The 4R-tauopathies represent a group of neurodegenerative disorders characterized by the accumulation of hyperphosphorylated 4-repeat (4R) tau protein, including [Progressive Supranuclear Palsy (PSP)](/diseases/progressive-supranuclear-palsy), [Corticobasal Degeneration (CBD)](/diseases/corticobasal-degeneration), [Argyrophilic Grain Disease (AGD)](/diseases/argyrophilic-grain-disease), [Globular Glial Tauopathy (GGT)](/diseases/globular-glial-tauopathy), and [Frontotemporal Dementia with Parkinsonism-17 (FTDP-17)](/genes/mapt). While tau pathology is the hallmark of these disorders, emerging evidence demonstrates that RNA metabolism dysregulation plays a critical pathogenic role, with RNA-binding proteins (RBPs) such as TDP-43, FUS, and heterogeneous nuclear ribonucleoproteins (hnRNPs) contributing to disease progression[@baker2021][@dormann2021].
This pathway model maps the complete landscape of RNA metabolism dysfunction in 4R-tauopathies, examining splicing alterations, RNA granule formation, translational dysregulation, and shared mechanisms with TDP-43 proteinopathies in [Amyotrophic Lateral Sclerosis (ALS)](/mechanisms/als-tdp43-pathway) and [Frontotemporal Dementia (FTD)](/mechanisms/ftd-tdp43-pathway).
The 4R-tauopathies represent a group of neurodegenerative disorders characterized by the accumulation of hyperphosphorylated 4-repeat (4R) tau protein, including [Progressive Supranuclear Palsy (PSP)](/diseases/progressive-supranuclear-palsy), [Corticobasal Degeneration (CBD)](/diseases/corticobasal-degeneration), [Argyrophilic Grain Disease (AGD)](/diseases/argyrophilic-grain-disease), [Globular Glial Tauopathy (GGT)](/diseases/globular-glial-tauopathy), and [Frontotemporal Dementia with Parkinsonism-17 (FTDP-17)](/genes/mapt). While tau pathology is the hallmark of these disorders, emerging evidence demonstrates that RNA metabolism dysregulation plays a critical pathogenic role, with RNA-binding proteins (RBPs) such as TDP-43, FUS, and heterogeneous nuclear ribonucleoproteins (hnRNPs) contributing to disease progression[@baker2021][@dormann2021].
This pathway model maps the complete landscape of RNA metabolism dysfunction in 4R-tauopathies, examining splicing alterations, RNA granule formation, translational dysregulation, and shared mechanisms with TDP-43 proteinopathies in [Amyotrophic Lateral Sclerosis (ALS)](/mechanisms/als-tdp43-pathway) and [Frontotemporal Dementia (FTD)](/mechanisms/ftd-tdp43-pathway).
TDP-43 is a nuclear DNA/RNA-binding protein encoded by the [TARDBP](/genes/tardbp) gene, involved in multiple RNA processing functions including transcription regulation, alternative splicing, RNA transport, and stability[@baker2021]. In healthy neurons, TDP-43 predominantly localizes to the nucleus, but in disease states it mislocalizes to the cytoplasm where it forms inclusion bodies.
| Disease | TDP-43 Inclusions | Frequency | Reference |
|---------|-------------------|-----------|-----------|
| PSP | Neuronal and glial cytoplasmic inclusions | 10-30% | [@baker2021tdp] |
| CBD | Motor cortex and basal ganglia | 20-40% | [@koga2017tdp] |
| AGD | Limbic system, amygdala | 15-25% | [@yokota2020tdp] |
| GGT | White matter, oligodendrocytes | 5-15% | [@ahmed2013ggt] |
| FTDP-17 | Frontal cortex, brainstem | Variable | [@zheng2022tdp] |
Pathogenic mechanisms:
FUS is another DNA/RNA-binding protein involved in transcription, RNA splicing, transport, and translation[@dormann2021]. Pathogenic FUS mutations cause familial ALS and FTD, but FUS pathology is also observed in 4R-tauopathies.
The hnRNP family includes over 20 proteins (hnRNPA1, hnRNPA2B1, hnRNPK, hnRNPL, hnRNPU, etc.) that regulate RNA splicing, stability, transport, and translation[@jeanmarc2022].
| hnRNP | Function | Dysregulation in 4R-Tauopathies |
|-------|----------|--------------------------------|
| [hnRNPA1](/proteins/hnrnp-a1-protein) | Splicing regulation, stress granule formation | Aggregate formation in PSP and CBD |
| [hnRNPA2B1](/proteins/hnrnpa2b1-protein) | RNA splicing, transport | Mutations cause multisystem proteinopathy |
| [HNRNPK](/proteins/hnrnpk-protein) | Transcription, RNA processing | Altered expression in CBD |
| hnRNPL | Alternative splicing | Dysregulated in PSP |
The MAPT gene produces six tau isoforms through alternative splicing of exons 2, 3, and 10. Exclusion of exon 10 produces 3R tau, while inclusion produces 4R tau. In 4R-tauopathies, there is a selective increase in 4R tau isoforms[@wang2024].
Splicing regulators affected:
TDP-43 depletion leads to the inclusion of cryptic exons in multiple transcripts [@ling2025]:
| Disease | Key Splicing Alterations | Reference |
|---------|-------------------------|-----------|
| PSP | Aberrant splicing of neuronal transcripts, MAPT splice variants | [@lawton2012psp] |
| CBD | Splicing changes in cytoskeletal, synaptic genes | [@koga2018cbd] |
| AGD | Limbic system splicing alterations | [@mithihara2019agd] |
Stress granules (SGs) are cytoplasmic RNA-protein aggregates formed under stress conditions (oxidative stress, heat shock, viral infection) to stall translation and protect mRNAs [@wolozin2022]. They contain:
| Feature | PSP | CBD | AGD | GGT |
|---------|-----|-----|-----|-----|
| TIA1-positive SGs | ++ | ++ | + | + |
| G3BP1-positive SGs | ++ | ++ | + | + |
| Co-localization with tau | Yes | Yes | Rare | Yes |
Pathogenic cascade:
P-bodies are cytoplasmic foci involved in mRNA decay and storage. Unlike stress granules, they are present constitutively and increase under specific conditions [@standart2024].
4R-tauopathies exhibit widespread translational dysregulation:
| Target | Function | Dysregulation | Consequence |
|--------|----------|---------------|-------------|
| Synaptic proteins | Neurotransmission | Reduced synthesis | Synaptic dysfunction |
| Mitochondrial proteins | Energy metabolism | Impaired translation | Energy failure |
| Cytoskeletal proteins | Structure | Altered expression | Axonal transport defects |
The concept of "ribostasis" refers to the proper balance of ribosome biogenesis, translation, and mRNA decay [@hetauer2023]. In 4R-tauopathies:
| Mechanism | 4R-Tauopathies | ALS/FTD | Shared? |
|-----------|----------------|---------|---------|
| TDP-43 aggregation | + | +++ | Yes |
| Stress granule formation | ++ | +++ | Yes |
| Nuclear import defects | + | +++ | Yes |
| Cryptic exon splicing | + | +++ | Yes |
| FUS pathology | + | +++ | Partial |
| hnRNP dysfunction | ++ | +++ | Yes |
| Target | Approach | Stage | Reference |
|--------|----------|-------|-----------|
| TDP-43 nuclear import | Small molecule enhancers | Preclinical | [@neefjes2021] |
| Stress granule clearance | Autophagy modulators | Preclinical | [@wedge2021] |
| Splicing correction | ASO-mediated | Clinical (ALS) | [@corti2022] |