A scalable human neuron model of Alzheimer’s disease relevant tauopathy reveals mechanisms linking Tau fibrillization to synaptic dysfunction

ABSTRACT Tauopathies, including Alzheimer’s disease, are driven by pathological aggregation of hyperphosphorylated Tau, which disrupts synaptic integrity, impairs neuronal communication, and contributes to cognitive decline. To dissect tauopathy pathogenesis and enable therapeutic discovery, reliable and scalable human iPSC-neuron models are essential. Here, we developed two complementary iPSC-derived neuron models: an endogenous Tau seeding model, in which neurons are challenged with pre-formed Tau fragments that form paired helical filament (PHF)-consistent structures, and a Tau-0N3R overexpression seeding model to accelerate pathology. Both models recapitulate hallmark features of tauopathy, including the progressive formation of intracellular, hyperphosphorylated, sarkosyl-insoluble, and conformationally altered Tau aggregates (AT8, MC1 positive), along with synaptic and neuronal dysfunction. Cryogenic electron tomography (cryo-ET) further revealed the morphology of Tau fibrils within cells, as well as the ultrastructure of Tau fibrils trapping synaptic vesicles in situ . Using this platform, we performed integrated phosphoproteomics, high-content screening, and functional validation to identify key pathways driving Tau aggregation. MARK2-mediated phosphorylation within Tau’s microtubule-binding domain emerged as an early trigger of aggregation, confirmed by site-specific mutagenesis. In parallel, small molecules targeting the PI3K/mTOR/GSK3 pathway reduced aggregation and restored synaptic function, with GSK3 inhibition lowering phosphorylation at critical aggregation-driving sites on Tau. Together, these findings establish a physiologically relevant, scalable platform for therapeutic screening that connects Tau seed uptake, site-specific phosphorylation, fibril formation, and synaptic disruption, ultimately identifying mechanistically separable intervention points along the aggregation cascade. HIGHLIGHTS - Development of scalable iPSC-neuron models enables tauopathy drug discovery and reconstructs progressive Tau seeding, fibrillization and synaptic dysfunction - Cryo-ET reveals the ultrastructure of Tau fibrils within human neurons and their accumulation at synapses. - Temporal phosphoproteomics identifies early modulation of MARK-regulated Tau phosphosites. - PI3K–mTOR and GSK3 regulate distinct stages of the Tau aggregation cascade. - Site-specific mutagenesis confirms critical Tau residues required for Tau aggregation.