84B facilitates tau propagation via RYR3-mediated exocytosis in response to neuroinflammationPreprint
Yoon, G., Park, H., Park, J. E., Kam, M. K., Kim, J.-H., Kim, E., Park, S.-H., Kim, H., Johnson, G. V. W., Choi, J., et al. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2025.12.28.696549
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Winalai, C., & Bicout, D. (2026) · NeuroImage · doi:10.1016/j.neuroimage.2026.121700
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Oo, W. J., Sia, W. T., Lee, J. Y., Chen, C. H., Chang, W., & Chye, S. M. (2026) · CNS & Neurological Disorders - Drug Targets · doi:10.2174/0118715273400895251129055504
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Mosconi, M., Leonardi, C., Armour-Garb, Z., Rocutto, B., Beeg, M., Meisl, G., Ortigosa-Pascual, L., Broggini, L., Salmona, M., Ricagno, S., et al. (2026) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2532775123 · Cited by 5
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Metadata
- Authors
- Zhang, Y., Wu, K.-M., Yang, L., Dong, Q., & Yu, J.-T.
- Affiliations
- Shanghai Medical College of Fudan University (CN)
- Corresponding author
- Yu, Jin-Tai
- Venue
- Molecular Neurodegeneration
- Published
- 2022-04-07
- Volume
- 17
- Issue
- 1
- Pages
- 28-28
- ISSN
- 1750-1326 (ISSN-L)
- PMC
- PMC8991707
- OpenAlex
- W4223629343
- Cited by
- 323
- References
- 228
- Citations by year
- 2026: 69 · 2025: 83 · 2024: 97 · 2023: 60 · 2022: 14
- FWCI
- 8.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Molecular Neurodegeneration (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Natural Science Foundation of China (91849126)
- Shanghai Municipal Science and Technology Major Project (No.2018SHZDZX01)
- 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
- Health Sciences › Medicine › Clinical Neurology › Amyotrophic Lateral Sclerosis Research
- Keywords
- tauopathy, tau protein, neurodegenerative diseases, tau isoforms, tau biomarkers, cerebrospinal fluid biomarkers, blood-based biomarkers, neuroimaging, disease-modifying therapy, early diagnosis
- MeSH terms
- Inclusion Bodies, Humans, Neurons, tau Proteins, Neurodegenerative Diseases, Protein Isoforms, Tauopathies
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