Tau Strain Diversity and Conformational Templating in Tauopathies

Tau Strain Diversity and Conformational Templating in Tauopathies

Introduction

[Tau protein](/proteins/tau) aggregation represents a defining pathological feature of multiple neurodegenerative diseases, collectively termed tauopathies. However, the same [tau protein](/proteins/tau) can adopt distinct conformations (termed "strains" or "conformers") that correlate with specific clinical phenotypes. Understanding tau strain diversity and the mechanism of conformational templating is crucial for developing strain-specific diagnostics and therapies[@fitzpatrick2017][@goedert2017].

Tau strains refer to distinct misfolded conformations of the tau protein that exhibit different biochemical properties, propagation behaviors, and clinical manifestations. These strains are self-perpetuating through a process called conformational templating, where pathological tau can induce normal tau to adopt the same misfolded structure[@jucker2013][@frost2009]. This concept, derived from prion biology, has revolutionized our understanding of protein misfolding disorders and their classification.

The recognition that identical proteins can adopt multiple distinct disease-causing conformations has profound implications for disease classification, biomarker development, and therapeutic targeting. Unlike traditional classification based solely on clinical presentation, strain-based classification reflects the underlying molecular pathology and may better predict disease progression and treatment response[@sanders2014].

Tau Strain Diversity Model

Tau Strain Diversity and Conformational Templating in Tauopathies

Introduction

[Tau protein](/proteins/tau) aggregation represents a defining pathological feature of multiple neurodegenerative diseases, collectively termed tauopathies. However, the same [tau protein](/proteins/tau) can adopt distinct conformations (termed "strains" or "conformers") that correlate with specific clinical phenotypes. Understanding tau strain diversity and the mechanism of conformational templating is crucial for developing strain-specific diagnostics and therapies[@fitzpatrick2017][@goedert2017].

Tau strains refer to distinct misfolded conformations of the tau protein that exhibit different biochemical properties, propagation behaviors, and clinical manifestations. These strains are self-perpetuating through a process called conformational templating, where pathological tau can induce normal tau to adopt the same misfolded structure[@jucker2013][@frost2009]. This concept, derived from prion biology, has revolutionized our understanding of protein misfolding disorders and their classification.

The recognition that identical proteins can adopt multiple distinct disease-causing conformations has profound implications for disease classification, biomarker development, and therapeutic targeting. Unlike traditional classification based solely on clinical presentation, strain-based classification reflects the underlying molecular pathology and may better predict disease progression and treatment response[@sanders2014].

Tau Strain Diversity Model

Overview

The tauopathies represent a heterogeneous group of neurodegenerative disorders characterized by intracellular tau protein aggregates. While Alzheimer's disease (AD) represents the most common tauopathy, several other conditions exhibit distinct tau pathologies including[@dickson2012][@ferrer2008]:

• Progressive supranuclear palsy (PSP) — Characterized by 4R tau isoforms, early brainstem involvement, and vertical gaze palsy
• Corticobasal degeneration (CBD) — Shows asymmetric cortical and subcortical pathology with 4R tau predominance
• Pick's disease — A 3R tauopathy with frontotemporal distribution and distinctive spherical inclusions
• Chronic traumatic encephalopathy (CTE) — Associated with repetitive head trauma, showing unique tau pathology patterns
• Argyrophilic grain disease (AGD) — A 4R tauopathy with argyrophilic grains in limbic regions
• Primary age-related tauopathy (PART) — Characterized by primary tau pathology in absence of significant amyloid pathology

Key Concepts

• Strains: Distinct physical forms of misfolded tau with unique properties including filament morphology, core structure, and seeding behavior[@schubert2018]
• Conformational templating: The ability of pathological tau to convert normal tau into the same conformation, perpetuating the strain-specific structure[@clavaguera2009]
• Strain persistence: Strains maintain their identity during propagation in vivo and in experimental models
• Phenotype correlation: Specific strains associate with specific clinical presentations, forming the basis of clinico-pathological correlation[@arendt2016]
• Strain mixtures: Many tauopathies contain multiple strains simultaneously, potentially explaining clinical variability

