Tau Concentrations Research Articles

Semorinemab Pharmacokinetics and The Effect on Plasma Total Tau Pharmacodynamics in Clinical Studies.

Semorinemab is a monoclonal antibody that targets the N-terminal domain of the tau protein that is in clinical development for the treatment of Alzheimer's disease. To perform model-based evaluations of the observed pharmacokinetics in serum and the total plasma tau target-engagement dynamics from clinical studies evaluating semorinemab. The observed semorinemab pharmacokinetics and plasma tau target engagement from phase 1 and 2 clinical studies were modeled using a non-linear mixed effect target-mediated drug disposition model. The model was simulated to understand target engagement at clinical dose levels. The clinical studies testing semorinemab were evaluated in healthy volunteers, subjects with prodromal-to-mild Alzheimer's disease, and subjects with mild-to-moderate Alzheimer's disease. The data included a total of 8430 semorinemab serum concentrations and 4772 total tau protein plasma concentrations from 463 subjects treated with a range of single and multiple doses of semorinemab. Serum concentrations of semorinemab and the total plasma tau concentrations were measured after administration of a range of doses of semorinemab to subjects with Alzheimer's disease. A sensitivity analysis was performed wherein key target-mediated drug disposition model parameters were estimated separately between healthy volunteers, subjects with prodromal-to-mild Alzheimer's disease, and subjects with mild-to-moderate Alzheimer's disease. Serum concentrations of semorinemab were consistent across studies and showed a dose-proportional increase across the evaluated dose range. The pharmacokinetic profile was comparable between healthy volunteers and subjects with Alzheimer's disease. Total plasma tau concentrations increased in a dose-dependent non-linear manner upon semorinemab administration. The target-mediated drug disposition model adequately described the serum pharmacokinetics and protein dynamics with an estimated antibody-ligand binding strength, Kss, of 42.7 nM. The estimated values of clearance and central volume of distribution were 0.109 L/day/70 kg and 2.95 L/70 kg, respectively, and were consistent with typical values for IgG mAbs. In the sensitivity analysis, Kss (32 nM) and baseline tau protein (0.30 µM) were estimated to be lower for healthy volunteers compared to subjects with Alzheimer's disease but were comparable between subjects with Alzheimer's disease of different severities (Kss: 52-57 nM, baseline tau: 0.44-0.47 µM). The models suggested that peripheral target engagement was over 90% at the clinical doses in each of the diagnostic subgroups. Our target-mediated drug disposition model adequately described the serum pharmacokinetics and the peripheral non-linear increase with dose of the total tau. The model confirmed that these dose-response relationships were consistent across populations of healthy volunteers and subjects with different severities of Alzheimer's disease.

Level of blood Tau and p‐Tau : a non‐invasive approach for the diagnosis of Alzheimer’s Disease(AD)

AbstractBackgroundProminent expression of Tau and phosphorylated Tau in cerebrospinal fluid (CSF) is one of the well‐known hallmarks of the Alzheimer’s disease (AD). High levels of p‐Tau can easily differentiate AD from other neurodegenerative disease. However, the serum levels of these proteins in AD patients are not well explored. This study provides an alternative non‐invasive approach to diagnose the disease by evaluating the level of Tau and p‐Tau181 in serum samples.MethodBlood samples were collected from 39 AD patients, 37 MCI patients and 37 elderly individuals as controls. Quantification of tau and pTau in serum samples was done with the help of a label free real time Surface Plasmon Resonance technology, and further validated by Western Blot. Statistical analysis, including Receiver Operating Characteristic (ROC), was done for further affirmation.ResultThe concentrations of serum Tau and p‐Tau181 were significantly higher (p<0.00001) in AD (Tau; 47.49±9.00ng/µL, p‐Tau181; 0.161±0.04 ng/µL) compared to MCI (Tau; 39.26±7.78 ng/µL, p‐Tau181; 0.135±0.02 ng/µL) and were further compared to elderly controls (Tau; 34.92±6.58 ng/µL, p‐Tau181; 0.122±0.01 ng/ µL). A significant (p<0.0001) downhill correlation was found between Tau as well as p‐Tau181 levels with HMSE and MoCA score.ConclusionThis study for the first time reports the concentration of Tau and p‐Tau181 in serum of AD and MCI patients. The cut‐off values of Tau and p‐Tau181 of AD and MCI patients with sensitivity and specificity reveal that serum level of these proteins can be used as a predictive marker for AD and MCI.

