Journal Article DZNE-2025-00436

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Alpha synuclein co-pathology is associated with accelerated amyloid-driven tau accumulation in Alzheimer's disease.

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2025
Biomed Central London

Molecular neurodegeneration 20(1), 31 () [10.1186/s13024-025-00822-3]

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Abstract: Aggregated alpha-Synuclein (αSyn) is a hallmark pathology in Parkinson's disease but also one of the most common co-pathologies in Alzheimer's disease (AD). Preclinical studies suggest that αSyn can exacerbate tau aggregation, implying that αSyn co-pathology may specifically contribute to the Aβ-induced aggregation of tau that drives neurodegeneration and cognitive decline in AD. To investigate this, we combined a novel CSF-based seed-amplification assay (SAA) to determine αSyn positivity with amyloid- and tau-PET neuroimaging in a large cohort ranging from cognitively normal individuals to those with dementia, examining whether αSyn co-pathology accelerates Aβ-driven tau accumulation and cognitive decline.In 284 Aβ-positive and 308 Aβ-negative subjects, we employed amyloid-PET, Flortaucipir tau-PET, and a CSF-based αSyn seed-amplification assay (SAA) to detect in vivo αSyn aggregation. CSF p-tau181 measures were available for 384 subjects to assess earliest tau abnormalities. A subset of 155 Aβ-positive and 135 Aβ-negative subjects underwent longitudinal tau-PET over approximately 2.5 years. Using linear regression models, we analyzed whether αSyn SAA positivity was linked to stronger Aβ-related increases in baseline fluid and PET tau biomarkers, faster Aβ-driven tau-PET increase, and more rapid cognitive decline.αSyn SAA positivity was more common in Aβ + vs. Aβ- subjects and increased with clinical severity (p < 0.001). Most importantly, αSyn positivity was also associated with greater amyloid-associated CSF p-tau181 increases (p = 0.005) and higher tau-PET levels in AD-typical brain regions (p = 0.006). Longitudinal analyses confirmed further that αSyn positivity was associated with faster amyloid-related tau accumulation (p = 0.029) and accelerated amyloid-related cognitive decline, potentially driven driven by stronger tau pathology.Our findings suggest that αSyn co-pathology, detectable via CSF-based SAAs, is more prevalent in advanced AD and contributes to the development of aggregated tau pathology thereby driving faster cognitive decline. This highlights that a-Syn co-pathology may specifically accelerate amyloid-driven tau pathophysiology in AD, underscoring the need to consider αSyn in AD research and treatment strategies.

Keyword(s): Alzheimer Disease: diagnostic imaging (MeSH) ; Humans (MeSH) ; tau Proteins: metabolism (MeSH) ; Alzheimer Disease: metabolism (MeSH) ; Alzheimer Disease: pathology (MeSH) ; Female (MeSH) ; Male (MeSH) ; alpha-Synuclein: metabolism (MeSH) ; Aged (MeSH) ; Positron-Emission Tomography (MeSH) ; Amyloid beta-Peptides: metabolism (MeSH) ; Middle Aged (MeSH) ; Aged, 80 and over (MeSH) ; Biomarkers: metabolism (MeSH) ; Biomarkers: cerebrospinal fluid (MeSH) ; Cognitive Dysfunction: metabolism (MeSH) ; Cognitive Dysfunction: pathology (MeSH) ; Amyloid: metabolism (MeSH) ; Brain: metabolism (MeSH) ; Brain: pathology (MeSH) ; tau Proteins ; alpha-Synuclein ; Amyloid beta-Peptides ; Biomarkers ; MAPT protein, human ; Amyloid

Classification:

Contributing Institute(s):
  1. Clinical Research (Munich) (Clinical Research (Munich))
  2. Clinical Neurodegeneration (AG Levin)
  3. Molecular Neurodegeneration (AG Haass)
Research Program(s):
  1. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)
  2. 352 - Disease Mechanisms (POF4-352) (POF4-352)

Appears in the scientific report 2025
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Medline ; Creative Commons Attribution CC BY 4.0 ; DOAJ ; OpenAccess ; Article Processing Charges ; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; DOAJ Seal ; Ebsco Academic Search ; Essential Science Indicators ; Fees ; IF >= 15 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection
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Institute Collections > M DZNE > M DZNE-Clinical Research (Munich)
Document types > Articles > Journal Article
Institute Collections > M DZNE > M DZNE-AG Haass
Institute Collections > M DZNE > M DZNE-AG Levin
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 Record created 2025-03-19, last modified 2026-01-05


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