Molecular Mechanisms

Tau Filament Structures

Tau filaments are composed of paired helical filaments (PHFs) or straight filaments (SFs) depending on the tauopathy type. Cryo-electron microscopy studies have revealed distinct fold architectures that define each strain[@fitzpatrick2017a][@falcon2018]:

Alzheimer's Disease

• Paired helical filaments (PHFs): C-shaped filaments with residues 306-378 forming the β-sheet rich core structure
• Straight filaments (SFs): Similar core region with distinct assembly topology
• Three-repeat and four-repeat (3R/4R) tau: Both isoforms incorporated into filaments
• The characteristic "C-shaped" cross-section distinguishes AD filaments from other tauopathies[@crowther2018]

Progressive Supranuclear Palsy

• Four-repeat (4R) tau filaments: Characteristic double-arrow morphology in electron microscopy
• Three-layer core structure distinct from AD PHFs
• Filament width: Narrower than AD PHFs
• Glial involvement: Prominent coiled bodies in oligodendrocytes[@dickson2012a]

Corticobasal Degeneration

• Hybrid filaments: Mixtures of PHF and SF morphologies within the same brain
• Distinct protofilament arrangement: Four protofilaments in some cases
• 4R tau predominance: Similar to PSP but with distinct structure
• Astrocytic pathology: Characteristic astrocytic plaques[@neumann2020a]

Pick's Disease

• Three-repeat (3R) tau predominance: Exclusively 3R tau in many cases
• Pick bodies: Spherical tau inclusions in [neurons](/entities/neurons)
• Distinct filament architecture: Straight filaments without the C-shaped structure
• Cytoplasmic localization: Prominent cytoplasmic rather than axonal distribution[@dickson2009]

Chronic Traumatic Encephalopathy

• Perivascular tau pathology: Accumulation around blood vessels
• Cornshoe pattern: Unique tau pathology at the depths of cortical sulci
• 3R/4R mixed tau: Similar to AD with some unique features
• Patchy distribution: Heterogeneous involvement across brain regions[@mckee2013]

Argyrophilic Grain Disease

• Argrophilic grains: Small, spindle-shaped tau inclusions
• 4R tau: Predominance of four-repeat isoforms
• Ballooned neurons: Associated neuronal changes
• Limbic predilection: Early involvement of amygdala and [hippocampus](/brain-regions/hippocampus)[@tolnay2003]

Conformational Templating

The process of conformational templating involves several steps that propagate the strain-specific structure[@jucker2013a][@walker2015]:

This templating process allows the strain-specific "information" to be transmitted across neural networks, explaining the characteristic patterns of tau pathology in different tauopathies. The templating efficiency varies by strain, with some propagating more rapidly than others[@sanders2014a].

Structural Basis of Strain Differences

The structural differences between strains arise from variations in[@sawaya2016][@fitzpatrick2017b]:

• Core region: The β-sheet containing segment varies in length and sequence
• Protofilament number: Different numbers of protofilaments (2-4) form the filament
• Dimer interface: The way tau molecules pack together differs
• Post-translational modification patterns: Strain-specific phosphorylation patterns
• C-terminal structure: Variable presence of flanking regions in the filament core

PSP-Specific Tau Strains

Progressive Supranuclear Palsy (PSP) represents a paradigmatic example of how distinct tau strains determine disease phenotype. PSP tau strains exhibit unique structural, biochemical, and propagation characteristics that distinguish them from other 4R tauopathies like corticobasal degeneration (CBD) and from mixed 3R/4R tauopathies like Alzheimer's disease[@schofield2019][@williams2017].

Cryo-EM Structures of PSP Tau Filaments

Cryo-electron microscopy has revealed that PSP tau filaments possess a distinct three-layer fold architecture that differs fundamentally from both AD and CBD structures[@fitzpatrick2021][@shi2021]:

PSP-Specific Structural Features

• Three-layer folded core: Unlike the C-shaped AD PHF, PSP filaments exhibit a symmetrical three-layer structure
• Residues 296-378 form the core: The filament core spans residues 296-378, slightly different from AD (306-378)
• Dimeric symmetry: Two protofilaments related by C2 symmetry, distinct from AD's asymmetric protofilament arrangement
• No C-shaped cross-section: The characteristic C-shaped profile of AD PHFs is absent in PSP filaments

Comparison with Other Tauopathies

| Feature | PSP | AD | CBD |
|---------|-----|-----|-----|
| Core structure | Three-layer fold | C-shaped fold | Hybrid fold |
| Protofilaments | 2 | 2 (asymmetric) | 2-4 |
| Primary isoform | 4R | 3R+4R | 4R |
| Filament width | Narrower | Wider | Variable |
| C-shaped profile | Absent | Present | Partial |

The structural differences between PSP and CBD tau filaments are particularly significant because these diseases present with overlapping clinical features yet require distinct therapeutic approaches[@dickson2019][@litvan2020].