Routes to standardisation for tau protein measurement in CSF

AbstractBackgroundCSF biomarkers are the target of several commercially available in vitro diagnostic (IVD) kits allowing an early diagnosis of Alzheimer’s disease (AD) and eventually the monitoring of treatment effects in clinical trials. Tau hyper‐phosphorylation is one of the main hallmarks of AD and its measurement provides higher accuracy to stratify patients at an early‐stage.Due to the rapid advancements in proteomics, standardisation of measurements can be achieved through the development of reference measurement procedures (RMPs) and certified reference materials (CRMs).MethodSI‐traceable protein and peptide primary calibrators were developed for t‐tau and p‐tau: mass fraction was determined by amino acid analysis and purity was assessed by LC‐MS at high resolution. CSF pools at different tau concentration were used for the development and validation of LC‐IDMS candidate RMP and their commutability was assessed.ResultAn LC‐IDMS candidate reference method was develop and validated in CSF for t‐tau using a SI‐traceable candidate protein primary calibrator. Three different CSF pools (low, medium, high) were successfully quantified with a relative expanded uncertainty below 10%. The commutability of 13 matrix‐based CRMs was assessed involving 8 immunoassays from 5 IVD providers by measuring 40 single CSF donations.According to the AT(N) classification, high levels of p‐tau(181) are highly correlated to tau pathology and commercially available immunoassays are able to target this specific epitope. We conducted a feasibility study on the development of a candidate reference method for p‐tau(181) in CSF relying on a SI‐traceable peptide primary calibrator and an antibody‐free sample preparation workflow.New assays targeting p‐tau(217) in CSF and plasma were also developed, making it necessary the organisation of standardisation initiatives. We sourced and characterised multiple phosphopeptide primary calibrators as well as a GSK3beta‐phosphorylated protein primary calibrator for the development of an LC‐MS RMP including an immunoprecipitation step in the sample preparation workflow.Conclusiontau is considered as a priority for the IFCC WG on NDD and the development of SI traceable RMPs and CRMs is essential to underpin a worldwide standardisation of results. This will help IVD providers to address the traceability requirements of the IVDR thus facilitating regulatory approvals of the kits.

Topological Network Analysis of Beta‐Amyloid and Tau in Alzheimer’s Disease Using PET Imaging Data

AbstractBackgroundAlzheimer’s disease (AD) is characterized by the presence of beta‐amyloid (Aβ) and tau in the brain. Understanding the interplay between these proteins and their spatial distribution may provide insights into disease progression. This study aims to investigate the topological features of Aβ and tau networks in AD, mild cognitive impairment (MCI), and normal cognition (NC) groups using PET images from the ADNI dataset.MethodPartial correlation matrices between the standardized uptake value ratio of 68 regions of interest (ROI’s) were used to generate networks for the AD, MCI, and NC groups, with nodes representing ROI’s and edges representing correlation coefficients. Topological features, including H0 features (connected components), H1 features (loops), and landscape functions of H1 features, were calculated for each sample’s persistent homology. For each group, 100 bootstrapping samples were used to generate the 95% confidence intervals for landscape functions. The connected components were further studied by representing the samples as hierarchical tree structures. In the tree space, the first few generated connections, representing the most consistent pairs of regions positive for Aβ and tau, were compared across groups. Clustering performances were compared using Wasserstein distance of H0 features, Wasserstein distance of H1 features, landscape function distance, and geodesic distance in tree space respectively.ResultThe geodesic distance in tree space showed the best clustering accuracy in both Aβ and tau analyses. Compared with Aβ, H1 features and the corresponding landscape functions performed better for tau. Unique connections in AD and MCI groups were identified, with AD showing more unique connections than MCI compared to NC samples. Dominant unique connections in the AD group included left‐right isthmus cingulate and left fusiform‐left inferior temporal for Aβ, and left‐right paracentral and left cuneus‐left pericalcarine for tau. These connections indicate region pairs with related concentrations of Aβ and tau in AD.ConclusionTopological network analysis can reveal complex underlying structures in PET images and identify consistent patterns in ROI’s associated with Aβ and tau localization. Tau aggregation exhibits more complex behavior than Aβ and is more strongly associated with AD. The identified unique connections in the AD group may serve as potential biomarkers for disease progression.

Cognitive activity, cognitive function, and neurological blood biomarkers

AbstractBackgroundMore frequent engagement in cognitive activity is associated with better cognitive function in older adults, but the mechanism of action is not fully understood. Debate remains whether increased cognitive activity provides a meaningful benefit for cognitive health or if decreased cognitive activity represents a prodrome of cognitive impairment. Neurological biomarkers provide a novel way to examine this relationship in the context of cognitive aging.MethodsWe examined the association of cognitive activity, cognitive function, and concentrations of three biomarkers in community‐dwelling participants of a longitudinal, population‐based study. Cognitive activity was measured at baseline by asking participants to rate the frequency of 7 activities: 1) Viewing television, 2) Listening to the radio, 3) Visiting a museum, 4) Playing games, such as cards, checkers, crosswords, or other puzzles or games, 5) Reading books, 6) Reading magazines, and 7) Reading newspapers. Cognitive function was measured with a battery of four tests (Mini‐Mental State Examination, Digit Symbol Test, and the immediate and delayed recall of the East Boston Test) averaged into a composite score. At baseline, we evaluated the concentration of total tau (tau), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP).ResultsThe study sample comprised 1,168 older participants, primarily non‐Hispanic Blacks (60%) and women (63%). At baseline, they were an average of 77 years old with 12.6 years of education. Mixed‐effects models showed that cognitive activity was associated with better cognitive functioning at baseline and over time. These relationships remained after each biomarker was added to the model. Over an average of 6.4 years of follow‐up, cognitive activity was associated with cognitive decline in the model with tau (estimate = 0.0123; p‐value = 0.03) and was mildly attenuated in the models with NfL, (estimate = 0.0110; p‐value = 0.06), and GFAP (estimate = 0.0111; p‐value = 0.06). Biomarkers did not modify the association between cognitive activity and cognitive function over time.ConclusionThe benefits of cognitive activity on cognition appear to be independent of biomarkers: tau, NfL, and GFAP. More frequent cognitive activity may benefit the cognitive health of older adults with a wide range of potential disease risk and presentations.

