Down Syndrome (DS) is a common genetic condition caused by trisomy of chromosome 21. Among the complex clinical features including musculoskeletal, neurological and cardiovascular disabilities, individuals with DS develop progressive dementia and early onset Alzheimer's Disease (AD). This is attributed to the increased gene dosage of amyloid precursor protein (APP), the formation of self-propagating Aβ and tau prion conformers, and the deposition of neurotoxic Aβ plaques and tau neurofibrillary tangles. Tau amyloid fibrils have previously been established to adopt many distinct conformations across different neurodegenerative conditions. Here we characterized 4 DS cases spanning 36 to 63 years in age by spectral confocal imaging with conformation-specific dyes and cryo-electron microscopy (cryo-EM) to determine structures of isolated tau fibrils. High-resolution structures reveal paired helical (PHF) and straight filament (SF) conformations of tau that are identical to those determined from AD. The PHFs and SFs are made of two C-shaped protofilaments with a cross-β/β-helix motif. Similar to AD, most filaments adopt the PHF form, while a minority (∼20%) form SFs. For the youngest individual with no documented dementia samples exhibited sparse tau deposits. To isolate tau for cryo-EM from this challenging sample we employed a novel "affinity grid" method involving a graphene-oxide surface derivatized with anti-tau antibodies. This improved isolation and revealed primarily tau PHFs and a minor population of SSPE type II-like filaments are present at this early age. These findings expand the similarities between AD and DS to the molecular level providing insight into their related pathologies and the potential for targeting common tau filament folds by small molecule therapeutics and diagnostics.

Cryo-EM Structures Reveal Tau Filaments from Down Syndrome Adopt Alzheimer’s Disease Fold