Big tau aggregation disrupts microtubule tyrosination and causes myocardial diastolic dysfunction: from discovery to therapy

Marco Luciani, Mauro Montalbano, Luca Troncone, Camilla Bacchin, Keita Uchida, Gianlorenzo Daniele, Bethany Jacobs Wolf, Helen M. Butler, Justin Kiel, Stefano Berto, Cortney Gensemer, Kelsey Moore, Jordan Morningstar, Thamonwan Diteepeng, Onder Albayram, José F. Abisambra, Russell A. Norris, Thomas G. Di Salvo, Benjamin Prosser, Rakez KayedFederica del Monte

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background Amyloid plaques and neurofibrillary tangles, the molecular lesions that characterize Alzheimer's disease (AD) and other forms of dementia, are emerging as determinants of proteinopathies 'beyond the brain'. This study aims to establish tau's putative pathophysiological mechanistic roles and potential future therapeutic targeting of tau in heart failure (HF). Methods and results A mouse model of tauopathy and human myocardial and brain tissue from patients with HF, AD, and controls was employed in this study. Tau protein expression was examined together with its distribution, and in vitro tau-related pathophysiological mechanisms were identified using a variety of biochemical, imaging, and functional approaches. A novel tau-targeting immunotherapy was tested to explore tau-targeted therapeutic potential in HF. Tau is expressed in normal and diseased human hearts, in contradistinction to the current oft-cited observation that tau is expressed specifically in the brain. Notably, the main cardiac isoform is high-molecular-weight (HMW) tau (also known as big tau), and hyperphosphorylated tau segregates in aggregates in HF and AD hearts. As previously described for amyloid-beta, the tauopathy phenotype in human myocardium is of diastolic dysfunction. Perturbation in the tubulin code, specifically a loss of tyrosinated microtubules, emerged as a potential mechanism of myocardial tauopathy. Monoclonal anti-tau antibody therapy improved myocardial function and clearance of toxic aggregates in mice, supporting tau as a potential target for novel HF immunotherapy. Conclusion The study presents new mechanistic evidence and potential treatment for the brain-heart tauopathy axis in myocardial and brain degenerative diseases and ageing.

Original languageEnglish (US)
Pages (from-to)1560-1570
Number of pages11
JournalEuropean Heart Journal
Issue number17
StatePublished - May 1 2023


  • Alzheimer's
  • HMW tau
  • Heart failure
  • immunotherapy
  • tau protein

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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