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The long-term impact of cumulative blast overpressure on brain health is poorly understood, and sensitive biomarkers are needed for early detection and monitoring of subclinical injury in high-risk populations. In this cross-sectional study, 25 actively serving male Canadian Special Operations Forces personnel (mean [SD] age, 43.6 [6.1] years) with \u226516 years of breaching and explosives experience were compared with 10 age-matched Canadian Armed Forces controls (mean [SD] age, 39.8 [6.8] years) with minimal blast exposure. All participants underwent [18F]flortaucipir PET imaging to quantify cortical tau deposition, MRI, ultrasensitive digital immunoassay for plasma biomarkers, and comprehensive clinical and neurocognitive testing. Group differences in regional [18F]flortaucipir standardized uptake value ratios were assessed using analysis of covariance, and voxelwise Z-score mapping identified clusters of elevated tracer uptake (&amp;gt;2 SD above control mean). Linear regression analyses were conducted to examine associations between PET tau signal, plasma biomarkers, cumulative blast exposure and clinical outcomes. Special Operations Forces personnel exhibited significantly higher [18F]flortaucipir uptake in the frontal (P &amp; 0.022) and temporal cortices (P &amp; 0.037) compared with controls. Voxelwise mapping revealed tau clusters in 88% of exposed individuals, with nearly half localized to the frontal cortex. Elevated PET signal correlated with cumulative years of breaching, post-concussive symptoms, sleep disturbance and functional impairment. Plasma biomarkers showed converging evidence of neurodegeneration: brain-derived tau, glial fibrillary acidic protein and amyloid-\u03b242 levels were significantly associated with regional tau PET uptake. A reduced amyloid-\u03b242\/40 ratio and elevated phosphorylated tau isoforms further supported early molecular changes consistent with neurodegeneration. Cumulative occupational blast overpressure exposure in Special Operations Forces is associated with frontal-predominant tau deposition and plasma biomarker signatures of astroglial activation, axonal injury and CNS-specific tau release. These convergent imaging and molecular findings support a link between repetitive blast exposure and early-stage tauopathy, and highlight the value of combined tau PET imaging and fluid biomarkers as non-invasive tools for early detection, monitoring, and targeted risk mitigation in blast-exposed populations.<\/jats:p>","DOI":"10.1093\/braincomms\/fcag070","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T13:04:49Z","timestamp":1773234289000},"source":"Crossref","is-referenced-by-count":2,"title":["Tau-PET imaging and blood biomarkers reveal early tauopathy in special operations forces exposed to repetitive blast"],"prefix":"10.1093","volume":"8","author":[{"given":"Shamantha J","family":"Lora","sequence":"first","affiliation":[{"name":"Brain Health Imaging Centre, Centre for Addiction and Mental Health , Toronto, ON M5T 1R8 ,","place":["Canada"]},{"name":"Institute of Medical Sciences, University of Toronto , Toronto, ON M5S 3H2 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