Association of Objective Sleep Duration with Cognition and Brain Aging Biomarkers in Older Adults

AbstractBackgroundThe neuropathological mechanisms linking sleep duration with mild cognitive impairment (MCI) are poorly understood.MethodThis population‐based study included 2032 dementia‐free participants (age ≥60 years; 55.1% women) derived from the baseline survey of the Multimodal Interventions to Delay Dementia and Disability in Rural China; of these, data were available from 841 participants for Alzheimer’s plasma biomarkers (e.g., amyloid‐β [Aβ], total tau, and neurofilament light chain [NfL] protein), 1044 for serum microvascular biomarkers (e.g., soluble adhesion molecules), and 834 for brain MRI biomarkers (e.g., total brain tissue, whiter matter, grey matter, hippocampus, lacunes, enlarged perivascular spaces [EPVS], and white matter hyperintensity [WMH]). We assessed sleep duration using the electrocardiogram‐based cardiopulmonary coupling analysis, global and domain‐specific cognitive function using a neuropsychological test battery, and MCI following the Petersen’s criteria. Data were analyzed with multivariable logistic and general linear models.ResultIn the total sample (n = 2032), 510 participants were diagnosed with MCI, including 438 with amnestic MCI and 72 with non‐amnestic MCI. Objectively‐measured long sleep duration (>8 vs. 6‐8 hours) was significantly associated with an increased likelihood of MCI and lower scores in global cognition, verbal fluency, attention, and executive function (P<.05). In the subsamples, long sleep duration was associated with higher plasma concentrations of Aβ40, total tau, and NfL, a lower Aβ42/Aβ40 ratio, and smaller volumes of total brain tissue, grey matter, and hippocampus (P<.05). There were no significant associations of sleep duration with serum soluble adhesion molecules concentrations, white matter volumes, WMH volumes, global EPVS, and lacunes (P >.05).ConclusionAlzheimer’s and neurodegenerative pathologies represent common pathways linking long sleep duration with poor cognition in older adults.

Molecular MRI Identifies Sexually Dimorphic AD Pathology in 3x Tg‐AD Mice

AbstractBackgroundWomen exhibit higher prevalence of Alzheimer’s disease (AD) with faster cognitive decline compared to men, but the mechanisms of this dimorphism remain understudied. Astrocyte function and morphology is distinct in some regions of male and female adult brains which may reflect different courses taken by the neurodegenerative process. Additionally, the p‐tau levels are higher in females than in males. The 3xTg AD mouse model, which manifests amyloid and tau pathology, has been reported to exhibit similar sexual dimorphism. In this work, we investigated whether molecular MRI using a targeted agent that detects hyperphosphorylative cells expressing cell‐surface vimentin predominantly on neurons and the disease associated astrocytes in early states of tau pathology can be used for in vivo imaging of sexual dimorphism in AD pathology.MethodLiposomal Withaferin nanoparticles (WNP) that contain Gd/DOTA for an MRI readout were injected in 3xTg AD mice, at 2‐,5‐,7‐ 9‐ and 12‐ months of age. Animals (n = 14/timepoint, 7 males and 7 females) underwent contrast enhanced magnetic resonance imaging (MRI) using T1 weighted sequences to visualize hyperphosphorylative cells expressing cell surface vimentin. Animals were euthanized after the final time point and brains were harvested for histology and immunofluorescence analysis. CE‐MR images were analyzed for signal enhancement.ResultIn this study, we report the sexually dimorphic nature of the cell surface vimentin expressed by the hyperphosphorylative cells in the brain using the 3xTg AD mice. Both sexes were imaged at 2‐,5‐,7‐ and 9‐ months of age to reveal significant differences in the expression of VIM in males and . Signal enhancement in post‐contrast MRI scans over the baseline scans showed significantly higher enhancement in the females compared with the males (p<0.05) Simultaneously, we also investigate the plasma concentrations of total tau, ptau181, amyloid beta 40 and 42.ConclusionFemale mice expressed higher vimentin in comparison with males, thus reflecting changes in the neurodegenerative processes in the brains of females and males of this strain. Sexually dimorphic molecular changes were successfully visualized by molecular MRI.

