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Zagotenemab is a humanized monoclonal antibody developed as an immunotherapy targeting tau protein pathology in Alzheimer's disease. It was derived from the mouse monoclonal antibody MCI-1 and specifically binds to a pathological conformation of tau, with high affinity for soluble aggregated (misfolded) tau over monomeric forms. Zagotenemab acts by binding to extracellular misfolded tau aggregates, particularly at amino acids 7–9 in the N-terminal region and 312–322 in the microtubule-binding region of the tau protein. The mechanism aims to neutralize toxic tau species, block or delay their transcellular spread, reduce neurofibrillary tangle formation, and potentially slow neuronal loss associated with Alzheimer’s disease progression. Despite promising preclinical results showing reduced pathological tau accumulation in animal models, clinical trials failed to demonstrate efficacy in slowing cognitive decline or functional deterioration in early symptomatic Alzheimer’s disease patients[1][3][4][5][6].
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