Acta Neuropathologica

Myelin oligodendrocyte basic protein (MOBP) is an abundant oligodendrocyte gene implicated in multiple neurodegenerative diseases. Genetic variation at the MOBP locus has been associated with risk for progressive supranuclear palsy (PSP), amyotrophic lateral sclerosis (ALS), frontotemporal lobar degeneration (FTD), corticobasal degeneration (CBD), Alzheimers disease (AD), Lewy body dementia (LBD), and Creutzfeldt-Jakob disease (CJD). Epigenetically, MOBP promoter hypermethylation and reduced expression have been reported in multiple system atrophy (MSA). Although MOBP is thought to play a role in oligodendrocyte morphology and myelin structure, how genetic and epigenetic variation at this locus influences gene regulation and contributes to disease risk remains poorly understood across neurodegenerative disorders. Here, we investigated whether shared or disease-specific genetic mechanisms at MOBP converge on altered DNA methylation and expression across neurodegenerative disorders. We analysed MOBP variants using summary statistics from recent GWAS for ALS, PSP, FTD, LBD, PD, MSA, AD, and CJD. Colocalisation (COLOC and SuSiE-coloc) was used to test whether disease-associated variants overlapped between diseases, and with oligodendrocyte expression quantitative trait loci (eQTLs) and bulk brain methylation quantitative trait loci (mQTLs). To further investigate mQTL effects at this locus, rs1768208, a variant previously associated with PSP, was genotyped in an overlapping brain methylation cohort, allowing direct testing of genotype-methylation associations in frontal white matter tissue. ALS and PSP GWAS demonstrated strong association at MOBP, with most strongly associated SNPs (e.g. rs631312, rs616147, rs1768208) shared between both disorders. Colocalisation analyses indicated high posterior probability that ALS and PSP share the same causal variant, with weaker overlap with FTD. mQTL colocalisation highlighted cg15069948, located near an exon junction within MOBP, as strongly colocalising with the ALS/PSP risk variants. In complementary tissue analyses, rs1768208-T carriers showed hypomethylation at cg15069948 in PSP brains. No genotype-methylation effects were detected in MSA or Parkinsons disease. Together with prior evidence of promoter hypermethylation and reduced expression in MSA, our findings identify cg15069948 as a regulatory methylation site linking ALS/PSP risk variants to altered MOBP methylation, and support MOBP dysregulation as a shared feature of neurodegeneration. However, the underlying mechanisms appear disease-specific, highlighting the complexity of involvement of this gene across neurodegenerative disorders.

Transactive response DNA binding protein 43 kDa (TDP-43) pathology, is a central molecular hallmark of amyotrophic lateral sclerosis (ALS). However, the underlying triggers are incompletely understood. Here, we show that infection with herpes simplex virus (HSV) induces molecular hallmarks of ALS in various in vitro and in vivo models and is associated with an increased risk of ALS in human population data. German healthcare provider data (n = 238,440) and herpesvirus serology of an ALS patient and control cohort (n = 1,100) showed that HSV infection elevated the ALS risk by 210% and odds by [~]65%, respectively. On a molecular level, HSV infection promoted TDP-43 pathology in neuronal cell models, human iPSC-derived motoneurons and cerebral organoids, mice, and human tissue sections. This effect was triggered by HSV-1 or 2, but not by several other related herpesviruses. Mechanistically, the infected cell protein 0 (ICP0) of HSV-1/2 drives TDP-43 pathology by disturbance of promyelocytic leukemia nuclear bodies (PML-NBs), thereby abrogating TDP-43 SUMO2/3ylation. Taken together, we reveal a previously unrecognized association between HSV infection and ALS and clarify the underlying molecular mechanism that drives TDP-43 pathology. Our data may guide future studies into therapeutic and prophylactic interventions against ALS.