Developing Topics.

Alzheimer's disease is characterized by cortical hyperexcitability in the early stages, which may be attributed to the intricate interplay between tau and amyloid β pathologies. To combat the propagation of tau pathology and cognitive decline, it may be beneficial to maintain a high degree of functional brain network segregation. Additionally, the use of non-invasive brain stimulation techniques to alter cortical excitability could help alleviate cognitive deficits. However, it is unclear how these interventions are related to tau or amyloid biomarkers. In this study, 530 participants aged 40 to 65 from the Barcelona Brain Health Initiative cohort were analyzed to investigate the connection between plasma concentration of tau phosphorylated at amino acid 181 (pTau181), cortical excitability, and segregation of functional brain networks. Participants had functional magnetic resonance imaging (fMRI), electroencephalography (EEG), and pTau181 available. A subset of 47 participants also underwent transcranial magnetic stimulation with concurrent EEG (TMS-EEG). Cortical excitability was assessed using the one-over-f slope of the EEG power spectrum (1/f-slope) and evoked response to a TMS perturbation (TEP) of the left prefrontal cortex (L-PFC) between 160-240ms post single-pulse TMS. The degree of segregation between major functional networks was measured from fMRI data using the system segregation statistic. A generalized linear model with a gamma distribution (Table 1) revealed that steeper 1/f-slope correlated with higher pTau181 concentration, particularly in participants older than 53 years of age (Figure 1.A), or system segregation below 0.28 (Figure 1.B). A multiple linear regression within the TMS-EEG subsample (Table 2) revealed that the TEP response correlated positively with pTau181 as age increased, and that this model, despite including a smaller sample size, better explained pTau181 concentrations. The study shows that cortical excitability is related to pTau181 based on age and system segregation. The TEP response is a more sensitive marker than unperturbed EEG metrics in explaining the relation between excitability and pTau181 concentrations. Combined TMS with EEG could potentially be an inexpensive and scalable approach for early identification and longitudinal tracking of middle-aged adults at risk for cognitive decline and dementia.

Day‐to‐day Sleep Variability in Val66Met BDNF Carriers: A Potential Biological Pathway Between BDNF Activity and Alzheimer’s Disease Pathology?

AbstractBackgroundWe previously showed that day‐to‐day sleep variability was associated with biomarkers of Alzheimer’s disease (AD) pathology. Given that brain‐derived neurotrophic factor (BDNF) activity has been involved in both AD and cognitive impacts of lifestyle risk factors, we sought to evaluate day‐to‐day sleep variability in those carrying the Met allele of the Val66Met BDNF polymorphism, which affects BDNF release. Additionally, we explored whether BDNF polymorphism modified the association between CSF AD pathology and day‐to‐day sleep variability.MethodThe PREVENT‐AD cohort enrolls dementia‐free persons with a parental history of sporadic AD. We characterized 203 dementia‐free participants from this cohort at the polymorphic BDNF locus, identifying 136 persons with genotype Val/Val (age 68.2±5.3y, 75%women), 67 Met heterozygotes/homozygotes (68.4±5.6y, 73% women, including six Met/Met homozygotes). After a week of actigraphy, we calculated these participants’ standard deviation of day‐to‐day sleep characteristics. We used t‐tests to compare day‐to‐day sleep variability in sleep characteristics between Val homozygotes and Met carriers. In a subsample of 101 participants, we assayed CSF Aβ42, t‐tau and p‐tau181, and used age‐ and sex‐adjusted linear regressions with an interaction term to test for moderation by BDNF genotype (36 Met carriers vs. 65 Val homozygotes) between sleep variability and CSF biomarker results.ResultAs compared to Val homozygotes, sleep was disturbed and unstable in BDNF Met carriers (heterozygotes/homozygotes). They had higher day‐to‐day variability in sleep fragmentation (activity counts, wake after sleep onset, fragmentation index), sleep onset latency, and sleep duration, resulting in weekly sleep patterns that were more fragmented and less efficient. Further, BDNF genotype moderated the association between CSF t‐tau and p‐tau181 with day‐to‐day sleep duration variability, such that only Met carriers showed an association between elevated tau concentration and sleep duration variability.ConclusionBDNF Met carriers had disturbed and unstable daily sleep patterns. Because the Met allele is known to decrease plasticity of neural mechanisms, the ability to achieve healthy and stable sleep may depend on such mechanisms. Thus, poorer sleep in Met carriers might be a biological mechanism by which altered BDNF activity affects tau pathology or, alternatively, accumulated AD pathology in Met carriers may disrupt sleep‐wake patterns.

