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Phosphorylated tau in the retina correlates with tau pathology in the brain in Alzheimer’s disease and primary tauopathies

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A Correction to this article was published on 23 December 2022

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Abstract

The retina is a potential source of biomarkers for the detection of neurodegenerative diseases. Accumulation of phosphorylated tau (p-tau) in the brain is a pathological feature characteristic for Alzheimer’s disease (AD) and primary tauopathies. In this study the presence of p-tau in the retina in relation to tau pathology in the brain was assessed. Post-mortem eyes and brains were collected through the Netherlands Brain Bank from donors with AD (n = 17), primary tauopathies (n = 8), α-synucleinopathies (n = 13), other neurodegenerative diseases including non-tau frontotemporal lobar degeneration (FTLD) (n = 9), and controls (n = 15). Retina cross-sections were assessed by immunohistochemistry using antibodies directed against total tau (HT7), 3R and 4R tau isoforms (RD3, RD4), and phospho-epitopes Ser202/Thr205 (AT8), Thr217 (anti-T217), Thr212/Ser214 (AT100), Thr181 (AT270), Ser396 (anti-pS396) and Ser422 (anti-pS422). Retinal tau load was compared to p-tau Ser202/Thr205 and p-tau Thr217 load in various brain regions. Total tau, 3R and 4R tau isoforms were most prominently present in the inner plexiform layer (IPL) and outer plexiform layer (OPL) of the retina and were detected in all cases and controls as a diffuse and somatodendritic signal. Total tau, p-tau Ser202/Thr205 and p-tau Thr217 was observed in amacrine and horizontal cells of the inner nuclear layer (INL). Various antibodies directed against phospho-epitopes of tau showed immunoreactivity in the IPL, OPL, and INL. P-tau Ser202/Thr205 and Thr217 showed significant discrimination between AD and other tauopathies, and non-tauopathy cases including controls. Whilst immunopositivity was observed for p-tau Thr212/Ser214, Thr181 and Ser396, there were no group differences. P-tau Ser422 did not show any immunoreactivity in the retina. The presence of retinal p-tau Ser202/Thr205 and Thr217 correlated with Braak stage for NFTs and with the presence of p-tau Ser202/Thr205 in hippocampus and cortical brain regions. Depending on the phospho-epitope, p-tau in the retina is a potential biomarker for AD and primary tauopathies.

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Most data generated or analyzed during this study are included in this published manuscript and the supplementary material. Additional data are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to acknowledge all donors and their caregivers. We thank N.P. Smoor for his technical expertise and assistance in retinal tissue preparation. We thank Michiel Kooreman for helping with clinical data retrieval and his assistance at the Netherlands Brain Bank in collecting brain sections. We thank Jacoline B. ten Brink and Arthur A.B. Bergen for their technological support and advice on the retina. We thank Gina Gase for technical assistance with tissue preparation and immunohistochemistry. We thank A. Dijkstra for contributing to the assessment of the visual system. Illustration was created with BioRender.com.

Funding

This research was funded by the Netherlands Organisation for Scientific Research (NWO, MEDPHOT P18-26 Project 5).

Author information

Author notes

  1. Frederique J. Hart de Ruyter and Tjado H. J. Morrema are co-first authors.

Authors and Affiliations

  1. Amsterdam UMC Location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, The Netherlands

    Frederique J. Hart de Ruyter, Tjado H. J. Morrema, Baayla D. C. Boon, Annemieke J. Rozemuller & Jeroen J. M. Hoozemans

  2. Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands

    Frederique J. Hart de Ruyter, Jurre den Haan, Philip Scheltens, Baayla D. C. Boon & Femke H. Bouwman

  3. Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands

    Jos W. R. Twisk

  4. Vrije Universiteit Amsterdam, LaserLaB, Physics and Astronomy, Amsterdam, The Netherlands

    Johannes F. de Boer

  5. Mayo Clinic, Neuroscience, Jacksonville, FL, USA

    Baayla D. C. Boon

  6. Laboratory for Neuropathology, Department of Imaging and Pathology, KU Leuven (University of Leuven), Leuven Brain Institute, O&N IV Herestraat 49, 3000, Louvain, Belgium