Motor neuron (MN) loss is a hallmark of neurodegenerative disorders, yet its assessment remains variable, confounding mechanistic and therapeutic interpretation. To address this, we conducted a systematic review and meta-analysis of spinal muscular atrophy (SMA) mouse studies, revealing 60% variability in reported MN loss, largely attributable to nonspecific spinal cord sampling. Using a whole-segment approach with tissue clearing, MN tracing, and multimodal imaging, we confirmed segment-dependent differences in MN counts. Common MN markers (SMI-32, Nissl) lacked specificity, whereas choline acetyltransferase (ChAT) provided robust labeling in murine and human spinal cords. Deep learning-based whole-mount segmentation enabled unbiased MN quantification and validated manual counts. Integrating analysis with computational modeling established segment sampling as a key driver of variability and revealed degeneration patterns: widespread MN loss in amyotrophic lateral sclerosis (ALS), selective MN loss in severe SMA, and preservation in mild SMA models. These findings establish a framework for reproducible MN quantification. HighlightsO_LISpinal cord segment-specific analysis reduces variability and allows accurate MN quantification C_LIO_LIChAT is the most reliable MN marker in murine and human spinal cords C_LIO_LIDeep learning-based segmentation enables unbiased MN quantification in intact spinal cords C_LIO_LIMN degeneration is widespread in ALS but restricted to pools innervating proximal muscles in severe SMA C_LI

The role of the epigenome in age-related neurodegenerative disorders remains understudied. Here, we analyzed circulating cell-free DNA (cfDNA) from blood to detect methylation changes as a liquid-biopsy for Amyotrophic Lateral Sclerosis (ALS). Our study included 20 patients with sporadic ALS, 10 patients with C9orf72-associated ALS, 10 asymptomatic carriers of the C9orf72 repeat expansion mutation, and 21 non-disease controls. Following targeted enzymatic methyl-sequencing (EM-seq) of [~]4 million CpG sites, we detected numerous differentially methylated genes, including several implicated in ALS disease risk and pathogenesis. By integrating multiple epigenetic features, we delineated a distinct epigenetic signature, which achieved an average area under the curve (AUC) of 0.91 {+/-} 0.10 upon receiver operator characteristic (ROC) analysis, which enabled detection of [~]70% of ALS patients with close to 100% specificity. Furthermore, we also identified a set of genes whose methylation status significantly correlated with clinical disease progression and cerebrospinal fluid (CSF) neurofilament levels. Our results reveal the potential of cfDNA-based biomarkers to accurately diagnose ALS and potentially predict disease progression.

Parkinsons disease is defined clinically by motor dysfunction, but its pathology is not confined to nigral dopaminergic neurons. Prominent non-motor features including cognitive impairment, autonomic failure and sleep disturbance indicate widespread neurodegeneration that remains incompletely characterised. We pre-registered and conducted a multilevel meta-analysis of 166 case-control post-mortem studies published between 1963 and 2025, mapping neuronal loss across 85 brain regions, 38 cell types and 145 region-cell populations. The evidence base behind this map is thin. Only 4 of 145 populations are adequately powered, and 82% of Allen Brain Atlas regions have never been quantified in Parkinsons disease. A further 18 populations would reach adequate power with five or fewer additional studies, identifying an efficient route to closing current gaps. Noradrenergic neurons of the locus coeruleus degenerate to a similar extent as substantia nigra dopaminergic neurons, with both populations losing more than 60% of neurons. Cholinergic neurons of the basal nucleus and pedunculopontine tegmental nucleus and dopaminergic neurons of the ventral tegmental area show significant but less severe loss. These findings establish Parkinsons disease as a multi-system neurodegenerative disorder and expose key gaps and biases in the existing literature.

