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<p>Plasma tau phosphorylated at threonine 181 (p-tau181) and 217 (p-tau217) have demonstrated high accuracy for Alzheimer’s disease (AD) diagnosis, defined by CSF/PET amyloid beta (A<i>β</i>) positivity, but most studies have been performed in research cohorts, limiting their generalizability. We studied plasma p-tau217 and p-tau181 for CSF A<i>β</i> status discrimination in a cohort of consecutive patients attending an academic memory clinic in Spain (July 2019–June 2024). All patients had CSF AD biomarkers performed as part of their routine clinical assessment. A<i>β</i> positivity was defined with a local cut-off of CSF A<i>β</i><sub>1–42</sub> &lt; 600&#xa0;pg/mL; in patients with borderline A<i>β</i><sub>1–42</sub> values or when there was a mismatch between the A<i>β</i> and the T status (T + if CSF p-tau181 ≥ 65&#xa0;pg/mL), a ratio A<i>β</i><sub>1–42</sub>/A<i>β</i><sub>1–40</sub> &lt; 0.07 was used. Plasma p-tau217 and p-tau181 were measured retrospectively, from blood samples collected at first visit, with Fujirebio Lumipulse and Quanterix Simoa assays, respectively. We included 468 patients (mean age 67&#xa0;years, 50% female, 61% A<i>β</i> positive). Plasma p-tau217 outperformed plasma p-tau181 in discriminating CSF A<i>β</i> status (AUC 0.95 vs 0.90, <i>p</i> = 0.005). A 97.5% sensitivity and specificity plasma p-tau217 algorithm, classifying patients into three groups of A<i>β</i> probability (Low, Intermediate and High), resulted in 67% of patients in the Low and High groups, having their A<i>β</i> status predicted (as negative and positive, respectively) with 96% accuracy. The remaining 33% in the Intermediate group were candidates to undergo CSF/PET testing. A model with a 10% variation in p-tau217 levels yielded small changes in accuracy (95%). In conclusion, plasma p-tau217 could have discriminated CSF A<i>β</i> status in two-thirds of patients with very high accuracy in a memory clinic cohort. These results support the implementation of plasma p-tau217 as an initial diagnostic tool in memory clinics for AD diagnosis, reducing the need for more invasive/expensive testing.</p>

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Accuracy and clinical applicability of plasma tau 181 and 217 for Alzheimer’s disease diagnosis in a memory clinic cohort

  • 期刊论文

  • 发表日期：

    2025年1月23日

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  • Jordi Sarto,
  • Diana Esteller-Gauxax,
  • Núria Guillén,
  • Neus Falgàs,
  • Sergi Borrego-Écija,
  • Miquel Massons,
  • Guadalupe Fernández-Villullas,
  • Yolanda González,
  • Adrià Tort-Merino,
  • Beatriz Bosch,
  • Magda Castellví,
  • Gerard Piñol-Ripoll,
  • Jordi Juncà-Parella,
  • Andrea del Val,
  • Agnès Pérez-Millan,
  • Aina Comas,
  • Anna Antonell,
  • Laura Naranjo,
  • Raquel Ruiz-García,
  • Josep María Augé,
  • Raquel Sánchez-Valle,
  • Albert Lladó,
  • Mircea Balasa

摘要

Plasma tau phosphorylated at threonine 181 (p-tau181) and 217 (p-tau217) have demonstrated high accuracy for Alzheimer’s disease (AD) diagnosis, defined by CSF/PET amyloid beta (Aβ) positivity, but most studies have been performed in research cohorts, limiting their generalizability. We studied plasma p-tau217 and p-tau181 for CSF Aβ status discrimination in a cohort of consecutive patients attending an academic memory clinic in Spain (July 2019–June 2024). All patients had CSF AD biomarkers performed as part of their routine clinical assessment. Aβ positivity was defined with a local cut-off of CSF Aβ1–42 < 600 pg/mL; in patients with borderline Aβ1–42 values or when there was a mismatch between the Aβ and the T status (T + if CSF p-tau181 ≥ 65 pg/mL), a ratio Aβ1–42/Aβ1–40 < 0.07 was used. Plasma p-tau217 and p-tau181 were measured retrospectively, from blood samples collected at first visit, with Fujirebio Lumipulse and Quanterix Simoa assays, respectively. We included 468 patients (mean age 67 years, 50% female, 61% Aβ positive). Plasma p-tau217 outperformed plasma p-tau181 in discriminating CSF Aβ status (AUC 0.95 vs 0.90, p = 0.005). A 97.5% sensitivity and specificity plasma p-tau217 algorithm, classifying patients into three groups of Aβ probability (Low, Intermediate and High), resulted in 67% of patients in the Low and High groups, having their Aβ status predicted (as negative and positive, respectively) with 96% accuracy. The remaining 33% in the Intermediate group were candidates to undergo CSF/PET testing. A model with a 10% variation in p-tau217 levels yielded small changes in accuracy (95%). In conclusion, plasma p-tau217 could have discriminated CSF Aβ status in two-thirds of patients with very high accuracy in a memory clinic cohort. These results support the implementation of plasma p-tau217 as an initial diagnostic tool in memory clinics for AD diagnosis, reducing the need for more invasive/expensive testing.