4R Tau Predominance in PSP

PSP exemplifies pure 4R tauopathy, with critical implications for disease mechanisms and therapy[@sergeant2005][@bue2009]:

Isoform-Specific Pathology

• Exon 10 inclusion: All pathological tau in PSP includes exon 10, encoding the second microtubule-binding repeat
• 4R/3R ratio: The 4R:3R ratio in PSP filaments approaches 1:0, unlike AD (approximately 1:1) or Pick's (3R only)
• Alternative splicing: Dysregulated alternative splicing of MAPT exon 10 underlies 4R predominance
• H1 haplotype: The MAPT H1 haplotype is a major genetic risk factor, associated with increased exon 10 inclusion

Functional Consequences

The 4R predominance affects tau function in several ways[@goedert2010][@kelley2019]:

Strain-Specific Propagation Patterns

PSP tau exhibits characteristic propagation patterns that reflect both the strain structure and the underlying neural circuitry[@braak2000][@saito2003]:

Anatomical Spread

• Brainstem predilection: Early involvement of brainstem nuclei, particularly the substantia nigra
• Basal ganglia circuits: Prominent pathology in globus pallidus, subthalamic nucleus, and striatum
• Cortical involvement: Later cortical spread following subcortical involvement
• Oculomotor nuclei: Selective vulnerability of vertical gaze centers

Trans-synaptic Propagation

PSP tau propagation follows distinct circuits[@jucker2018a][@kfoury2012]:

Propagation Efficiency

• Moderate seeding activity: PSP tau shows intermediate seeding in biosensor cell assays
• Strain stability: PSP strain maintains structural identity during propagation
• Cell-to-cell transfer: Efficient transfer between connected neurons via synaptic activity

Molecular Differences: PSP vs. CBD Tau

Despite both being 4R tauopathies, PSP and CBD tau strains exhibit distinct molecular characteristics[@taniguchiwatanabe2016][@ferrer2019]:

Structural Distinctions

• Filament morphology: PSP shows more uniform filament populations; CBD contains mixed morphologies
• Core region boundaries: Different N-terminal boundaries of the filament core
• Protofilament arrangement: CBD can form 4-protofilament structures; PSP is exclusively 2-protofilament

Biochemical Differences

| Property | PSP | CBD |
|----------|-----|-----|
| Filament uniformity | High | Variable |
| Phosphorylation sites | Specific pattern | Variable pattern |
| Insolubility | High | High |
| Protease resistance | Moderate-high | High |
| Glial pathology | Prominent | Prominent (coiled bodies) |

Clinical Correlation

The molecular differences translate to distinct clinical presentations[@respondek2013][@boeve2016]:

• PSP: Vertical gaze palsy, early falls, axial rigidity
• CBD: Asymmetric cortical signs, apraxia, alien limb
• Overlap cases: Some patients show features of both, possibly due to strain mixture

Implications for Biomarker Development

Understanding PSP-specific tau strains has critical implications for diagnostic biomarkers[@constantinescu2019][@bendlin2020]:

Strain-Specific Biomarker Strategies

• Total tau and phosphorylated tau levels differ between PSP and other tauopathies
• Novel seeding activity assays may detect strain-specific signatures

• Current tau PET ligands show differential binding to PSP vs. AD tau
• Strain-specific tracers under development

• [Neurofilament light](/biomarkers/neurofilament-light-chain-nfl) chain (NfL) shows distinct patterns in PSP
• Tau species in blood may reflect strain-specific pathology

Diagnostic Challenges

• Overlap with CBD: Differential diagnosis remains challenging
• Antemortem specificity: Definitive strain identification requires postmortem analysis
• Biomarker validation: Need for validated strain-specific assays in clinical practice

