Clinical Translation of Molecular Biomarkers in Alzheimer’s Disease: From Pathological Detection to Precision Medicine
DOI:
https://doi.org/10.62177/apjcmr.v1i3.455Keywords:
Alzheimer’s Disease, Biomarkers, Clinical Translation, Precision MedicineAbstract
Alzheimer’s disease (AD), as the predominant form of neurodegenerative disorders, exerts a profound impact on the health of the global elderly population. For decades, the elucidation of AD pathogenesis and the development of diagnostic and therapeutic approaches have been the focus of extensive research. Over recent years, a fundamental shift has occurred in AD diagnostics—transitioning from reliance on clinical diagnosis alone to biomarker-supported frameworks. AD biomarker research has transitioned from postmortem histopathology to in vivo detection paradigms, enabling precision diagnosis and intervention. This review synthesizes recent advances in molecular biomarkers across three domains: Fluid biomarkers, Molecular imaging and Innovative detection platforms, and also evaluates the challenges and prospects of the clinical transformation of molecular markers for AD.
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References
GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022 Feb;7(2):e105-e125. https://doi.org/10.1016/S2468-2667(21)00249-8.
Wang H, Sun M, Li W, Liu X, Zhu M, Qin H. Biomarkers associated with the pathogenesis of Alzheimer's disease. Front Cell Neurosci. 2023 Dec 7;17:1279046. https://doi.org/10.3389/fncel.2023.1279046.
National Health Commission Capacity Building and Continuing Education Center; Chinese Neuroscience Society; Aging Biomarker Consortium; Writing Group for the Chinese Guideline for Clinical Application of Fluid Biomarkers for Alzheimer’s Disease. [Chinese guideline for clinical application of fluid biomarkers for Alzheimer’s disease(2024 edition)]. Zhonghua Yi Xue Za Zhi. 2024 Sep 10;104(35):3292-3306. Chinese. https://doi.org/10.3760/cma.j.cn112137-20240523-01174.
Drew L. Alzheimer's disease: highlights from research. Nature. 2025 Apr;640(8059):S2-S3. https://doi.org/10.1038/d41586-025-01101-3.
Janelidze S, Stomrud E, Smith R, Palmqvist S, Mattsson N, Airey DC, et al. Cerebrospinal fluid p-tau217 performs better than p-tau181 as a biomarker of Alzheimer's disease. Nat Commun. 2020 Apr 3;11(1):1683. https://doi.org/10.1038/s41467-020-15436-0.
Karikari TK, Emeršič A, Vrillon A, Lantero-Rodriguez J, Ashton NJ, Kramberger MG, et al. Head-to-head comparison of clinical performance of CSF phospho-tau T181 and T217 biomarkers for Alzheimer's disease diagnosis. Alzheimers Dement. 2021 May;17(5):755-767. https://doi.org/10.1002/alz.12236.
Ashton NJ, Benedet AL, Pascoal TA, Karikari TK, Lantero-Rodriguez J, Brum WS, et al. Cerebrospinal fluid p-tau231 as an early indicator of emerging pathology in Alzheimer's disease. EBioMedicine. 2022 Feb;76:103836. https://doi.org/10.1016/j.ebiom.2022.103836.
Lantero-Rodriguez J, Montoliu-Gaya L, Benedet AL, Vrillon A, Dumurgier J, Cognat E, et al. CSF p-tau205: a biomarker of tau pathology in Alzheimer's disease. Acta Neuropathol. 2024 Jan 6;147(1):12. https://doi.org/10.1007/s00401-023-02659-w.
Islam T, Hill E, Abrahamson EE, Servaes S, Smirnov DS, Zeng X, et al. Phospho-tau serine-262 and serine-356 as biomarkers of pre-tangle soluble tau assemblies in Alzheimer's disease. Nat Med. 2025 Feb;31(2):574-588. https://doi.org/10.1038/s41591-024-03400-0.
Olsson B, Lautner R, Andreasson U, Öhrfelt A, Portelius E, Bjerke M, et al. CSF and blood biomarkers for the diagnosis of Alzheimer's disease: a systematic review and meta-analysis. Lancet Neurol. 2016 Jun;15(7):673-684. https://doi.org/10.1016/S1474-4422(16)00070-3.
Parnetti L. Trajectories of CSF and plasma biomarkers across Alzheimer's disease continuum: disease staging by NF-L, p-tau181, and GFAP. Neurobiol Dis. 2023 Dec;189:106356. https://doi.org/10.1016/j.nbd.2023.106356.
Pelkmans W, Shekari M, Brugulat-Serrat A, Sánchez-Benavides G, Minguillón C, Fauria K, et al. Astrocyte biomarkers GFAP and YKL-40 mediate early Alzheimer's disease progression. Alzheimers Dement. 2024 Jan;20(1):483-493. https://doi.org/10.1002/alz.13450.
