Abstract
A few protein kinases and phosphatases regulate tau protein phosphorylation and an imbalance in their enzyme activity results in tau hyper-phosphorylation. Aberrant tau phosphorylation causes tau to dissociate from the microtubules and clump together in the cytosol to form neurofibrillary tangles (NFTs), which lead to the progression of neurodegenerative disorders including Alzheimer’s disease (AD) and other tauopathies. Hence, targeting hyperphosphorylated tau protein is a restorative approach for treating neurodegenerative tauopathies. The cyclin-dependent kinase (Cdk5) and the glycogen synthase kinase (GSK3β) have both been implicated in aberrant tau hyperphosphorylation. The limited transport of drugs through the blood–brain barrier (BBB) for reaching the central nervous system (CNS) thus represents a significant problem in the development of drugs. Drug delivery systems based on nanocarriers help solve this problem. In this review, we discuss the tau protein, regulation of tau phosphorylation and abnormal hyperphosphorylation, drugs in use or under clinical trials, and treatment strategies for tauopathies based on the critical role of tau hyperphosphorylation in the pathogenesis of the disease.
Graphical Abstract
Pathology of neurodegenerative disease due to hyperphosphorylation and various therapeutic approaches including nanotechnology for its treatment.

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Data Availability
Not applicable as no datasets were generated or analysed during the current study.
Abbreviations
- NFTs:
-
Neurofibrillary tangles
- AD:
-
Alzheimer’s disease
- PD:
-
Parkinson’s disease
- Cdk5:
-
Cyclin-dependent kinase
- GSK3β:
-
Glycogen synthase kinase
- BBB:
-
Blood-brain barrier
- DALYs:
-
Disability-adjusted life-years
- MAPT:
-
Microtubule-associated protein tau FTDP-17, frontotemporal dementia associated with Parkinsonism having relation with chromosome 17
- PSP:
-
Progressive supranuclear palsy
- CBD:
-
Corticobasal degeneration
- PiD:
-
Pick’s disease
- AGD:
-
Argyrophilic grain disease
- GGT:
-
Globular glial tauopathy
- CNS:
-
Central nervous system
- pI:
-
Isoelectric point
- N:
-
Terminal, amino-terminal
- C:
-
Terminal, carboxy-terminal
- 3R:
-
C-terminal region with three microtubule-binding repeats of 31 or 32 amino acids
- 4R:
-
C-terminal region with four microtubule-binding repeats of 31 or 32 amino acids
- NMR:
-
Nuclear magnetic resonance
- PHFs:
-
Paired helical filaments
- Ser:
-
Serine
- Thr:
-
Threonine
- Tyr:
-
Tyrosine
- AMPK:
-
5′ Adenosine monophosphate-activated protein kinase
- MARK:
-
Microtubule affinity-regulating kinase
- PP1:
-
Protein phosphatase-1
- SFs:
-
Straight filaments
- Aβ:
-
β-Amyloid
- APP:
-
β-Amyloid precursor protein
- PS1:
-
Presenilin 1 gene
- PS2:
-
Presenilin 2 gene
- APOE:
-
Apolipoprotein E
- mTOR:
-
Mammalian target of rapamycin
- SNpc:
-
Substantia nigra pars compacta
- FTLD:
-
Frontotemporal lobar degeneration
- LC3:
-
Microtubule-associated protein 1A/1B-light chain 3
- Raptor:
-
Regulatory associated protein of mTOR
- mLST8:
-
Mammalian lethal with Sec13 protein 8
- PRAS40:
-
40 KDa proline-rich AKT substrate
- Deptor:
-
DEP-domain-containing mTOR-interacting protein
- Rictor:
-
Rapamycin-insensitive companion of mTOR
- mSIN1:
-
Mammalian stress-activated protein kinase interacting protein
- Protor-1:
-
Protein observed with Rictor-1
- HEAT:
-
Huntingtin, EF3, the A subunit of PP2A, TOR1
- 4EBPs:
-
EIF4E-binding proteins
- IL-2:
-
Interleukin-2
- TKIs:
-
Tyrosine kinase inhibitors
- EMA:
-
European Medicines Agency
- ADNP:
-
Activity-dependent neuroprotective protein
- TAI:
-
Tau aggregation inhibitor
- MTC:
-
Methylthioninium chloride
- LMT:
-
Leuco-methylthioninum
- LMTM:
-
Leucomethylthioninium bis-hydromethanesulfonate
- PPMT:
-
PP2A methyltransferase
- LCMT:
-
Leucine carboxyl methyl transferase
- PME:
-
PP2A methyl esterase
- SAD:
-
Single ascending dose
- CADRO:
-
Common Alzheimer’s and Related Dementias Research Ontology
- MOA:
-
Mechanisms of action
- DMTs:
-
Disease-modifying therapies
- CDR-SB:
-
Clinical Dementia Rating scale Sum of Boxes
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Acknowledgements
We would like to thank Dr. Alisha Jones (Incoming Assistant Professor at NYU) for critically reading the manuscript. The authors gratefully acknowledge RPBlab and GSlab members for critical suggestions.
Funding
Our lab is supported by SERB, DBT and ICMR, Government of India, grants which are duly acknowledged. AK, HKA and AS are supported by UGC-JRF, DHR-YSS and ICMR-SRF fellowships, respectively.
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GS and RPB conceived the plan. PK, AK, and HKA wrote first draft. AS, PKJ, GS, and RPB edited and finalized the draft in coordination with other authors. All authors have approved it for publication.
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Highlights
• Neurological disorders are increasingly associated with fatalities globally.
• Tauopathies are mostly caused by hyperphosphorylation of tau protein.
• Drugs under development target pathways like mTOR, phosphorylation, and aggregation.
• Biomarkers for an early diagnosis like phosphorylated sites are in developmental stages.
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Kaur, P., Khera, A., Alajangi, H.K. et al. Role of Tau in Various Tauopathies, Treatment Approaches, and Emerging Role of Nanotechnology in Neurodegenerative Disorders. Mol Neurobiol 60, 1690–1720 (2023). https://doi.org/10.1007/s12035-022-03164-z
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DOI: https://doi.org/10.1007/s12035-022-03164-z