The majority of genetic risk variants for late-onset Alzheimers disease (LOAD) reside within non-coding genomic regions, suggesting they exert pathogenic effects by disrupting transcriptional regulatory programs. To systematically identify functional variants, we performed an unbiased, high-throughput Massively Parallel Reporter Assay (MPRA) in the THP-1 human monocytic cell line, screening 2,231 SNPs across 24 LOAD GWAS loci. We identified 62 variants exhibiting significant allele-specific transcriptional regulatory output, including rs636317 in the MS4A locus. The risk allele of rs636317 disrupts a CTCF binding motif, altering fine-scale chromatin looping. To validate these findings, we employed CRISPR/Cas9 to generate an allele-specific deletion of the rs636317 T allele in H9 human embryonic stem cells. Monocytes differentiated from these edited cells displayed increased expression of MS4A4E, MS4A6A, and TREM2, along with highly elevated levels of soluble TREM2 (sTREM2). These results provide a mechanistic link between a non-coding genetic variant, transcriptional regulation of the MS4A family, and TREM2-mediated immune responses in Alzheimers disease pathogenesis.

Synucleinopathies are a group of neurodegenerative diseases characterized by the presence of misfolded -synuclein inclusions which cause progressive disease by spreading throughout the brain in a prion-like manner. Throughout the neurodegenerative disease field, the ability of a single protein to give rise to multiple distinct clinical disorders is explained by the strain hypothesis, or the idea that the misfolded protein conformation determines the resulting disease. This was initially shown using transmission studies in cell lines and mouse models; more recently cryo-electron microscopy (cryo-EM) validated this idea by identifying distinct -synuclein filament folds in brain tissues from patients with Parkinsons disease, multiple system atrophy (MSA), and juvenile-onset synucleinopathy. However, very little is known about the -synuclein filament structures that form in animal models of these disorders, and thus their relevance to human disease and suitability as models for therapeutic development remains a question. Here we report the first atomic resolution cryo-EM structures of -synuclein fibrils from an MSA patient sample before and after transmission to a transgenic mouse model of disease. Our findings indicate that while distinct adaptations occur during fibril replication in the mouse host, key structural facets are maintained, validating the merits of this transmission model for supporting preclinical research on MSA.

Nuclear depletion and cytoplasmic aggregation of TDP-43 occur in [~]97% of amyotrophic lateral sclerosis (ALS) cases and disrupt RNA processing through aberrant cryptic exon inclusion. Existing cellular models rely on partial knockdown, TARDBP mutations, or pharmacological stress, each with limitations. Here, we generated homozygous TARDBP-knockout human iPSC lines using CRISPR-Cas9 genome editing and differentiated them into spinal motor neurons (MNs). Knockout MNs demonstrated [~]16-fold lower differentiation efficiency than isogenic controls but retained neuronal marker expression. TDP-43 loss induced widespread cryptic exon inclusion and depletion of STMN2, UNC13A, and G3BP1. Integration of the CUTS splice biosensor yielded up to 4.5-fold cryptic GFP induction in knockout MNs, providing a reporter-based readout of TDP-43 dysfunction. Further, we validated the cardiac glycosides digoxin and ouabain as modulators of bortezomib-induced TDP-43 pathology. This genetically defined iPSC-derived MN model provides a platform for mechanistic and therapeutic interrogation of TDP-43-driven neurodegeneration in ALS.

SARM1 and NMNAT2 are two well described players in the Programmed Axon Death (PAxD) pathway. However, less is known about their transcriptional regulation, especially in humans, despite evidence that their expression levels influence axon vulnerability and thus modulation of expression presents a potential therapeutic target. Here, we used in-cell luciferase assays to functionally study the promoter regions of the human NMNAT2 and SARM1 genes. We find that human NMNAT2 expression can be driven by cAMP, acting through one cAMP response element (CRE), compared to two in mice. Naturally occurring single-nucleotide variants exist within the CRE, some of which lower NMNAT2 promoter activity by more than 50%. We also report an ultra-rare single nucleotide variant in the NMNAT2 promoter in an ALS patient in Project MinE. This variant demonstrates pathogenic potential by lowering NMNAT2 promoter activity in our assay. Project MinE also reveals a common SARM1 promoter variant that significantly increases SARM1 promoter activity in our assay. Thus, several single nucleotide changes in the NMNAT2 and SARM1 promoters modify transcription levels in the direction that would predict an increase in susceptibility to PAxD. These promoter variants refine our understanding of regulatory mechanisms affecting NMNAT2 and SARM1 expression and, together with previously reported coding variants for these genes, expand the catalogue of functionally relevant variants for future association studies in neurodegenerative diseases, including peripheral neuropathies and motor nerve disorders.