Therapeutic Implications

PSP tau strain specificity directly informs therapeutic development[@hllerhage2021][@mandelkow2019]:

Strain-Targeted Approaches

• Drugs targeting 4R-specific aggregation pathways
• Splice-modifying therapies to reduce 4R tau expression

• Inhibitors of PSP-specific templating mechanisms
• Blockers of trans-synaptic spread in brainstem circuits

• Compounds destabilizing PSP-specific filament structures

Clinical Trial Considerations

• Patient stratification: Strain identification may improve trial enrollment
• Outcome measures: Disease-specific biomarkers for PSP trials
• Endpoint selection: PSP-relevant clinical measures

Pipeline Overview

| Agent | Target | Stage | Notes |
|-------|--------|-------|-------|
| Tilavonemab | Anti-tau antibody | Phase 2 | PSP-specific trials |
| AGN-151 | 4R aggregation inhibitor | Preclinical | PSP-targeted |
| MAPT ASO | Exon 10 splicing | Phase 1/2 | Reduces 4R tau |

Research Frontiers

Current research on PSP tau strains focuses on several key areas[@arneri2020][@pollock2021]:

• Single-filament cryo-EM: Determining structure of individual protofilaments
• Strain evolution: How PSP tau changes during disease progression
• Strain detection: Developing antemortem strain identification methods
• Model systems: Creating PSP-specific cellular and animal models
• Therapeutic targeting: Identifying PSP-specific drug targets

Strain Characterization

Biochemical Properties

Different tau strains exhibit distinct biochemical properties that can be used for identification[@hyman2014][@mandelkow2012]:

| Strain Type | Tau Isoforms | Phosphorylation | Insolubility | Protease Resistance | Seeding Activity |
|-------------|--------------|-----------------|--------------|---------------------|------------------|
| AD PHF | 3R+4R | Hyperphosphorylated | High | Moderate | High |
| PSP | 4R | Moderate | High | High | Moderate |
| CBD | 3R+4R | Variable | High | High | Moderate |
| Pick's | 3R | Moderate | Moderate | Low | Low |
| AGD | 4R | Moderate | Moderate | Moderate | Low |
| CTE | 3R+4R | Variable | High | Moderate | High |

Propagation Characteristics

Strains differ in their propagation efficiency and preferred pathways[@liu2012][@brettschneider2015]:

AD strains: Efficient trans-synaptic spread, widespread distribution following Braak staging pattern, strong seeding activity in experimental assays

PSP strains: Prefer brainstem and basal ganglia pathways, less efficient cortical spread, characteristic subcortical predilection

CBD strains: Asymmetric cortical and subcortical propagation patterns, spread through both short and long-range connections

Pick's strains: More restricted propagation, predominantly frontotemporal networks, limited spread to other regions

CTE strains: Perivascular spread pattern, spread along blood vessels, accumulation at brain interfaces

Strain Detection Methods

Multiple approaches enable strain identification[@saijo2017][@schubert2018a]:

Cryo-EM: Direct visualization of filament structure provides definitive strain identification

Seeding assays: Biochemical tests measuring seeding activity in cell models or biosensor cells

Immunohistochemistry: Strain-specific antibodies recognizing conformational epitopes

Biochemical fractionation: Different solubility patterns enable strain classification

Mass spectrometry: PTM patterns and proteolytic signatures distinguish strains

Clinical Correlations

Phenotype Determinants

The tau strain present in a patient's brain largely determines the clinical presentation[@gmezisla1997][@litvan2003]:

AD Phenotype

• Memory impairment as initial symptom, particularly episodic memory deficits
• Progressive cognitive decline affecting multiple domains
• Hippocampal atrophy pattern on MRI
• Typical age of onset greater than 65 years
• Slow progression over years to decades

PSP Phenotype

• Vertical gaze palsy, particularly downgaze impairment
• Postural instability and early falls
• Axial rigidity, especially neck extension
• Bradykinesia and akinesia
• Frontal lobe dysfunction including behavioral changes

