Astrocyte reactivity associates with tau phosphorylation and neurodegeneration before detectable amyloid‐β pathology

Abstract Background Aβ plaques are the first detectable signs of AD pathology. Our group recently demonstrated that the astrocyte activation marker, glial fibrillary acidic protein (GFAP), has a pivotal role in the association between Aβ burden and tau phosphorylation. However, the role of astrocyte activation in individuals that do not present detectable Aβ pathology using biomarkers is still underexplored. Here we sought to understand the association between plasma GFAP with tau phosphorylation and neurodegeneration in Aβ negative individuals. Method 598 study participants [cognitively unimpaired, (CU)=200, and cognitively impaired, (CI)=398] from two cohorts (TRIAD, Canada and BICWALZ, South Korea) were assessed for Aβ‐PET, plasma GFAP, p‐tau217, NfL, and hippocampal volume measures. Pearson correlations between plasma GFAP and plasma p‐tau217, plasma NfL along with hippocampal volume was performed in Aβ‐PET negative individuals. Result Remarkably, we found that plasma GFAP levels positively correlate with plasma p‐tau217 levels in Aβ‐PET negative individuals in both cohorts [TRIAD cohort: r=0.23, p=0.01; BICWALZ cohort: r=0.21, p=0.0001; Figure: 1A, B]. Further, the correlation between plasma GFAP with plasma NfL has also been found to be positively correlated among the two cohorts [TRIAD cohort: r=0.45, p=0.0001; BICWALZ cohort: r=0.49, p=0.0001; Figure: 2A, B]. We also observed that hippocampal volume, as a neurodegeneration marker, reveals a significant negative Pearson correlation with plasma GFAP levels in Aβ‐PET negative human individuals from both the cohorts [TRIAD cohort: r=‐0.27, p=0.0009; BICWALZ cohort: r=‐0.24, p=0.0001; Figure: 3A, B]. Conclusion Our study provides evidence from research and clinical cohorts that astrocyte reactivity may be associated with very early tau phosphorylation and neurodegeneration in the absence of Aβ pathology.