Despite growing evidence for glial involvement in Parkinsons disease, oligodendrocyte dysfunction remains poorly defined. To address this gap, we compared single-cell RNA sequencing from a mouse model of -synuclein aggregation pathology with fresh human brain tissue from deep brain stimulation surgery to build a cross-species framework of disease progression. In total, we profiled over 200,000 cortical transcriptomes, including 55,000 oligodendrocytes. Early disease in mice was characterized by inflammatory activation, while advanced stages in both species converged on metabolic dysfunction, including impaired ribosomal output, chaperone stress responses, ubiquitination deficits, and lysosomal perturbation. In patients, APLP1 was upregulated and correlated with clinical disease progression and increased levodopa demand, linking -synuclein spread in oligodendrocytes to disease severity. APP and CNTN pathways emerged as key signalling axes, with CNTN reflecting weakened reparative communication and reduced resilience. Together, these findings define oligodendrocyte subtype dynamics as shared and clinically relevant features of PD progression.

Microglial activation has been closely associated with accelerated ALS disease progression. However, specific microglial pathways that regulate microglial activation and ALS disease progression remain limitedly understood. Here, we determined the role of Clec7a (or Dectin-1), a core signature gene of disease-associated microglia (DAM) in ALS, in regulating microglial activation and ALS disease progression. Our spinal cord scRNA-Seq results found that Clec7a deficiency specifically attenuated microglial neuroimmune gene expression in SOD1G93A mice and human ALS. In addition, in vivo two-photon imaging of human (h) TDP43 phagocytosis by microglia in the cortex showed that Clec7a deficiency promotes microglial phagocytosis of pathological hTDP43 by enhancing microglial process dynamics. Subsequent survival analysis further showed that selective deletion of Clec7a in microglia mitigates motor neuron degeneration and delays disease progression in SOD1G93A ALS mice. Together, our results establish that Clec7a is a key regulator in shaping disease microglial functions and promotes disease progression in ALS.

Multiple system atrophy (MSA) is a sporadic progressive neurodegenerative disorder characterised by central nervous system alpha-synuclein inclusions. MSA pathologically most commonly shows a spectrum of two patterns, olivopontocerebellar atrophy and striatonigral degeneration, with significant overlap. Although germline variants are unlikely to play a major role, an association with the KCTD7 gene was recently reported. Somatic mutations are abundant in the brain, and may play a role in neurodegeneration. In MSA, somatic SNCA (alpha-synuclein) copy number gains occur, but single nucleotide mutations have not been investigated. In Alzheimers disease, somatic mutations in tumour suppressor genes were reported in microglia. We hypothesised that brain somatic mutations in SNCA, KCTD7, or the tumour suppressor genes mutated in Alzheimers, may contribute to MSA. To test this, we developed a targeted duplex sequencing pipeline using unique molecular identifiers, encompassing SNCA, KCTD7, and 10 tumour suppressor genes. Seven of these are involved in clonal haematopoiesis, an age-related process which predisposes to haematological malignancy, and can be subdivided into myeloid and lymphoid, based on the cell type affected, with the former much more frequent. We analysed DNA from the cerebellum, cingulate cortex, and putamen of 20 MSA cases (10 olivopontocerebellar atrophy, 10 striatonigral degeneration) and 9 controls. We observed an enrichment of clonal haematopoiesis gene mutations in MSA brains (median 1 vs 0, p=0.054). These included mutations in DNMT3A and TET2, the most frequently affected myeloid clonal haematopoiesis genes, and a recurrent mutation in three cases in KMT2D, a lymphoid clonal haematopoiesis gene. Clonal haematopoiesis mutations were often found in multiple brain regions, and multiregional mutations occurred in 12/20 MSA cases versus 1/9 controls (p=0.020), with 11 cases harbouring clonal haematopoiesis mutations in all three brain regions, compared to 0/9 controls (p=0.005). In striatonigral degeneration, clonal haematopoiesis mutations showed elevated variant allele fractions in the most pathologically affected region, the putamen, versus the cerebellum (p=0.013). MSA clonal haematopoiesis mutations included eight unique non-synonymous variants, which had higher allelic fractions than synonymous changes (p=0.076), and five of these were predicted to confer a proliferative advantage and were found in multiple brain regions. We detected no coding SNCA mutations, and the small number of KCTD7 variants, including one coding deletion, precludes any conclusions. These findings reveal enrichment of clonal haematopoiesis mutations in MSA brain, potentially due to infiltration from the periphery, suggesting a disease-associated proliferative process extending beyond peripheral haematopoiesis.

