Mechanistic modeling of tau biomarkers for amyloid load. A Quantitative Systems Pharmacology study of amyloid‐tau interaction.

Abstract

AbstractBackgroundRecent clinical trials with amyloid antibodies have suggested a beneficial effect on cognitive scales after clearing most of the amyloid load. Interestingly, substantial reduction in plasma or CSF tau biomarkers were documented providing interesting insights into the amyloid‐tau interactions in the human AD patient.MethodWe developed a Quantitative Systems Pharmacology (QSP) platform for late MCI‐prodromal AD subjects that combined an earlier published Physiology‐Based Pharmacokinetic (PBPK)‐ QSP model of amyloid aggregation with a novel QSP model describing the impact of amyloid monomers on glutamatergic and nicotinic neurotransmission and neuronal firing, the neuronal activity‐dependent tau release, subsequent tau uptake in the afferent neuron and dynamics of tau biomarkers in CSF and plasma.ResultThe combined model quantitatively reproduced (1) the cortical hyperactivity and higher tau biomarker levels associated with increasing amyloid deposition in observational studies, (2) the differential decrease in CSF and plasma tau biomarkers in clinical trials with various amyloid antibodies. Dynamics of monomeric brain Ab40 and Ab42 and their effect on neuronal firing, rather than reduction in SUVR can better explain the clinically observed changes in CSF or plasma tau between aducanumab, lecanemab, donanemab and gantenerumab. The range of commonly used comedications and common dopaminergic and serotonergic genotype variants affecting neuronal activity can partially explain the variability of tau biomarkers response as downstream effects of amyloid removal.ConclusionThis study suggests a direct link between amyloid dynamics and plasma / CSF tau levels through modulation of neuronal activity. The calibrated QSP model sets the stage for modeling long‐term effects of amyloid therapy on tau pathology progression and identification of optimal trial design for combination therapies.