Tau oligomer heterogeneity and associated protein profile in slowly versus rapidly progressive Alzheimer's disease

Rapidly progressive Alzheimers disease (rpAD) is a rare but devastating clinical variant characterized by abrupt cognitive decline, yet the molecular features underlying this phenotype remain unknown. Tau oligomers (TauO) are key mediators of tau toxicity, but whether their biochemical properties differ across AD subtypes has not been examined in human brain. We isolated endogenous TauO from frontal cortex of well-characterized control, slowly progressive AD (spAD), and rpAD cases using T22 immunoprecipitation and performed ultrastructural, biochemical, and proteomic characterization. rpAD TauO displayed compact, densely aggregated morphology and exhibited the highest levels of disease-associated phosphorylation (pS396, pS422). Label-free proteomics revealed that control and spAD shared a robust TauO interactome enriched for translation, proteostasis, mitochondrial metabolism, and vesicle trafficking. Strikingly, these modules were absent in rpAD, which instead showed selective enrichment for aldehyde detoxification, amino-acid and carbon metabolism, and actin-regulatory pathways. rpAD TauO demonstrated increased association with SERPINA1, ALDH9A1, MAPRE3, DPYSL2/3, and NFASC, and reduced association with MRPL17 and C9. Functionally, rpAD TauO induced the strongest toxicity in SH-SY5Y cells. Together, these findings indicate that rpAD likely harbors a biochemically distinct TauO species, defining a molecular signature that may underpin its fulminant clinical progression and support the development of subtype-specific therapeutic strategies.