Cerebrovascular features of Alzheimer’s disease in adults with Down syndrome

AbstractBackgroundCerebrovascular disease contributes to clinical onset and course of Alzheimer’s disease (AD) but it is unclear if it is related directly to AD pathogenesis. In late onset AD, MRI markers of small vessel cerebrovascular disease relate to AD diagnosis, genetic risk for AD, and severity of AD symptoms, but it is not possible to determine whether these associations reflect comorbidity due to risk factor exposure or whether they represent a core feature of AD. We have been studying cerebrovascular features of Alzheimer’s disease in adults with Down syndrome, who are at genetic risk for developing AD but have very low prevalence of classical vascular risk factors.MethodIn the context of the Alzheimer’s Biomarker Consortium – Down Syndrome (ABC‐DS), a US‐based multisite observational study of the clinical, biomarker, and pathological features of AD in adults with Down syndrome, our laboratory has analyzed high‐resolution, harmonized MRI scans for markers of cerebrovascular disease, including white matter hyperintensities (WMH), enlarged perivascular spaces, microbleeds, and infarcts, in adults with Down syndrome across the adult lifespan. We tested the association of these markers with age, AD‐related clinical diagnoses, proteomic profiles of vascular function and inflammation, and AD‐related biofluidic biomarker concentrations.ResultOur studies show that MRI‐derived markers of cerebrovascular disease are prevalent in adults with Down syndrome and increase in severity across AD‐associated clinical diagnoses. Age analyses suggest that there is an inflection of these markers at around age 40, when other pathological features also begin to emerge. Proteomic correlates of these cerebrovascular disease markers suggest an association with inflammatory processes in presymptomatic and neurodegenerative processes in symptomatic adults with Down syndrome. Finally, markers of cerebrovascular disease are particularly associated with plasma phosphorylated tau concentrations in adults with Down syndrome.ConclusionOur work shows that MRI‐derived markers of cerebrovascular disease are prevalent, related to AD symptoms, temporally track with AD pathology, relate to inflammation and neurodegeneration markers, and associate with markers of tau pathology. Without the confound of exposure to peripheral vascular risk factors, these observations suggest that cerebrovascular disease represents a “core feature” of AD that contributes both to symptoms and to disease pathogenesis.

A prospective feasibility trial exploring novel biomarkers for neurotoxicity after isolated limb perfusion.

Isolated limb perfusion (ILP) is a regional cancer treatment in which high-dose chemotherapy is administered in an isolated extremity. The main side effect is regional toxicity, which occasionally leads to nerve damage. Measuring neuroaxonal biomarkers, might be a method predicting such complications. Therefore, the primary aim of the study is to investigate if neuronal biomarkers are measurable and alters in an isolated extremity during ILP. Secondly, if postoperative regional toxicity, alterations in sensitivity, and/or muscle strength are correlated to the biomarker levels. Eighteen scheduled ILP-patients were included in the study. Glial fibrillary acidic protein (GFAP), neurofilament light (NfL), and tau concentrations were measured in plasma sampled preoperatively, at the start and end of the ILP, on days 3 and 30, using ultrasensitive Single molecule array (Simoa) technology. The patients were assessed by a physiotherapist pre- and postoperatively. At ILP end, significantly higher NfL and tau levels were measured in the extremity than in the corresponding systemic circulation (NfL; 17 vs 6ng/L, p < .01, tau; 1.8 vs 0.6ng/L, p < .01), and the extremity levels were significantly increased at ILP end (NfL; 66 ± 37%, p < .001, tau; 75 ± 45%, p = .001). On days 3 and 30, significantly increased NfL and GFAP levels were measured systemically (NfL day 3: 69 ± 30%, p < .001; day 30: 76 ± 26%, p < .001; GFAP day 3: 33 ± 22%, p < .002; day 30: 33 ± 23%, p ≤ .004). Finally, no significant correlations were found between regional toxicity or between postoperative muscle or sensitivity decrease and biomarker release. During ILP, NfL and tau levels increased significantly. No obvious correlations were observed between biomarker release and regional toxicity or decreased muscle strength or sensitivity, although large-scale studies are warranted.

Abstract 14308: Perioperative Cyclohexanone Exposure During Neonatal Congenital Heart Surgery Potentiates Brain Injury

