Tauopathies are neurodegenerative diseases characterized by tau inclusions in brain cells. Seed-competent tau species have been suggested to spread from cell to cell in a stereotypical manner, indicating that this may involve a prion-like mechanism. Although the intercellular mechanisms of transfer are unclear, extracellular vesicles (EVs) could be potential shuttles. We assessed this in humans by preparing vesicles from fluids (brain-derived enriched EVs [BD-EVs]). These latter were isolated from different brain regions in various tauopathies, and their seeding potential was assessed in vitro and in vivo. We observed considerable heterogeneity among tauopathies and brain regions. The most striking evidence was coming mainly from Alzheimer’s disease where the BD-EVs clearly contain pathological species that can induce tau lesions in vivo. The results support the hypothesis that BD-EVs participate in the prion-like propagation of tau pathology among tauopathies, and there may be implications for diagnostic and therapeutic strategies.

Tauopathies are neurodegenerative disorders involving the accumulation of tau isoforms in cell subpopulations such as astrocytes. The origins of the 3R and 4R isoforms of tau that accumulate in astrocytes remain unclear. Extracellular vesicles (EVs) were isolated from primary neurons overexpressing 1N3R or 1N4R tau or from human brain extracts (progressive supranuclear palsy or Pick disease patients or controls) and characterized (electron microscopy, nanoparticle tracking analysis (NTA), proteomics). After the isolated EVs were added to primary astrocytes or human iPSC-derived astrocytes, tau transfer and mitochondrial system function were evaluated (ELISA, immunofluorescence, MitoTracker staining). We demonstrated that neurons in which 3R or 4R tau accumulated had the capacity to transfer tau to astrocytes and that EVs were essential for the propagation of both isoforms of tau. Treatment with tau-containing EVs disrupted the astrocytic mitochondrial system, altering mitochondrial morphology, dynamics and redox state. Although similar levels of 3R and 4R tau were transferred, 3R tau-containing EVs were significantly more damaging to astrocytes than 4R tau-containing EVs. Moreover, EVs isolated from the brain fluid of patients with different tauopathies affected mitochondrial function in astrocytes derived from human iPSCs. Our data highlight that tau pathology spreads to surrounding astrocytes via EVs-mediated transfer and modify their function.

Background: Tauopathies encompass a spectrum of neurodegenerative disorders which are marked by the pathological aggregation of tau protein into paired helical filaments (PHF-tau), neurofibrillary tangles (NFTs) and Glial-fibrillary tangles (GFTs). These aggregates impair cellular, mitochondrial, and synaptic functions. The emergence of extracellular tau (ePHF-tau), featuring a myriad of isoforms and phosphorylation states, presents a challenge in comprehending its nuanced effects on neural cells, particularly concerning synaptic and mitochondrial integrity. Methods: We studied the impact of ePHF-tau (2N4R) on different states and ages of primary cultures of rat neuroglia. Using confocal microscopy and proteomic analysis of synaptosomes, we studied the impact of ePHF-tau on neurite and synapse number. We monitored mitochondrial responses in neurons and astrocytes over 72 hours using advanced fluorescence microscopy for dynamic, high-throughput analysis. Results: Treatment with ePHF-tau has a strong effect on the neurites of immature neurons, but its toxicity is negligible when the neurons are more mature. At the mature stage of their development, we observed a substantial increase in the density of the PSD-95/vGlut1 zone in neurite, suggesting altered synaptic connectivity and ePHF-tau excitotoxicity. Proteomics revealed significant changes in mitochondrial protein in synaptosomes following exposure to ePHF-tau. In the neuronal compartment, real-time imaging revealed rapid and persistent mitochondrial dysfunction, increased ATP production, and reduced mitochondrial turnover. In contrast, we observed increased mitochondrial turnover and filamentation after treatment in the astrocyte processes, indicating cell-specific adaptive responses to ePHF-tau. Conclusions: This study sheds light on the intricate effects of extracellular tau aggregates on neuronal and astrocytic mitochondrial populations, highlighting how tau pathology can lead to mitochondrial disturbances and synaptic alterations. By delineating the differential responses of neurons and astrocytes to ePHF-tau, our findings pave the way for developing targeted therapeutic interventions to mitigate the detrimental impacts of tau aggregates in neurodegenerative diseases.

Tauopathies are neurodegenerative disorders characterized by abnormal tau aggregation, with primary 3R (e.g., Picks disease, PiD) and 4R (e.g., progressive supranuclear palsy, PSP) variants posing a significant diagnostic challenge. Here, we examined brain-derived extracellular vesicles (BD-EVs) isolated from the prefrontal cortex of PiD (3R), PSP (4R), and non-demented controls (CTRL) to determine if these vesicles reflect disease-specific proteomic signatures. We found that while tau pathology does not substantially alter BD-EV concentration or the enrichment of core vesicular markers, it does influence their size distribution and protein cargo. BD-EV samples from PiD patients exhibited a greater abundance of small vesicles and distinct protein profiles when compared to PSP and CTRL. Weighted Gene Co-expression Network Analysis (WGCNA) identified four key protein modules to account for variance between patient groups Endoplasmic Reticulum, Mitochondria, Microtubules, and Trivalent Inorganic Cation Transport. In PiD, astrocyte-derived mitochondrial proteins were significantly elevated, whereas neuronal microtubule-related proteins were diminished relative to both PSP and CTRL. Notably, changes in the mitochondrion and microtubule modules enhanced the detection of PiD pathology. Cellular origin annotation revealed a marked shift in BD-EV composition: PiD samples exhibited an increased astrocytic signature, while both PiD and PSP showed a reduction in neuronal proteins compared to CTRL. Crucially, the enrichment of astrocytic mitochondrial and endoplasmic reticulum proteins, alongside reduced neuronal proteins, correlated strongly with the severity of tau pathology (AT8-stained aggregates) in patient brains. These findings demonstrate that BD-EVs capture tau isoform-specific cellular and molecular alterations, offering a window into disease mechanisms at the neuron-glia interface. By linking distinct protein signatures and their cellular origins to tau pathology severity, our results highlight the potential of BD-EV profiling as a biomarker strategy for distinguishing between and monitoring the progression of 3R and 4R tauopathies.