-Synuclein nitration is a prominent post-translational modification in Parkinsons disease, but whether nitrated -synuclein merely reflects oxidative stress or actively contributes to pathology remains unclear. Here, we generated and characterized 6G6, an antibody selective for Tyr39-nitrated -synuclein, and tested whether targeting this modified -synuclein species affected pathology in different mouse models of -synuclein aggregation and spread. In two models of -synuclein overexpression targeting medullary vagal neurons, oxidative stress was induced by either exposure to the herbicide paraquat or transgenic heterozygous expression of the Gba1-L444P mutation. Both conditions were characterized by robust -synuclein spreading that was markedly counteracted by 6G6 administration. A third model consisted of an injection of -synuclein fibrils into the striatum of -synuclein-overexpressing mice. In this model, treatment with 6G6 protected against fibril-induced aggregate pathology and ensuing degeneration of nigral dopaminergic neurons. In a pilot human study, CSF levels of Tyr39-nitrated -synuclein were measured and found increased in Parkinson patients as compared to controls. These findings identify Tyr39-nitrated -synuclein as a pathogenic, therapeutically targetable -synuclein species linking oxidative/nitrative stress to PD pathological processes.

Friedreichs ataxia (FA) is a rare autosomal recessive neurodegenerative disorder caused by reduced expression of frataxin, a mitochondrial protein important for iron-sulfur cluster assembly and mitochondrial homeostasis. Although FA has traditionally been attributed to neuronal dysfunction, increasing evidence suggests that glial cells play a critical role in disease progression, although their contribution remains poorly defined. Using the FXNI151F mouse model, we investigated cell-type-specific metabolic and redox alterations in neurons and glial populations from the cerebrum, cerebellum, and dorsal root ganglia (DRG). Neuronal and glial-enriched fractions were isolated by immunomagnetic separation and analyzed for mitochondrial function, iron metabolism and reactive oxygen species (ROS). The analyses identified the DRG as the most severely affected region, exhibiting early and pronounced mitochondrial respiratory deficits, increased ROS, mitochondrial iron accumulation, lipid peroxidation, and reduced levels of glutathione peroxidase 4 and nuclear factor erythroid 2-related factor 2 in both neuronal and non-neuronal cells. These results highlight the vulnerability of sensory neurons and their supporting satellite glial cells. In contrast, in the cerebrum and cerebellum, astrocytes displayed earlier and more severe alterations than neurons, including impaired respiratory chain efficiency, disrupted complex I-III supercomplex interaction, elevated ROS, and hallmarks of ferroptosis. Neuronal abnormalities emerged later, suggesting that glial dysfunction precedes -or drives- neuronal pathology within the central nervous system. Overall, these findings reveal pronounced region and cell-type-specific vulnerabilities in FA and support the importance of targeting glial mechanisms--particularly iron dysregulation, oxidative stress, and ferroptosis-- as targets for potential therapeutic strategies.