Introduction: Neurodevelopmental delay is hallmark for children with congenital heart defects. Risk factors include industrial contaminants in medical devices, such as cyclohexanone. Hypothesis: To evaluate associations between perioperative cyclohexanone and cyclohexanone metabolites with perioperative biomarkers of brain injury. Methods: From 75 neonates who underwent congenital heart surgery involving cardiopulmonary bypass (CPB), we assayed perioperative serum samples (preoperation, post-CPB, 24 hours postoperation) for cyclohexanone, two cyclohexanone metabolites (trans-1,2- and trans-1,4-cyclohexanediol), and biomarkers of brain injury: glial fibrillary acidic protein (GFAP), neurofilament light (NF-L), and Tau. We calculated the molar sum of cyclohexanone metabolites (Σmetabolites), and at each timepoint we used quantile regression to evaluate differences in median brain injury biomarker concentrations (pg/mL) per doubling in concentration of cyclohexanone or Σmetabolites (ng/mL). We adjusted associations for cyclohexanone assay batch, postnatal age at surgery (days), weight at surgery (kg), The Society of Thoracic Surgeons and The European Association for Cardio-Thoracic Surgery (STAT) mortality risk category, and total duration of CPB (min). Results: In adjusted analyses, a doubling in preoperation cyclohexanone concentration was associated with a 19 pg/mL (95% CI: 3, 35) greater median Tau concentration. Similarly, a doubling in post CPB cyclohexanone was associated with an 88 pg/mL (95% CI: 20, 156) greater median concentration of Tau and 137 pg/mL (95% CI: 54, 220) greater median concentration of NF-L. Associations with Σmetabolites were generally null, though a doubling in post-CPB concentration was associated with a 34.7 pg/mL (95% CI: -0.8, 70) greater NF-L and 54.1 pg/mL (95% CI: 15, 94) greater Tau concentration. Associations with GFAP at all timepoints were null. Conclusions: Perioperative cyclohexanone exposure is associated with worse neurodevelopmental outcomes and in this study, cyclohexanone levels were associated with NF-L and Tau which are measures of axonal damage. Interventions to reduce cyclohexanone exposure may improve long term neurodevelopment.

Plasma Amyloid-β, Total Tau, and Neurofilament Light Chain Across the Alzheimer's Disease Clinical Spectrum: A Population-Based Study.

Plasma biomarkers have emerged as a promising approach for characterizing pathophysiology in mild cognitive impairment (MCI) and Alzheimer's disease (AD). We aimed to characterize plasma biomarkers for AD and neurodegeneration across the AD clinical continuum, and to assess their ability to differentiate between AD, MCI, and normal cognition. This population-based study engaged 1,446 rural-dwelling older adults (age ≥60 years, 61.0% women) derived from MIND-China; of these, 402 were defined with MCI and 142 with AD. Plasma amyloid-β (Aβ), total tau (t-tau), and neurofilament light chain (NfL) concentrations were analyzed using the Simoa platform. Data were analyzed using linear and logistic regression models, and receiver operating characteristic (ROC) analysis. Across the AD clinical spectrum, plasma Aβ40 and NfL increased, whereas Aβ42/Aβ40 ratio decreased. Plasma t-tau was higher in people with AD dementia than those with MCI or normal cognition. Plasma NfL outperformed other biomarkers in differentiating AD from normal cognition (area under the ROC curve [AUC] = 0.75), but all plasma biomarkers performed poorly to distinguish MCI from normal cognition (AUC <0.60). Plasma NfL in combination with age, sex, education, and APOE genotype yielded the AUC of 0.87 for differentiating between AD and normal cognition, 0.79 between AD and MCI, and 0.64 between MCI and normal cognition. In this Chinese population, AD plasma biomarkers vary by age, sex, and APOE genotype. Plasma Aβ, t-tau, and NfL differ across the AD clinical spectrum, and plasma NfL appears to be superior to plasma Aβ and t-tau for defining the clinical spectrum.

Plasma Aβ42/Aβ40 and phospho-tau217 concentration ratios increase the accuracy of amyloid PET classification in preclinical Alzheimer's disease.

Incorporating blood-based Alzheimer's disease biomarkers such as tau and amyloid beta (Aβ) into screening algorithms may improve screening efficiency. Plasma Aβ, phosphorylated tau (p-tau)181, and p-tau217 concentration levels from AHEAD 3-45 study participants were measured using mass spectrometry. Tau concentration ratios for each proteoform were calculated to normalize for inter-individual differences. Receiver operating characteristic (ROC) curve analysis was performed for each biomarker against amyloid positivity, defined by>20 Centiloids. Mixture of experts analysis assessed the value of including tau concentration ratios into the existing predictive algorithm for amyloid positron emission tomography status. The area under the receiver operating curve (AUC) was 0.87 for Aβ42/Aβ40, 0.74 for phosphorylated variant p-tau181 ratio (p-tau181/np-tau181), and 0.92 for phosphorylated variant p-tau217 ratio (p-tau217/np-tau217). The Plasma Predicted Centiloid (PPC), a predictive model including p-tau217/np-tau217, Aβ42/Aβ40, age, and apolipoprotein E improved AUC to 0.95. Including plasma p-tau217/np-tau217 along with Aβ42/Aβ40 in predictive algorithms may streamline screening preclinical individuals into anti-amyloid clinical trials. gov Identifier: NCT04468659 HIGHLIGHTS: The addition of plasma phosphorylated variant p-tau217 ratio (p-tau217/np-tau217) significantly improved plasma biomarker algorithms for identifying preclinical amyloid positron emission tomography positivity. Prediction performance at higher NAV Centiloid levels was improved with p-tau217/np-tau217. All models generated for this study are incorporated into the Plasma Predicted Centiloid (PPC) app for public use.