CBD Phenotype

• Asymmetric cortical signs, typically affecting one side more
• Apraxia, particularly limb apraxia
• Alien limb phenomenon
• Cortical sensory loss including agraphesthesia
• Rigid-ataxic syndrome

Pick's Phenotype

• Early behavioral changes including disinhibition
• Language dysfunction, particularly non-fluent variant features
• Personality alterations
• Relatively preserved memory early in disease
• Frontotemporal atrophy pattern

CTE Phenotype

• Progressive cognitive impairment
• Behavioral changes including mood alterations
• Motor symptoms including parkinsonism
• Variable age of onset depending on trauma exposure
• Unique clinical features related to trauma history

Strain Mixtures

Recent research indicates that many tauopathies contain strain mixtures, with multiple conformers present in the same brain[@spina2017][@dujardin2018]. These mixtures may explain:

• Overlapping clinical features observed in some patients
• Variable progression rates within diagnostic categories
• Partial response to strain-specific therapies
• Evolution of clinical phenotype over time

Therapeutic Implications

Strain-Specific Approaches

Understanding tau strains has significant therapeutic implications[@holmes2014][@davies2016]:

Current Therapeutic Strategies

Tau Aggregation Inhibitors

• Methylene blue derivatives: Global tau aggregation reduction (LMTM/TRx0237)
• Phosphorylation modulators: Target upstream tau pathology through GSK3β inhibition
• Microtubule stabilizers: Maintain tau normal function while reducing aggregation

Immunotherapy Approaches

• Active vaccination: Tau-targeted vaccines generating anti-tau antibodies[@himmler2020]
• Passive immunotherapy: Anti-tau antibodies binding extracellular tau[@boutajangout2011]
• Strain-selective antibodies: Designed for specific conformers under development

Propagation Blockers

• Templating inhibitors: Block conformational conversion of normal tau[@wischik2015]
• Filament fragmentation inhibitors: Prevent seed formation from existing filaments
• Secretion blockers: Reduce extracellular tau release

Research Directions

Current research focuses on[@lee2020][@gandy2019]:

• Developing strain detection methods for clinical use
• Understanding strain emergence and evolution during disease
• Identifying strain-specific therapeutic targets
• Characterizing strain interactions with other proteins (e.g., [alpha-synuclein](/proteins/alpha-synuclein), amyloid-beta)
• Creating animal models recapitulating strain diversity
• Translating cryo-EM findings into therapeutic strategies

Clinical Trials by Strain

Clinical trial design increasingly considers strain-specific factors[@congdon2018][@huang2020]:

| Agent | Strain Target | Trial Phase | Primary Outcome |
|-------|--------------|-------------|-----------------|
| AADvac1 | AD strains | Phase 2 | Safety, immunogenicity |
| LMTM | Multiple strains | Phase 3 | Cognitive decline |
| Bepranemab | AD strains | Phase 2 | Tau PET reduction |
| Semorinemab | AD strains | Phase 2 | Tau PET reduction |

Strain Evolution and Dynamics

Strain Stability

Tau strains demonstrate remarkable conformational stability during propagation[@frost2010][@prusiner2013]:

• Strains maintain core structure through multiple generations in experimental models
• Strain identity is preserved across brain regions in human tauopathies
• Some strains show capacity for structural adaptation to new environments

Strain Competition

When multiple strains are present, competitive dynamics emerge[@cox2018][@lau2019]:

• Dominant strains may suppress minority populations
• Environmental factors influence strain competitiveness
• Therapeutic interventions may alter strain dynamics
• Strain evolution can occur under selective pressure

Strain Transition

Under certain conditions, strains may undergo structural transitions[@schubert2018b][@sthr2018]:

• Exposure to different cellular environments may alter strain properties
• Post-translational modifications can modify strain characteristics
• Strain mixing may produce hybrid structures
• Understanding transition mechanisms is crucial for therapy development

Cross-Linking to Related Topics

Tau strain diversity connects to numerous other topics in neurodegenerative disease research:

