Anti-acetylated-tau immunotherapy [Neurosurgery Wiki]

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====== Anti-acetylated-tau immunotherapy ======

Anti-acetylated-tau [[immunotherapy]] is a targeted approach aimed at treating tauopathies by focusing specifically on tau proteins that have undergone acetylation, a post-translational modification that can exacerbate tau pathology. This therapeutic strategy involves developing antibodies that specifically recognize and bind to acetylated forms of tau, promoting their clearance and reducing their toxic effects.

Background on Tau Acetylation
Tau Protein: A microtubule-associated protein that stabilizes microtubules in neurons.
Acetylation: The addition of an acetyl group to lysine residues on tau, which can reduce tau's ability to bind microtubules and increase its propensity to aggregate.
Pathological Role: Acetylated tau is often found in neurofibrillary tangles in tauopathies, contributing to neuronal dysfunction and cell death.
Mechanism of Anti-Acetylated-Tau Immunotherapy
Antibody Design:

Specificity: Monoclonal antibodies are designed to specifically bind to acetylated tau, distinguishing it from normal, non-acetylated tau.
Target Sites: These antibodies target acetylation sites on tau that are critical for its pathological aggregation.
Mechanism of Action:

Binding: The antibodies bind to acetylated tau, tagging it for clearance.
Clearance: Once bound, the acetylated tau is recognized by microglia and other components of the immune system, leading to its degradation.
Prevention of Aggregation: By targeting acetylated tau, these antibodies can prevent the formation of neurofibrillary tangles.
Preclinical and Clinical Development
Preclinical Studies:

Animal Models: Research in animal models of tauopathy has shown that anti-acetylated-tau antibodies can reduce tau pathology and improve cognitive function.
Mechanistic Insights: Studies have demonstrated that these antibodies can effectively clear acetylated tau and reduce its spread in the brain.
Clinical Trials:

Phase 1: Initial trials focus on safety and tolerability in humans.
Phase 2 and 3: Later trials assess efficacy in reducing tau pathology and improving clinical outcomes in patients with tauopathies.
Challenges and Considerations
Specificity:

Off-Target Effects: Ensuring that antibodies do not cross-react with other proteins or normal tau is crucial to avoid unintended side effects.
Epitope Selection: Choosing the right acetylation sites on tau for antibody targeting is key to maximizing therapeutic efficacy.
Delivery:

Blood-Brain Barrier: Developing methods to efficiently deliver antibodies across the blood-brain barrier remains a significant challenge.
Immune Response:

Inflammation: Managing potential inflammatory responses triggered by the immune system's clearance of acetylated tau.
Disease Stage:

Early Intervention: Anti-acetylated-tau immunotherapy may be most effective when administered early in the disease process, before extensive tau pathology has developed.
Future Directions
Combination Therapies:

Synergistic Approaches: Combining anti-acetylated-tau antibodies with other treatments, such as anti-amyloid therapies, kinase inhibitors, or neuroprotective agents, may enhance overall efficacy.
Personalized Medicine:

Biomarker Development: Identifying biomarkers for tau acetylation can help tailor treatments to individual patients and monitor therapeutic responses.
Advanced Delivery Systems:

Nanotechnology: Exploring novel delivery mechanisms, such as nanoparticles, to improve antibody penetration into the brain.
Conclusion
Anti-acetylated-tau immunotherapy represents a promising and specific approach to treating tauopathies by targeting a key pathological modification of tau. While challenges remain, ongoing research and clinical trials are critical to optimizing this therapeutic strategy and determining its potential to slow or halt the progression of neurodegenerative diseases characterized by tau pathology.
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Parra Bravo et al. investigated the therapeutic efficacy of two different antibodies that specifically target [[acetylated lysine 174]] on tau (ac-tauK174). 
They treated PS19 mice, which harbor the P301S tauopathy mutation that causes FTLD, with anti-ac-tauK174 and measured effects on tau pathology, neurodegeneration, and neurobehavioral outcomes. Furthermore, PS19 mice received treatment post-TBI to evaluate the ability of the immunotherapy to prevent TBI-induced exacerbation of tauopathy phenotypes. Ac-tauK174 measurements in human plasma following TBI were also collected to establish a link between trauma and acetylated tau levels, and single nuclei RNA-sequencing of post-TBI brain tissues from treated mice provided insights into the molecular mechanisms underlying the observed treatment effects.

Anti-ac-tauK174 treatment mitigates neurobehavioral impairment and reduces tau pathology in PS19 mice. Ac-tauK174 increases significantly in human plasma 24 h after TBI, and anti-ac-tauK174 treatment of PS19 mice blocked TBI-induced neurodegeneration and preserved memory functions. Anti-ac-tauK174 treatment rescues alterations of microglial and oligodendrocyte transcriptomic states following TBI in PS19 mice.

The ability of anti-ac-tauK174 treatment to rescue neurobehavioral impairment, reduce tau pathology, and rescue glial responses demonstrates that targeting tau acetylation at K174 is a promising neuroprotective therapeutic approach to human tauopathies resulting from TBI or genetic disease
((Parra Bravo C, Krukowski K, Barker S, Wang C, Li Y, Fan L, Vázquez-Rosa E, Shin MK, Wong MY, McCullough LD, Kitagawa RS, Choi HA, Cacace A, Sinha SC, Pieper AA, Rosi S, Chen X, Gan L. Anti-acetylated-tau immunotherapy is neuroprotective in tauopathy and brain injury. Mol Neurodegener. 2024 Jun 24;19(1):51. doi: 10.1186/s13024-024-00733-9. PMID: 38915105.)).