Neuro-Specific and Immuno-Inflammatory Biomarkers in Umbilical Cord Blood in Neonatal Hypoxic-Ischemic Encephalopathy

Objectives: The aim of the study was to evaluate neuronal injury and immuno-inflammatory biomarkers in umbilical cord blood (UCB) at birth, in cases with perinatal asphyxia with or without hypoxic-ischemic encephalopathy (HIE), compared with healthy controls and to assess their ability to predict HIE. Study Design: In this case-control study, term infants with perinatal asphyxia were recruited at birth. UCB was stored at delivery for batch analysis. HIE was diagnosed by clinical Sarnat staging at 24 h. Glial fibrillary acidic protein (GFAP), the neuronal biomarkers tau and neurofilament light protein (NFL), and a panel of cytokines were analyzed in a total of 150 term neonates: 50 with HIE, 50 with asphyxia without HIE (PA), and 50 controls. GFAP, tau, and NFL concentrations were measured using ultrasensitive single-molecule array (Simoa) assays, and a cytokine screening panel was applied to analyze the immuno-inflammatory and infectious markers. Results: GFAP, tau, NFL, and several cytokines were significantly higher in newborns with moderate and severe HIE compared to a control group and provided moderate prediction of HIE II/III (AUC: 0.681–0.827). Furthermore, the levels of GFAP, tau, interleukin-6 (IL-6), and interleukin-8 (IL-8) were higher in HIE II/III cases compared with cases with PA/HIE I. IL-6 was also higher in HIE II/III compared with HIE I cases. Conclusions: Biomarkers of brain injury and inflammation were increased in umbilical blood in cases with asphyxia. Several biomarkers were higher in HIE II/III versus those with no HIE or HIE I, suggesting that they could assist in the prediction of HIE II/III.

Evolving prion-like tau conformers differentially alter postsynaptic proteins in neurons inoculated with distinct isolates of Alzheimer’s disease tau

ObjectivesAlthough accumulation of misfolded tau species has been shown to predict cognitive decline in patients with Alzheimer’s disease (AD) and other tauopathies but with the remarkable diversity of clinical manifestations, neuropathology profiles, and time courses of disease progression remaining unexplained by current genetic data. We considered the diversity of misfolded tau conformers present in individual AD cases as an underlying driver of the phenotypic variations of AD and progressive loss of synapses.MethodsTo model the mechanism of tau propagation and synaptic toxicity of distinct tau conformers, we inoculated wild-type primary mouse neurons with structurally characterized Sarkosyl-insoluble tau isolates from the frontal cortex of six AD cases and monitored the impact for fourteen days. We analyzed the accumulation rate, tau isoform ratio, and conformational characteristics of de novo-induced tau aggregates with conformationally sensitive immunoassays, and the dynamics of synapse formation, maintenance, and their loss using a panel of pre-and post-synaptic markers.ResultsAt the same concentrations of tau, the different AD tau isolates induced accumulation of misfolded predominantly 4-repeat tau aggregates at different rates in mature neurons, and demonstrated distinct conformational characteristics corresponding to the original AD brain tau. The time-course of the formation of misfolded tau aggregates and colocalization correlated with significant loss of synapses in tau-inoculated cell cultures and the reduction of synaptic connections implicated the disruption of postsynaptic compartment as an early event.ConclusionsThe data obtained with mature neurons expressing physiological levels and adult isoforms of tau protein demonstrate markedly different time courses of endogenous tau misfolding and differential patterns of post-synaptic alterations. These and previous biophysical data argue for an ensemble of various misfolded tau aggregates in individual AD brains and template propagation of their homologous conformations in neurons with different rates and primarily postsynaptic interactors. Modeling tau aggregation in mature differentiated neurons provides a platform for investigating divergent molecular mechanisms of tau strain propagation and for identifying common structural features of misfolded tau and critical interactors for new therapeutic targets and approaches in AD.

Using Fatty Acid-Binding Proteins as Potential Biomarkers to Discriminate between Parkinson's Disease and Dementia with Lewy Bodies: Exploration of a Novel Technique.

