Journal
BRAIN
Volume 144, Issue -, Pages 325-339Publisher
OXFORD UNIV PRESS
DOI: 10.1093/brain/awaa399
Keywords
Alzheimer's disease; blood biomarkers; tau; positron emission tomography; cerebrospinal fluid
Categories
Funding
- Miguel Servet program of the Spanish Instituto de Salud Carlos III (ISCIIIFEDER) [CP19/00031]
- Brightfocus Foundation [A2020812F]
- Swedish Alzheimer Foundation (Alzheimerfonden) [AF-930627]
- Swedish Brain Foundation (Hjarnfonden) [FO2020-0240]
- Swedish Dementia Foundation (Demensforbundet)
- Agneta PrytzFolkes & Gosta Folkes Foundation [2020-00124]
- Aina (Ann) Wallstroms and Mary-Ann Sjobloms Foundation
- Anna Lisa and Brother Bjornsson's Foundation
- Gamla Tjanarinnor
- Gun and Bertil Stohnes Foundation
- Paulo Foundation
- Orion Research Foundation
- European Union's Horizon 2020 Research and Innovation Program under the Marie Sklodowska-Curie action [752310]
- Instituto de Salud Carlos III [PI19/00155]
- Spanish Ministry of Science, Innovation and Universities (Juan de la Cierva Programme grant) [IJC2018-037478-I]
- Swedish Research Council [2017-02869, 2018-02532, 2017-00915]
- European Research Council [681712]
- Swedish State Support for Clinical Research [ALFGBG720931]
- Alzheimer Drug Discovery Foundation (ADDF), USA [RDAPB-2018092016615, 201809-2016862]
- UK Dementia Research Institute at UCL
- Swedish Alzheimer Foundation [AF742881, AF-740191]
- Hjarnfonden, Sweden [FO2017-0243]
- Swedish government [ALFGBG-715986, ALFGBG-813971]
- Swedish County Councils, the ALF [ALFGBG-715986, ALFGBG-813971]
- European Union Joint Program for Neurodegenerative Disorders [JPND2019-466-236]
- Knut and Alice Wallenberg Foundation (Wallenberg Centre for Molecular and Translational Medicine) [KAW 2014.0363]
- Alzheimer's Disease Neuroimaging Initiative (ADNI) (National Institutes of Health) [U01 AG024904]
- DOD ADNI (Department of Defense) [W81XWH-12-2-0012]
- National Institute on Aging
- National Institute of Biomedical Imaging and Bioengineering
- AbbVie
- Alzheimer's Association
- Alzheimer's Drug Discovery Foundation
- Araclon Biotech
- BioClinica, Inc.
- Biogen
- Bristol-Myers Squibb Company
- CereSpir, Inc.
- Cogstate
- Eisai Inc.
- Elan Pharmaceuticals, Inc.
- Eli Lilly and Company
- EuroImmun
- F. Hoffmann-La Roche Ltd and its affiliated company Genentech, Inc.
- Fujirebio
- GE Healthcare
- IXICO Ltd.
- Janssen Alzheimer Immunotherapy Research & Development, LLC.
- Johnson & Johnson Pharmaceutical Research & Development LLC.
- Lumosity
- Lundbeck
- Merck Co., Inc.
- Meso Scale Diagnostics, LLC.
- NeuroRx Research
- Neurotrack Technologies
- Novartis Pharmaceuticals Corporation
- Pfizer Inc.
- Piramal Imaging
- Servier
- Takeda Pharmaceutical Company
- Transition Therapeutics
- Canadian Institutes of Health Research
- Swedish Research Council [2017-02869] Funding Source: Swedish Research Council
- Vinnova [2017-02869] Funding Source: Vinnova
Ask authors/readers for more resources
Measurement of tau phosphorylated at threonine 181 (p-tau181) in blood plasma is proposed as a specific biomarker for Alzheimer's disease. Longitudinal study reveals that plasma p-tau181 increases before amyloid-beta markers reach abnormal levels, correlating with amyloid-beta pathology. Plasma p-tau181 also shows associations with widespread cortical tau aggregation and may be a useful diagnostic and screening tool for Alzheimer's disease.
Tau phosphorylated at threonine 181 (p-tau181) measured in blood plasma has recently been proposed as an accessible, scalable, and highly specific biomarker for Alzheimer's disease. Longitudinal studies, however, investigating the temporal dynamics of this novel biomarker are lacking. It is therefore unclear when in the disease process plasma p-tau181 increases above physiological levels and how it relates to the spatiotemporal progression of Alzheimer's disease characteristic pathologies. We aimed to establish the natural time course of plasma p-tau181 across the sporadic Alzheimer's disease spectrum in comparison to those of established imaging and fluid-derived biomarkers of Alzheimer's disease. We examined longitudinal data from a large prospective cohort of elderly individuals enrolled in the Alzheimer's Disease Neuroimaging Initiative (ADNI) (n=1067) covering a wide clinical spectrum from normal cognition to dementia, and with measures of plasma p-tau181 and an F-18-florbetapir amyloid-beta PET scan at baseline. A subset of participants (n=864) also had measures of amyloid-beta(1-42) and p-tau181 levels in CSF, and another subset (n=298) had undergone an F-18-flortaucipir tau PET scan 6 years later. We performed brain-wide analyses to investigate the associations of plasma p-tau181 baseline levels and longitudinal change with progression of regional amyloid-beta pathology and tau burden 6 years later, and estimated the time course of changes in plasma p-tau181 and other Alzheimer's disease biomarkers using a previously developed method for the construction of long-term biomarker temporal trajectories using shorter-term longitudinal data. Smoothing splines demonstrated that earliest plasma p-tau181 changes occurred even before amyloid-beta markers reached abnormal levels, with greater rates of change correlating with increased amyloid-beta pathology. Voxel-wise PET analyses yielded relatively weak, yet significant, associations of plasma p-tau181 with amyloid-beta pathology in early accumulating brain regions in cognitively healthy individuals, while the strongest associations with amyloid-beta were observed in late accumulating regions in patients with mild cognitive impairment. Cross-sectional and particularly longitudinal measures of plasma p-tau181 were associated with widespread cortical tau aggregation 6 years later, covering temporoparietal regions typical for neurofibrillary tangle distribution in Alzheimer's disease. Finally, we estimated that plasma p-tau181 reaches abnormal levels similar to 6.5 and 5.7 years after CSF and PET measures of amyloid-beta, respectively, following similar dynamics as CSF p-tau181. Our findings suggest that plasma p-tau181 increases are associated with the presence of widespread cortical amyloid-beta pathology and with prospective Alzheimer's disease typical tau aggregation, providing clear implications for the use of this novel blood biomarker as a diagnostic and screening tool for Alzheimer's disease.
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