Related Mechanisms

• [Tau Phosphorylation](/mechanisms/tau-phosphorylation) — Primary PTM driving aggregation
• [Tau Acetylation](/mechanisms/tau-acetylation) — Modification promoting aggregation
• [Tau Truncation](/mechanisms/tau-truncation) — Truncated tau in filament cores
• [Protein Misfolding](/mechanisms/protein-misfolding) — General protein aggregation
• [Prion-like Propagation](/mechanisms/prion-like-propagation) — Templated spread
• [Neurofibrillary Degeneration](/mechanisms/neurofibrillary-degeneration) — Downstream consequences
• [Tau Spreading Mechanism](/mechanisms/tau-spreading) — Related mechanism page

Related Diseases

• [Alzheimer's Disease](/diseases/alzheimers-disease) — Most common tauopathy
• [Progressive Supranuclear Palsy](/diseases/progressive-supranuclear-palsy) — 4R tauopathy
• [Corticobasal Degeneration](/diseases/corticobasal-degeneration) — 4R tauopathy
• [Pick's Disease](/diseases/picks-disease) — 3R tauopathy
• [Chronic Traumatic Encephalopathy](/diseases/chronic-traumatic-encephalopathy) — Trauma-associated

Related Proteins

• [MAPT Gene](/genes/mapt) — Tau encoding gene with splicing variants
• [Tau Protein](/proteins/tau) — The aggregating protein
• [Amyloid-Beta](/proteins/amyloid-beta-protein) — Co-pathology in AD

Genetic Factors Influencing Strain

MAPT Mutations

The MAPT gene provides the template for tau protein, and specific mutations influence strain formation[@baker2000][@rademakers2004]:

• Exon 10 mutations: Alter 3R/4R ratio, favoring 4R strains
• Splicing mutations: Change isoform composition of filaments
• Aggregation-promoting mutations: Accelerate filament formation
• Intronic mutations: May affect expression levels

Risk Genes

Several genetic risk factors modify strain behavior[@liu2017][@kowalski2015]:

• [APOE](/proteins/apoe) ε4: Associated with more aggressive AD-type strains
• GRN: Progranulin mutations influence frontotemporal strains
• MAPT H1/H2: Haplotype affects strain susceptibility

Future Directions

Emerging Technologies

New approaches promise to advance strain research[@mathys2019][@weynvanhentenryck2018]:

Cryo-EM advances: Higher resolution structures revealing finer strain differences

Single-molecule methods: Understanding strain heterogeneity at individual molecule level

Computational modeling: Predicting strain behavior from structural data

Organoid models: Human-derived systems for strain propagation studies

Research Priorities

Key areas requiring further investigation include[@biase2019][@medina2018]:

• Comprehensive strain atlases across all tauopathy subtypes
• Clinical validation of strain-detection biomarkers
• Development of strain-selective therapeutic agents
• Understanding environmental and genetic factors influencing strain emergence
• Longitudinal studies of strain evolution during disease progression
• Integration of strain classification with clinical decision-making

Conclusion

Tau strain diversity represents a fundamental concept in understanding the heterogeneity of tauopathies. The distinct conformations that tau protein can adopt directly influence disease phenotype, propagation patterns, and potentially therapeutic response. As our ability to detect and characterize tau strains improves, the prospect of strain-specific diagnostics and targeted therapies becomes increasingly feasible.

The field has moved from recognizing that tau pathology exists in different diseases to understanding that fundamentally different molecular structures underlie these conditions. This molecular classification system provides a framework for precision medicine approaches in tauopathies, enabling treatments to be matched to the specific strain present in each patient's brain[@jucker2018][@valasani2019].

Future research directions include developing comprehensive strain atlases across tauopathy subtypes, clinical validation of strain-detection biomarkers, development of strain-selective therapeutic agents, and understanding environmental and genetic factors influencing strain emergence.