Multiple sclerosis (MS) is a progressive neuroinflammatory demyelinating disease of the central nervous system (CNS) that remains incurable. Autoreactive myelin-specific T cells contribute to immunopathology by directly targeting and damaging oligodendrocytes in situ. In oligodendrocytes, several immune-modulatory functions have been described that can ameliorate immune damage. However, a systematic discovery of cell-intrinsic mechanisms that protect oligodendrocytes against T cell-derived cytotoxic mechanisms has not been performed. We used human MO3.13 oligodendrocytic cells and human antigen-specific cytotoxic T cells to conduct a high-throughput (HTP) RNAi-based screen with altogether 4155 genes to identify oligodendrocyte-intrinsic immune resistance genes (IRGs). The screen revealed 133 candidate IRGs. Among them, we validated 32, which exerted a strong immuno-protective phenotype. We studied IRG expression landscapes in human brain cell subsets from postmortem brain tissues of MS and control individuals. This revealed clustered expression of IRGs in a cell-type and oligodendrocyte subset-specific manner and differential IRG expression between MS patients and controls in distinct oligodendrocyte subclusters. ChEA3 analysis revealed cell type-specific expression of transcription factors that can drive expression of respective IRGs. Explorative molecular mode of action analyses of five selected IRGs, STK11, KCNH8, ABCA2, SLC1A3 and CHRNA1 revealed that these prevented death receptor-mediated apoptosis induced by T cell-derived cytotoxic molecules. In particular, they controlled TRAIL-induced apoptosis by suppressing JNK1 activation through interfering with several upstream pathways regulating metabolic, potassium, cholesterol, glutamate and acetylcholine homeostasis. In addition, STK11, ABCA2, and CHRNA1 regulated TRAIL-R2 surface expression contributing to increased TRAIL-sensitivity whereas KCNH8 expression in oligodendrocytes inhibited secretion of inflammatory cytokines by cytotoxic T cells. Taken together, we here demonstrate the existence of multiple co-expressed IRGs in human oligodendrocytes that regulate multifaceted mechanisms of T cell resistance and are dysregulated in oligodendrocyte subsets of MS patients.

T cells modulate disease associated neuroinflammation in Parkinsons disease (PD). We report that circulating CD4+ T cells from people with PD have a dysregulated transcriptional and cytokine response to fasting and refeeding and an altered metabolic profile. The CD4+ T cell secretome mediates a metabolic program in neurons that is impaired in PD, revealing dysfunctional neuro-immune signalling that may contribute to disease pathology.

Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease of the central nervous system with a complex etiology. Recent genomic studies highlight the contribution of expression quantitative trait loci (eQTLs) in modulating gene expression and disease susceptibility. Given the emerging role of circular RNAs (circRNAs) in MS, we hypothesized that genetic variants may regulate circRNA expression through circRNA-specific eQTLs (circ-eQTLs). We performed a cis-circ-eQTL analysis integrating circRNA expression and whole-genome genotyping data from 30 MS patients and 18 healthy controls using a linear regression model adjusted for disease status and sex. Candidate circ-eQTLs were prioritized based on MS-associated regions and known splicing QTLs (sQTLs) from GTEx and validated in an independent cohort (67 MS, 64 controls). Association analysis in a larger cohort (2831 MS, 3191 controls) evaluated two candidate variants for MS risk. We identified 42,077 significant cis-circ-eQTLs and validated three. Two SNPs, rs7214410 and rs11079784, modulated hsa_circ_0106983 expression, and rs7214410 also acted as an sQTL affecting EFCAB13 splicing. rs7214410 showed stronger association with MS than rs11079784. Our findings reveal extensive genetic regulation of circRNA expression and highlight rs7214410 as a dual-function variant refining the MS susceptibility locus on chromosome 17.

