| Biomarker / diagnostic feature | Modality / specimen | Intended use | Key quantitative finding | Source (DOI / year) |
|---|---|---|---|---|
| Neurofilament light chain (NfL) | CSF and plasma | Prognosis; supportive differential diagnosis | NfL concentrations are reported to be **2–5× higher in PSP CSF** than in healthy controls and PD; similar plasma elevation reported, but specificity remains limited (pqac-00000030) | 10.1186/s12014-024-09507-3 / 2024 |
| CSF p-tau181 | CSF | Prognosis / disease monitoring | **Low CSF p-tau181** has been associated with **faster clinical progression** in PSP, but sensitivity/specificity are limited (pqac-00000009, pqac-00000032) | 10.1212/WNL.0000000000209585 / 2024 |
| Axon-guidance protein panel | CSF SOMAmer proteomics | Diagnostic discrimination | Axon-guidance proteins discriminated PSP vs controls with **AUC 0.924** (original cohort), **0.815** (validation), and **0.932** (neuropathology-confirmed cohort); top dysregulated pathway across cohorts (pqac-00000009, pqac-00000032) | 10.1212/WNL.0000000000209585 / 2024 |
| Galectin-10 (CLC) and CTLA-4 | CSF SOMAmer proteomics | Severity / progression correlation | Two inflammatory proteins, **galectin-10** and **CTLA-4**, correlated with **PSP Rating Scale** severity across cohorts (pqac-00000009, pqac-00000032) | 10.1212/WNL.0000000000209585 / 2024 |
| ATP6AP2 | CSF TMT mass-spectrometry proteomics | Diagnostic discrimination | **ATP6AP2 reduced in PSP** and had the highest classification performance with **AUC 0.922** for PSP vs PD/HC (pqac-00000011, pqac-00000030) | 10.1186/s12014-024-09507-3 / 2024 |
| Additional CSF proteomic candidates | CSF TMT mass-spectrometry proteomics | Diagnostic panel development | Other top candidates included **NEFM, EFEMP2, LAMP2, CHST12, FAT2, B4GALT1, LCAT, CBLN3, FSTL5, ATP6AP1, GGH**; pathways enriched for **cell adhesion, cholesterol metabolism, glycan biosynthesis** (pqac-00000011, pqac-00000030) | 10.1186/s12014-024-09507-3 / 2024 |
| Serum p-tau396 | Serum ELISA / SIMOA-based pilot biomarker study | Clinical staging / severity tracking | Of six serum tau species tested, **only p-tau396 was detectable**; it was **higher in PSP and PD vs controls** but overlapped between PSP and PD, and **strongly correlated with disease severity in PSP** (pqac-00000031) | 10.3390/diagnostics14232746 / 2024 |
| Serum tau species panel (t-tau, 4R-tau, tau aggregates, p-tau202, p-tau231, p-tau396) | Serum | Exploratory differential diagnosis | Most serum tau species were **undetectable or too low for ELISA**, arguing against current routine serum tau-species discrimination of PSP vs PD except possible staging value for p-tau396 (pqac-00000031) | 10.3390/diagnostics14232746 / 2024 |
| 18F-PI-2620 tau-PET | Tau PET | In vivo tau pathology; diagnostic enrichment; progression staging | In probable PSP-RS, **subcortical tau uptake** was associated with **higher NfL and NfL/t-tau**, lower GFAP-related ratios, **reduced brain volume**, and **worse executive function**; patients showed higher fluid biomarker levels than controls (pqac-00000015) | 10.1101/2024.10.14.24315486 / 2024 |
| NfL/t-tau ratio with PI-2620 tau-PET | Plasma/CSF + tau PET | Trial biomarker / disease monitoring | Biomarker ratios showed strong patient-control separation; reported **NfL/t-tau 98.9% (95% CI 96.16%–100%)** in comparative analysis and correlated with tau-PET burden (pqac-00000015) | 10.1101/2024.10.14.24315486 / 2024 |
| MRI midbrain and superior cerebellar peduncle atrophy | Structural MRI | Supportive diagnosis / differential diagnosis | **Midbrain** and **superior cerebellar peduncle atrophy** help differentiate PSP-RS; classic **“hummingbird”** and **“morning glory”** signs have **100% specificity but limited sensitivity** (pqac-00000002) | 10.1016/S1474-4422(17)30157-6 / 2017 |
| MRI / imaging supportive findings in MDS criteria | Imaging | Supportive diagnosis; exclusion of mimics | MDS criteria include imaging as supportive and exclusionary context; relevant structural abnormalities and severe leukoencephalopathy are exclusionary, underscoring MRI’s role in ruling out mimics (pqac-00000017, pqac-00000018) | 10.1002/mds.26987 / 2017 |


*Table: This table summarizes key fluid and imaging biomarkers for progressive supranuclear palsy, including diagnostic and prognostic use cases, quantitative findings, and source citations. It is useful for comparing emerging 2024 proteomic and tau-PET markers with established MRI and CSF indicators.*