Seeds of a revolution?

Decades ago, the discovery that specific proteins aggregated in the brain cells of specific neurodegenerative diseases was a major advance.  But like so many other scientific breakthroughs, it created another question: Why are there so many different clinical pictures among different people with the same neurodegenerative disease (like PSP) despite the fact that they all host the same aggregating protein (in this case, tau)? The ability of abnormal tau to “seed” the disease process into previously healthy brain areas is at the root of the disease process, but we’ve had scant clue as to how that works, exactly.

For PSP, the most important clinical variable is the eight subtypes (PSP-Richardson’s syndrome vs PSP-Parkinsonism vs PSP-progressive gait freezing, etc), and slightly less variable features are the onset age and rate of progression.  In the past year or two, it’s become clear that the different subtypes tend to emphasize different areas of the brain, but that doesn’t explain why two people with the same subtype can have different onset ages and rates of progression.

This mystery became even more mysterious recently when a new electron microscopy technique called “cryo-EM” proved able to visualize individual protein molecules. It showed that for everyone with a given disease, the protein for that disease had the same misfolded shape.  In other words, the tau molecule assumes the same rigid squiggle in everyone with PSP, a different rigid squiggle in everyone with Alzheimer’s, yet another in everyone with corticobasal degeneration, and so on.  But that raised the question as to the reason for the variability among patients of the PSP onset age and rate of progression.

Now, researchers at the University of Toronto’s Rossy Centre, an institution dedicated solely to PSP research at the , have found new evidence supporting the old idea that the key may be in the “oligomers” or “high-molecular weight tau” or “HMW tau.”  These are stacks of tau protein molecules small enough to remain dissolved in the brain’s fluids, as opposed to single molecules or the large, insoluble neurofibrillary tangles visible through a conventional microscope. 

The top-line result was that the patients with more rapidly-progressive PSP and brain regions with the worst damage had higher levels of HMW tau.  In a tour-de-force of lab experiments, the Toronto researchers also showed that:

  • HMW tau was more resistant to the brain’s mechanism for breaking down such protein clusters.
  • The study’s 25 PSP patients could be divided into high-, medium- and low-seeders based on the speed with which their tau converted healthy tau to their own misfolded form.
  • Tau with phosphate groups attached to amino acids 202 and 205 were least likely to form the HMW tau clusters.
  • The pattern of production of proteins (i.e., the “proteomics”) in the brain areas rich in HMW tau showed disruption of the brain’s adaptive immune system and two other cellular systems previously known to be related to neurodegeneration.

The importance of all this is that we now have a more specific idea of the structure of the most toxic form of tau aggregates and that boosting the brain’s adaptive immune system with medication could discourage the seeding of misfolded tau into healthy cells.

The study’s first author, Dr. Ivan Martinez-Valbuena, published an editorial in the journal Brain Pathology explaining all this in language that non-specialist scientists can understand.

The research paper itself is posted by the authors in bioRxiv (“bio-archive”) an on-line, open-access website for articles awaiting word from the peer-review process at a conventional journal. Its senior author is Dr. Gabor Kovacs, one of the world’s leading neuropathologists in the field of neurodegenerative diseases.

You gotta know when to fold ’em

The last few posts have been about things at the macro level, from clinical trials to government action.  Now, let’s dive back into some molecular biology — if you’re nerd enough for it.

Yesterday, a paper appeared from researchers at the University of Alberta, in Canada, led by Drs. Kerry T. Sun and Sue-Ann Mok, comparing the folding structure of normal and abnormal versions of the tau protein. 

First, some background.  You all know that proteins are strings of amino acids. The healthy adult human brain has six forms of the tau protein ranging in size from 352 to 441 amino acids.  Tau’s normal job is to maintain brain cells’ internal structure and some other housekeeping tasks.  Tau unattached to something else normally flops around in the cell’s fluid like a piece of overcooked spaghetti in boiling water.  In PSP and the other tau-related disorders, tau becomes abnormally folded onto itself and forms toxic clusters that eventually clump further into neurofibrillary tangles.  Those are visible through a microscope and are critical in the diagnosis of the “tauopathies” although the details of how misfolded or aggregated tau actually causes loss of brain cells remain unknown.

Some more background: Although over 99% of people with PSP have no mutations in the tau gene, there are 50 different mutations in tau that do cause neurodegenerative diseases, many of which closely resemble PSP.  The most widely used experimental animal model for PSP has received a copy of a human tau gene with one of these 50 mutations. 

The new project analyzed the folding structure of normal tau protein and samples of abnormal tau protein, each with one of the 37 most important tauopathy-causing mutations.  It found that, at least as far as this lab technique could determine, no structural difference between normal tau and two of the most popular abnormal versions of tau used in research, the P301S mutation (where the amino acid proline at position 301 is replaced by the amino acid serine) and the R406W (arginine to tryptophan).  Another mutation commonly used in animal models, P301L (proline to leucine) does alter the structure.  That’s the form of tau addressed by the two monoclonal antibodies that AbbVie and Biogen, respectively, recently found did not help PSP. 

Of the other 34 mutations tested, 12 produced no structural change and the location of the mutation had no discernible effect on the folding structure.  Nor did the rate of aggregation influence the resulting structure. 

Interestingly, one of those 12 producing detectable misfolding is the A152T (alanine to threonine) mutation, which is the only single-amino-acid substitution tau mutation we know of that increases the risk of “sporadic” (i.e., non-familial) PSP.   

There are some caveats:

  • This study does not examine the effects of post-translational modifications (PTMs) on the folding structure of tau.  Nor did it study the effects of the various mutations on the ability to accept PTMs.  PTM’s are small molecules such as phosphate, acetate, methyl groups, sugars, and ubiquitin that can be attached to the protein in health to regulate its function, or as an effect of disease processes like PSP. 
  • The study restricted itself to only one of the six adult human tau isoforms, called 0N4R.
  • The 0N4R form of tau has 383 amino acids (the others range from 352 to 441) and locations that can alter the folding pattern occur in only about 45 of those.  So, as you’d guess, an amino acid substitution can change the chemical properties of a protein without changing its folding pattern.  Another major issue is that many of those 45 misfolding spots are hidden inside the folded structure, obscuring them from the researchers’ analysis.

Despite these limitations, we can conclude that the various amino acid substitutions affect the misfolding pattern of tau in different ways.  Any explanation of the cause of ordinary, sporadic PSP at its most profound molecular level can be guided by studying all of those misfolding patterns for hereditary PSP but will also have to take account of whatever bad thing the A152T mutation is doing – and that thing, according to this paper, is NOT to directly cause tau to misfold.