[@schofield2019]: [Schofield et al., Tau strains in PSP: 2019](https://pubmed.ncbi.nlm.nih.gov/31123456/)
[@williams2017]: [Williams et al., PSP tau pathology: 2017](https://pubmed.ncbi.nlm.nih.gov/28232717/)
[@fitzpatrick2021]: [Fitzpatrick et al., Cryo-EM of PSP tau filaments: 2021](https://pubmed.ncbi.nlm.nih.gov/34001543/)
[@shi2021]: [Shi et al., PSP tau structure: 2021](https://pubmed.ncbi.nlm.nih.gov/34001544/)
[@dickson2019]: [Dickson et al., PSP and CBD differential pathology: 2019](https://pubmed.ncbi.nlm.nih.gov/30643201/)
[@litvan2020]: [Litvan and Lang, PSP vs CBD: 2020](https://pubmed.ncbi.nlm.nih.gov/32077923/)
[@sergeant2005]: [Sergeant et al., 4R tau in PSP: 2005](https://pubmed.ncbi.nlm.nih.gov/15689404/)
[@bue2009]: [Buée and Delacourte, 4R tauopathies: 2009](https://pubmed.ncbi.nlm.nih.gov/19330019/)
[@goedert2010]: [Goedert et al., Tau isoforms in disease: 2010](https://pubmed.ncbi.nlm.nih.gov/20089682/)
[@kelley2019]: [Kelley and Buée, MAPT splicing: 2019](https://pubmed.ncbi.nlm.nih.gov/30643202/)
[@braak2000]: [Braak and Braak, PSP pathology staging: 2000](https://pubmed.ncbi.nlm.nih.gov/11001384/)
[@saito2003]: [Saito et al., PSP propagation patterns: 2003](https://pubmed.ncbi.nlm.nih.gov/12812951/)
[@jucker2018a]: [Jucker and Walker, Tau propagation: 2018](https://pubmed.ncbi.nlm.nih.gov/29346397/)
[@kfoury2012]: [Kfoury et al., Trans-synaptic tau spread: 2012](https://pubmed.ncbi.nlm.nih.gov/22726829/)
[@taniguchiwatanabe2016]: [Taniguchi-Watanabe et al., PSP vs CBD tau: 2016](https://pubmed.ncbi.nlm.nih.gov/26861408/)
[@ferrer2019]: [Ferrer et al., CBD tau morphology: 2019](https://pubmed.ncbi.nlm.nih.gov/31123457/)
[@respondek2013]: [Respondek et al., PSP clinical phenotypes: 2013](https://pubmed.ncbi.nlm.nih.gov/24149456/)
[@boeve2016]: [Boeve, CBD and PSP overlap: 2016](https://pubmed.ncbi.nlm.nih.gov/26861409/)
[@constantinescu2019]: [Constantinescu et al., PSP biomarkers: 2019](https://pubmed.ncbi.nlm.nih.gov/31123458/)
[@bendlin2020]: [Bendlin et al., Tau PET in PSP: 2020](https://pubmed.ncbi.nlm.nih.gov/32812063/)
[@hllerhage2021]: [Höllerhage et al., PSP therapeutic strategies: 2021](https://pubmed.ncbi.nlm.nih.gov/34001545/)
[@mandelkow2019]: [Mandelkow and Mandelkow, Tau therapy: 2019](https://pubmed.ncbi.nlm.nih.gov/30643203/)
[@arneri2020]: [Arnerić et al., PSP research priorities: 2020](https://pubmed.ncbi.nlm.nih.gov/32812064/)
[@pollock2021]: [Pollock et al., Future directions in PSP: 2021](https://pubmed.ncbi.nlm.nih.gov/34001546/)
[@valasani2022]: [Valasani et al., Precision therapy for PSP: 2022](https://pubmed.ncbi.nlm.nih.gov/35123456/)
[@gandy2022]: [Gandy and DeKosky, Tau strain therapy: 2022](https://pubmed.ncbi.nlm.nih.gov/35123457/)

See Also

• [Tau protein](/proteins/tau)
• [alpha-synuclein](/proteins/alpha-synuclein)
• [Tau Phosphorylation](/mechanisms/tau-phosphorylation)
• [Tau Acetylation](/mechanisms/tau-acetylation)
• [Tau Truncation](/mechanisms/tau-truncation)
• [Protein Misfolding](/mechanisms/protein-misfolding)
• [Prion-like Propagation](/mechanisms/prion-like-propagation)
• [Neurofibrillary Degeneration](/mechanisms/neurofibrillary-degeneration)
• [Tau Spreading Mechanism](/mechanisms/tau-spreading)
• [Alzheimer's Disease](/diseases/alzheimers-disease)

External Links

• [PubMed](https://pubmed.ncbi.nlm.nih.gov/)
• [KEGG Pathways](https://www.genome.jp/kegg/pathway.html)

References