Spinal Cord Tau and Protein Copathologies Associated With Chronic Traumatic Encephalopathy

Area of Science:

• Neuropathology
• Neurodegenerative Diseases
• Traumatic Brain Injury

Background:

• Repetitive head impacts (RHI) are associated with neurodegenerative diseases like Alzheimer disease and amyotrophic lateral sclerosis.
• While brain pathologies in chronic traumatic encephalopathy (CTE) are understood, spinal cord pathology in at-risk individuals remains unclear.

Purpose of the Study:

• To investigate spinal cord pathologies in individuals with a history of RHI or CTE neuropathologic change (CTE-NC).

Main Methods:

• A case-control study of autopsied individuals was conducted.
• Immunohistochemistry was used to detect phosphorylated tau (p-tau), p-TDP-43, α-synuclein, and amyloid-β (Aβ).
• Clinical history and CTE-NC presence were assessed.

Main Results:

• All 20 individuals with CTE-NC showed spinal cord p-tau deposits, particularly those aged 65+ with RHI.
• Spinal p-tau pathology correlated with microglial activation and motor symptoms.
• Older CTE-NC cases with RHI also exhibited p-TDP-43, Aβ, and α-synuclein pathologies.

Conclusions:

• Autopsy evidence indicates a high prevalence of complex spinal pathology in CTE-NC.
• This supports the concept of trauma-related encephalomyelopathy.
• Cumulative trauma may drive widespread protein aggregation in older individuals with CTE-NC.