Formation of diffuse and fibrillar tangles in aging and early Alzheimer's disease

The changes in tau that are associated with the early formation of tangles in aging and in preclinical and very mild Alzheimer's Disease (AD) were studied with two antibodies against AD-specific tau: PHF-1, which recognizes a phosphorylated epitope at Ser396 through 404, and MC-1, which recognizes a folded, conformational epitope that includes amino acids at both 7 through 9 and 312 through 342. Both antibodies demonstrated cells with diffuse or granular staining (diffuse tangles) and cells with fibrillar staining (fibrillar tangles). The fibrillar tangles corresponded to classical tangles and increase exponentially with age and severity of AD. The diffuse tangles seemed to represent an earlier form of tangles; their density peaked around preclinical AD, and then decreased in more severe stages of AD. MC-1 consistently stained more diffuse tangles than PHF-1, suggesting that the conformational change in tau precedes phosphorylation at the PHF-1 epitope during paired helical filament formation.