Dark HE, An Y, Duggan MR, Joynes C, Davatzikos C, Erus G, et al. Alzheimer's and neurodegenerative disease biomarkers in blood predict brain atrophy and cognitive decline. Alzheimers Res Ther. 2024 Apr 30;16(1):94. https://doi.org/10.1186/s13195-024-01459-y.
Shen XN, Huang SY, Cui M, Zhao QH, Guo Y, Huang YY, et al. Plasma Glial Fibrillary Acidic Protein in the Alzheimer Disease Continuum: Relationship to Other Biomarkers, Differential Diagnosis, and Prediction of Clinical Progression. Clin Chem. 2023 Apr 3;69(4):411-421. https://doi.org/10.1093/clinchem/hvad018.
Tijms BM, Vromen EM, Mjaavatten O, Holstege H, Reus LM, van der Lee S, et al. Cerebrospinal fluid proteomics in patients with Alzheimer's disease reveals five molecular subtypes with distinct genetic risk profiles. Nat Aging. 2024 Jan;4(1):33-47. https://doi.org/10.1038/s43587-023-00550-7.
Chatterjee P, Pedrini S, Doecke JD, Thota R, Villemagne VL, Doré V, et al. Plasma Aβ42/40 ratio, p-tau181, GFAP, and NfL across the Alzheimer's disease continuum: A cross-sectional and longitudinal study in the AIBL cohort. Alzheimers Dement. 2023 Apr;19(4):1117-1134. https://doi.org/10.1002/alz.12724.
Lu Y, Pike JR, Chen J, Walker KA, Sullivan KJ, Thyagarajan B, et al. Changes in Alzheimer Disease Blood Biomarkers and Associations With Incident All-Cause Dementia. JAMA. 2024 Oct 15;332(15):1258-1269. https://doi.org/10.1001/jama.2024.6619.
Pilotto A, Quaresima V, Trasciatti C, Tolassi C, Bertoli D, Mordenti C, et al. Plasma p-tau217 in Alzheimer's disease: Lumipulse and ALZpath SIMOA head-to-head comparison. Brain. 2025 Feb 3;148(2):408-415. https://doi.org/10.1093/brain/awae368.
Janelidze S, Teunissen CE, Zetterberg H, Allué JA, Sarasa L, Eichenlaub U, et al. Head-to-Head Comparison of 8 Plasma Amyloid-β 42/40 Assays in Alzheimer Disease. JAMA Neurol. 2021 Nov 1;78(11):1375-1382. https://doi.org/10.1001/jamaneurol.2021.3180.
Benedet AL, Brum WS, Hansson O; Alzheimer’s Disease Neuroimaging Initiative; Karikari TK, Zimmer ER, et al. The accuracy and robustness of plasma biomarker models for amyloid PET positivity. Alzheimers Res Ther. 2022 Feb 7;14(1):26. https://doi.org/10.1186/s13195-021-00942-0.
Ashton NJ, Brum WS, Di Molfetta G, Benedet AL, Arslan B, Jonaitis E, et al. Diagnostic Accuracy of a Plasma Phosphorylated Tau 217 Immunoassay for Alzheimer Disease Pathology. JAMA Neurol. 2024 Mar 1;81(3):255-263. https://doi.org/10.1001/jamaneurol.2023.5319.
Palmqvist S, Janelidze S, Quiroz YT, Zetterberg H, Lopera F, Stomrud E, et al. Discriminative Accuracy of Plasma Phospho-tau217 for Alzheimer Disease vs Other Neurodegenerative Disorders. JAMA. 2020 Aug 25;324(8):772-781. https://doi.org/10.1001/jama.2020.12134.
Mattsson-Carlgren N, Collij LE, Stomrud E, Pichet Binette A, Ossenkoppele R, Smith R, et al. Plasma Biomarker Strategy for Selecting Patients With Alzheimer Disease for Antiamyloid Immunotherapies. JAMA Neurol. 2024 Jan 1;81(1):69-78. https://doi.org/10.1001/jamaneurol.2023.4596.
Bi X, Qian X, Xue B, Jin C, Tang H, Ye J, et al. Molecule-resolvable SERSome for metabolic profiling. Chem. 2025April 04; 102528. https://doi.org/10.1016/j.chempr.2025.102528
Flury A, Aljayousi L, Park HJ, Khakpour M, Mechler J, Aziz S, et al. A neurodegenerative cellular stress response linked to dark microglia and toxic lipid secretion. Neuron. 2025 Feb 19;113(4):554-571.e14. https://doi.org/10.1016/j.neuron.2024.11.018.
Ruan D, Sun L. Amyloid-β PET in Alzheimer's disease: A systematic review and Bayesian meta-analysis. Brain Behav. 2023 Jan;13(1):e2850. https://doi.org/10.1002/brb3.2850.