Retrospective studies in patients with non-muscle invasive bladder cancer (NMIBC) have reported a significant reduction in Alzheimers disease (AD) incidence (12-78%) among Bacillus Calmette-Guerin (BCG) recipients versus controls. To investigate the underlying mechanisms, we evaluated BCG in the PS19 mouse model of tauopathy. We found that BCG administration reduced hippocampal phospho-tau and microgliosis while preserving neuronal markers. In vivo volumetric T2-MRI demonstrated attenuation of brain atrophy accompanied by increased glutamate-weighted CEST-MRI signals. Functionally, BCG-treated mice showed improved performance in the novel object recognition test (NORT), as well as improved body-weight maintenance and survival. Transcriptomic profiling of the hippocampus revealed near complete normalization of the PS19 disease-associated gene expression signature towards that of healthy controls. Flow cytometric profiling of brain myeloid populations demonstrated a reduction in activated resident microglia, but total microglia cells remain elevated. Moreover, an increase of the co-stimulatory marker CD80 on the recruited peripheral myeloid cells ensues following BCG treatment. Consistent with this shift in myeloid state, primary brain myeloid cells from BCG-treated mice also exhibited enhanced phagocytosis of FITC-labeled tau fibrils and increased lactate production. Together, these findings indicate that BCG induces systemic and CNS myeloid cell reprogramming that limits neuroinflammation, enhances tau clearance, and rescues cognitive and neurodegenerative phenotypes in a tauopathy model. BCG is a safe, readily available therapy that merits consideration as a preventive agent against dementia. One sentence summaryBCG therapy prevents tauopathy in PS19 mouse model.

Amyotrophic lateral sclerosis (ALS) is a rapidly progressing neurodegenerative disease with a heterogeneous clinical presentation, complicating early diagnosis and therapeutic monitoring. To identify disease-specific biomarkers, we performed an unbiased cerebrospinal fluid (CSF) proteomic analysis in 87 ALS patients, 89 healthy controls, and 61 neurological controls using data-independent mass spectrometry. Across all quantified proteins, 399 were significantly dysregulated in ALS, including established neurodegeneration (NEFL, NEFM, UCHL1) and neuroinflammatory (CHIT1, CHI3L1, CHI3L2) markers. Correlation and pathway analyses uncovered dysregulation of immune, synaptic, and metabolic processes, with aberrant complement activation emerging as a hallmark. Complement proteins increased progressively with declining ALS Functional Rating Scale-Revised and longer disease duration, whereas early-stage markers (CLSTN3, CHAD, RELN) indicated pre-symptomatic neuronal and synaptic disruptions. Machine learning identified a minimal five-protein CSF panel (MB, ITLN1, YWHAG, FCGR3A, PGAM1) that accurately distinguished ALS patients from healthy controls, capturing disease-specific pathophysiology beyond general neurodegeneration. Our findings define a robust ALS-specific CSF proteomic signature, reveal prognostic protein candidates across disease stages, and provide a framework for diagnostic biomarker development, enabling earlier intervention and monitoring.

Cerebral amyloid angiopathy (CAA), a major vascular contributor to cognitive decline, is present in 85-95% of Alzheimers disease (AD) patients. Despite its high prevalence, the mechanisms by which CAA contributes to neurodegeneration remain poorly understood. Triggering receptor expressed on myeloid cells 2 (TREM2), an innate immune receptor expressed exclusively by microglia, regulates activation, phagocytosis, and amyloid clearance, thereby shaping neuroinflammation. Loss-of-function mutations in TREM2 markedly increase AD risk, but its role in CAA pathology remains unknown. To investigate this, we crossed the Familial Danish Dementia (Tg-FDD) mouse model, which accumulates robust vascular amyloid, with TREM2 knockout (TREM2KO) mice to generate Tg-FDD/TREM2KO animals. Histological and transcriptomic analyses revealed region-specific effects of TREM2 deficiency. In the cortex, TREM2 loss markedly reduced vascular amyloid deposition, accompanied by decreased tau pathology. In contrast, in the cerebellum, TREM2 deletion exacerbated vascular amyloid accumulation, promoted astrogliosis, and enhanced tau pathology. Transcriptomic profiling further identified distinct neuroinflammatory signatures between cortex and cerebellum, particularly in cytokine signaling, matrix remodeling, and lipid metabolism. Together, these findings demonstrate that TREM2 deficiency leads to region-specific effects on CAA, revealing extensive regional variability in vascular amyloid pathology and underscoring the importance of considering these differences when developing TREM2-based therapies.