Mol Neurobiol. 2026 Oct 31. pii: 1007. [Epub ahead of print]63(1):
Maintenance of protein homeostasis is essential for neuronal survival, and its disruption is a defining feature of neurodegenerative diseases. Neurons are particularly vulnerable to proteostatic stress due to their post-mitotic nature, long lifespan, and dependence on cytoskeletal integrity for structural stability, intracellular transport, and synaptic function. In tauopathies and related neurodegenerative disorders, misfolded proteins and aggregation-prone proteins burden the cellular quality-control systems, leading to cytoskeletal destabilization, synaptic dysfunction, and progressive neuronal loss. This review is organized around a central question: for a given tau species, defined by its isoform, post-translational modifications, and assembly state, what determines its fate? We examine how molecular chaperone networks, including HSP100, HSP90, HSP70, J-domain proteins (JDPs), small heat shock proteins (sHSPs), and the Prefoldin-CCT pathway, regulate the folding, disaggregation, sequestration, and degradation of pathogenic tau. We highlight how these chaperone networks influence key proteostasis checkpoints, determine whether tau refolds, is degraded, or is redirected toward toxic aggregation, and how these outcomes impact microtubule stability and neuronal function. Drawing on studies in yeast, Drosophila, mammalian models, and human tissues, we develop two key conclusions. First, chaperone activity is not uniformly protective against tauopathies; its effects depend on the tau species, cellular context, and disease stage. Second, because the cytoskeleton is both a chaperone client and an essential component of intracellular clearance pathways, tau pathology and proteostasis failure can reinforce one another. Finally, we discuss emerging therapeutic strategies and challenges in targeting chaperone networks to restore proteostasis while avoiding unintended neurotoxic consequences.
Keywords: Cytoskeletal dysfunction; Heat shock proteins; Molecular chaperones; Protein aggregation; Proteostasis; Tauopathy