Rafii MS. Tau PET Imaging for Staging of Alzheimer's Disease in Down Syndrome. Dev Neurobiol. 2019 Jul;79(7):711-715. https://doi.org/10.1002/dneu.22658.
Ward J, Ly M, Raji CA. Brain PET Imaging: Frontotemporal Dementia. PET Clin. 2023 Jan;18(1):123-133. doi: 10.1016/j.cpet.2022.09.010.
Leuzy A, Chiotis K, Lemoine L, Gillberg PG, Almkvist O, Rodriguez-Vieitez E, et al. Tau PET imaging in neurodegenerative tauopathies-still a challenge. Mol Psychiatry. 2019 Aug;24(8):1112-1134. https://doi.org/10.1038/s41380-018-0342-8.
Ossenkoppele R, van der Kant R, Hansson O. Tau biomarkers in Alzheimer's disease: towards implementation in clinical practice and trials. Lancet Neurol. 2022 Aug;21(8):726-734. https://doi.org/10.1016/S1474-4422(22)00168-5.
Weber DM, Taylor SW, Lagier RJ, Kim JC, Goldman SM, Clarke NJ, et al. Clinical utility of plasma Aβ42/40 ratio by LC-MS/MS in Alzheimer's disease assessment. Front Neurol. 2024 Mar 25;15:1364658. https://doi.org/10.3389/fneur.2024.1364658.
Sakimura K, Kawai T, Nashida R, Ishida Y, Harada K, Suzuki T, et al. A novel PDHK inhibitor restored cognitive dysfunction and limited neurodegeneration without affecting amyloid pathology in 5xFAD mouse, a model of Alzheimer's disease. Alzheimers Res Ther. 2024 Sep 5;16(1):197. https://doi.org/10.1186/s13195-024-01552-2.
Guo H, Yang R, Cheng W, Li Q, Du M. An Update of Salivary Biomarkers for the Diagnosis of Alzheimer's Disease. Int J Mol Sci. 2025 Feb 26;26(5):2059. https://doi.org/10.3390/ijms26052059.
Minhas PS, Jones JR, Latif-Hernandez A, Sugiura Y, Durairaj AS, Wang Q, et al. Restoring hippocampal glucose metabolism rescues cognition across Alzheimer's disease pathologies. Science. 2024 Aug 23;385(6711):eabm6131. https://doi.org/10.1126/science.abm6131.
Schäfer S, Herrmann J, Tovar S, Linz N, Tröger J. Speech-Based Digital Biomarkers for Alzheimer's Research. Methods Mol Biol. 2024;2785:299-309. https://doi.org/10.1007/978-1-0716-3774-6_18.
Sabbagh MN, Boada M, Borson S, Chilukuri M, Doraiswamy PM, Dubois B, et al. Rationale for Early Diagnosis of Mild Cognitive Impairment (MCI) Supported by Emerging Digital Technologies. J Prev Alzheimers Dis. 2020;7(3):158-164. https://doi.org/10.14283/jpad.2020.19.
Hajjar I, Okafor M, Choi JD, Moore E 2nd, Abrol A, Calhoun VD, Goldstein FC. Development of digital voice biomarkers and associations with cognition, cerebrospinal biomarkers, and neural representation in early Alzheimer's disease. Alzheimers Dement (Amst). 2023 Feb 5;15(1):e12393. https://doi.org/10.1002/dad2.12393.
Bjornstal O, Rogers K, Zhang W, Delhaye R, Malone M, Unger S, et al. The impact of decreased bead count to determine concentrations of amyloid beta1-42, total-tau, and phosphorylated-tau181 in human cerebrospinal fluid using xMAP technology. J Pharm Sci. 2011 Nov;100(11):4655-63. https://doi.org/10.1002/jps.22700.
Schneider T. International Alzheimer’s prevention trial in young adults begins. WashU Medicine. February 4, 2025. https://medicine.washu.edu/news/international-alzheimers-prevention-trial-in-young-adults-begins/
Wang W, Wang Q, Qi X, Gurney M, Perry G, Volkow ND, et al. Associations of semaglutide with first-time diagnosis of Alzheimer's disease in patients with type 2 diabetes: Target trial emulation using nationwide real-world data in the US. Alzheimers Dement. 2024 Dec;20(12):8661-8672. https://doi.org/10.1002/alz.14313.
Ornish D, Madison C, Kivipelto M, Kemp C, McCulloch CE, Galasko D, et al. Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer's disease: a randomized, controlled clinical trial. Alzheimers Res Ther. 2024 Jun 7;16(1):122. https://doi.org/10.1186/s13195-024-01482-z.
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Copyright (c) 2025 Zhizhen Li, Zhaohai Feng, Song He, Huaping Tang, Cai Zhao, Jinfeng Liu, Yao Su, Jiayang Duan, Xue Tian, Yong Yan, Xiaojing Shi, Xueling Bi

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Accepted: 2025-07-01
Published: 2025-07-07