    Dietmar R. Thal

  7. Department of Pathology, University Hospitals Leuven, 3000, Louvain, Belgium

    Dietmar R. Thal

  8. Amsterdam UMC Location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan 1117, Amsterdam, The Netherlands

    Frank D. Verbraak

  9. Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands

    Femke H. Bouwman & Jeroen J. M. Hoozemans

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  1. Frederique J. Hart de Ruyter
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Contributions

All authors contributed to the study conception and design. Experiments were performed by THJM. Data collection and analysis were performed by FJHR and THJM. The first draft of the manuscript was written by FJHR and JJMH. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Frederique J. Hart de Ruyter or Jeroen J. M. Hoozemans.

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Conflict of interest

F.J. Hart de Ruyter reports no competing interests; T.H.J. Morrema reports no competing interests; Dr. J. den Haan reports no competing interests; Prof. dr. J.W.R. Twisk reports no competing interests; Prof. dr. J.F. de Boer has acquired grant support (for the institution; Department of Physics, VU) from the Dutch Research Council (NWO) and from industry (Thorlabs, ASML, Heidelberg Engineering). He has received royalties related to IP on OCT technologies and semiconductor metrology. He has acted as an expert witness for a UK based law firm; Prof. Dr. P. Scheltens has received consultancy fees (paid to the university) from Alzheon, Brainstorm Cell and Green Valley. Within his university affiliation he is global PI of the phase 1b study of AC Immune, Phase 2b study with FUJI-film/Toyama and phase 2 study of UCB and phase 1 study with ImmunoBrain Checkpoint. He is chair of the EU steering committee of the phase 2b program of Vivoryon, the phase 2b study of Novartis Cardiology and co-chair of the phase 3 study with NOVO-Nordisk. He is also an employee of EQT Life Sciences (formerly LSP); Dr. B.D.C. Boon is supported by a research fellowship awarded by Alzheimer Nederland (#WE.15-2019-13); Prof. dr. D.R. Thal received speaker honorarium from Novartis Pharma Basel (Switzerland) and Biogen (USA), travel reimbursement from GE-Healthcare (UK), and UCB (Belgium), and collaborated with GE-Healthcare (UK), Novartis Pharma Basel (Switzerland), Probiodrug (Germany), and Janssen Pharmaceutical Companies (Belgium). He receives grants from Fonds Wetenschappelijk Onderzoek Vlaanderen (Belgium; FWO- G0F8516N, G065721N) and the Stichting Alzheimer Onderzoek (Belgium; SAO-FRA 2020/017); Prof. dr. A.J. Rozemuller reports no competing interests; Dr. F.D. Verbraak reports no competing interests; Dr. F. Bouwman performs contract research for Optina Dx and Optos, she has been an invited speaker at Roche and has been invited for expert testimony at Biogen. All funding is paid to her institution; Dr. J.J.M. Hoozemans received grants from the Dutch Research Council (ZonMW) and, Alzheimer Netherlands, performed contract research or received grants from Merck, ONO Pharmaceuticals, Janssen Prevention Center, DiscovericBio, AxonNeurosciences, Roche, Genentech, Promis, Denali, FirstBiotherapeutics, and Ensol Biosciences. All payments were made to the institution. Dr. J.J.M. Hoozemans participates in the scientific advisory board of Alzheimer Netherlands and is editor-in-chief for Acta Neuropathologica Communications.

Ethical approval

Donors signed informed consent for brain and eye autopsy and use of brain and retinal tissue and medical records for research prior to death. This study was approved by the ethical committee of the VU University Medical Center Amsterdam (VUmc).

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Hart de Ruyter, F.J., Morrema, T.H.J., den Haan, J. et al. Phosphorylated tau in the retina correlates with tau pathology in the brain in Alzheimer’s disease and primary tauopathies. Acta Neuropathol 145, 197–218 (2023). https://doi.org/10.1007/s00401-022-02525-1

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