An increase in the global aging population is leading to an increase in age-related conditions such as dementia and movement disorders, including Alzheimer's disease (AD), Parkinson's disease (PD), and dementia with Lewy bodies (DLB). The accurate prediction of risk factors associated with these disorders is crucial for early diagnosis and prevention. Biomarkers play a significant role in diagnosing and monitoring diseases. In neurodegenerative disorders like α-synucleinopathies, specific biomarkers can indicate the presence and progression of disease. We previously demonstrated the pathogenic impact of fatty acid-binding proteins (FABPs) in α-synucleinopathies. Therefore, this study investigated FABPs as potential biomarkers for Lewy body diseases. Plasma FABP levels were measured in patients with AD, PD, DLB, and mild cognitive impairment (MCI) and healthy controls. Plasma FABP3 was increased in all groups, while the levels of FABP5 and FABP7 tended to decrease in the AD group. Additionally, FABP2 levels were elevated in PD. A correlation analysis showed that higher FABP3 levels were associated with decreased cognitive function. The plasma concentrations of Tau, GFAP, NF-L, and UCHL1 correlated with cognitive decline. A scoring method was applied to discriminate between diseases, demonstrating high accuracy in distinguishing MCI vs. CN, AD vs. DLB, PD vs. DLB, and AD vs. PD. The study suggests that FABPs could serve as potential biomarkers for Lewy body diseases and aid in early disease detection and differentiation.

Perioperative brain injury marker concentrations in neonatal open-heart surgery: a prospective observational study.

Neonates with critical congenital heart defects undergoing open-heart surgery on cardiopulmonary bypass circulation are at risk for white matter brain injury. This article reports on pre- and postoperative plasma concentrations of brain injury markers glial fibrillary acidic protein (GFAP), neurofilament light (NfL) and Tau, and their respective associations with white matter lesions detected on postoperatively performed brain MRI. Forty term newborns with isolated critical congenital heart defects were included in a prospective observational study. Brain injury marker plasma concentrations were determined prior to surgery and at postoperative days 1, 2 and 3. Brain magnetic resonance imaging was performed pre- and postoperatively. Concentrations of brain injury markers were analysed using ultrasensitive single molecule array technology. Absolute pre- and postoperative plasma biomarker concentrations, and postoperative concentrations adjusted for preoperative concentrations were used for subsequent analysis. Plasma concentrations of GFAP, NfL and Tau displayed a well-defined temporal trajectory after neonatal cardiopulmonary bypass circulation. GFAP and Tau reached peak concentrations at postoperative day 2 (median concentrations 170.5 and 67.2 pg/ml, respectively), whereas NfL continued to increase throughout the study period (median concentration at postoperative day 3 191.5 pg/ml). Adjusted Tau at postoperative day 2 was significantly higher in infants presenting with white matter lesions on postoperative MRI compared to infants without white matter injury.

Hypotension during transsphenoidal pituitary surgery associated with increase in plasma levels of brain injury markers.

Patients undergoing pituitary surgery may experience short- and long-term postoperative morbidity. Intraoperative factors such as hypotension might be a contributing factor. Our aim was to investigate the association between intraoperative hypotension and postoperative plasma levels of tau, neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) as markers of perioperative brain injury. Between June 2016 and October 2017, 35 patients from the Gothenburg Pituitary Tumor Study were included. For tau, NfL, and GFAP, concentrations were measured in plasma samples collected before and immediately following surgery, and on postoperative days 1 and 5. The difference between the highest postoperative value and the value before surgery was used for analysis (∆taupeak , ∆NfLpeak , ∆GFAPpeak ). Intraoperative hypotension was defined as the area under the curve of an absolute threshold below 70 mmHg (AUC70) and a relative threshold below 20% (AUC20%) of the baseline mean arterial blood pressure. Plasma tau and GFAP were highest immediately following surgery and on day 1, while NfL was highest on day 5. There was a positive correlation between AUC20% and both ∆taupeak (r2 = .20, p < .001) and ∆NfLpeak (r2 = .26, p < .001). No association was found between AUC20% and GFAP or between AUC70 and ∆taupeak , ∆NfLpeak or ∆GFAPpeak . Intraoperative relative, but not absolute, hypotension was associated with increased postoperative plasma tau and NfL concentrations. Patients undergoing pituitary surgery may be vulnerable to relative hypotension, but this needs to be validated in future prospective studies.

Grey matter volume and CSF biomarkers predict neuropsychological subtypes of MCI

There is increasing evidence of different subtypes of individuals with mild cognitive impairment (MCI). An important line of research is whether neuropsychologically-defined subtypes have distinct patterns of neurodegeneration and cerebrospinal fluid (CSF) biomarker composition. In our study, we demonstrated that MCI participants of the ADNI database (N = 640) can be discriminated into 3 coherent neuropsychological subgroups. Our clustering approach revealed amnestic MCI, mixed MCI, and cluster-derived normal subgroups. Furthermore, classification modeling revealed that specific predictive features can be used to differentiate amnestic and mixed MCI from cognitively normal (CN) controls: CSF Aβ142 concentration for the former and CSF Aβ1–42 concentration, tau concentration as well as grey matter atrophy (especially in the temporal and occipital lobes) for the latter. In contrast, participants from the cluster-derived normal subgroup exhibited an identical profile to CN controls in terms of cognitive performance, brain structure, and CSF biomarker levels. Our comprehensive data analytics strategy provides further evidence that multimodal neuropsychological subtyping is both clinically and neurobiologically meaningful.