EMBO Molecular Medicine

Skeletal muscle possesses remarkable regenerative capacity. However, in limb-girdle muscular dystrophy-2F (LGMD2F), this capacity is compromised by persistent innate immune activation, whose transcriptional landscape remains unexplored. In parallel, (-)-Epicatechin has emerged as a promising compound with beneficial effects on muscle and notable anti-inflammatory properties. We therefore used (-)-Epicatechin treatment to test whether it can alleviate LGMD2F-associated transcriptional and immune dysregulation. Here we provide the first transcriptomic characterization of LGMD2F using the Sgcd-/- mouse model, along with the first RNA-sequencing-based evaluation of (-)-Epicatechin treatment. We profiled two functionally distinct muscles -- the soleus and EDL -- through bulk RNA-sequencing coupled with immune cell-deconvolution. Sgcd-/- muscles exhibited marked transcriptional dysregulation, more pronounced in the soleus and associated with enhanced innate immune signaling. (-)-Epicatechin induced a muscle- and genotype-dependent transcriptional response: in wild-type animals, the EDL displayed the highest number of differentially expressed transcripts, whereas in Sgcd-/- mice, the soleus showed the most prominent response. This shift was accompanied by downregulation of Toll-like receptor and RIG-I-like receptor pathways, along with suppression of NF-{kappa}B2 and interferon-stimulated genes. Together, these findings identify innate immune overactivation as a central feature of LGMD2F and reveal (-)-Epicatechin as a context-dependent modulator of muscle-specific transcriptional responses.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of poor prognosis, for which age is the strongest risk factor. Despite significant progress in the discovery of ALS-associated mutations, no model explains how such a diversity of mutations converges in a common pathology. In addition, most ALS cases are sporadic and lack known genetic drivers. We recently reported that arginine-rich peptides arising from the C9ORF72 mutation trigger a widespread accumulation of orphan ribosomal proteins (oRP). Here, we show that oRP accumulation is also observed upon expression of other RNA-related ALS mutations, such as hnRNPA2D290V and TDP-43A315T, as well as upon exposure to the ALS-related neurotoxin {beta}-N-methylamino-L-alanine (BMAA). Furthermore, the transcriptional signature of patients with sporadic ALS resembles that of Diamond-Blackfan anemia (DBA), a known ribosomopathy. Supporting the usefulness of our in vitro data, a transcriptional signature defined from these models provides diagnostic and prognostic value in ALS patients. We propose that the accumulation of oRPs due to dysfunctional ribosome biogenesis is a molecular hallmark of ALS that can contribute to the progressive loss of motor neurons in the disease.

Pathogenic variants in IFT140 are associated with a spectrum of syndromic and non-syndromic ciliopathies, with retinal degeneration as a common feature. Despite advances in understanding IFT140 function across various tissues, human retina-specific models are lacking. Here, we show that knock-in mice homozygous for the IFT140 patient variant c.932A>G (p.Y311C) did not develop retinal degeneration, while mice with the homozygous variant c.1451C>T (p.T484M), associated with non-syndromic retinal dystrophy, were embryonic lethal. Therefore, to understand the effect of these variants on retinal homeostasis, we generated novel human in vitro models of IFT140-associated retinal dystrophy, including CRISPR/Cas9 IFT140 knock-out (IFT140KO) induced pluripotent stem cells (iPSC) and patient-derived iPSC retinal pigment epithelium (iPSC-RPE) and retinal organoids (iPSC-ROs). IFT140KO iPSC-RPE cells display stubby cilia compared to isogenic controls, while IFT140T484M/T484Mpatient-derived iPSC-RPE cells exhibit slightly shorter cilia and cilia tip protein accumulation. Both IFT140KO and IFT140T484M/T484M iPSC-ROs show accumulation of cilia proteins at the connecting cilium and outer segment of photoreceptors, and mislocalization of rhodopsin to the inner segments and outer nuclear layer. Pharmacological screening of compounds previously reported to improve cilia structure identified the flavonoid eupatilin as the most effective molecule. Treatment with eupatilin improved cilium length and IFT traffic in iPSC-RPE, and IFT traffic and rhodopsin localization in iPSC-ROs. These findings emphasize the importance of human stem cell derived models to investigate tissue specific disease mechanisms and highlight the therapeutic potential of eupatilin to ameliorate cilia defects in retinal tissue.

Intracerebral haemorrhage is the most severe subtype of stroke; however, pre-clinical investigation often fails to translate to the clinic. Cerebral organoids offer an adaptable, in vitro model of human brain tissue for pre-clinical investigation of disease. We recently demonstrated that the tissue can be successfully vascularised to mimic the cerebrovasculature. Cerebrovascular weakness was induced with atorvastatin to mimic damage observed in intracerebral haemorrhage and to replicate the diseases pathological features. We used atorvastatin to disrupt functional morphology in human brain microvascular endothelial cells in 2D and 3D model systems. Whole human blood was added to initiate damage to cerebral tissues. Vascularised cerebral organoids exhibited loss of vascular integrity when treated with atorvastatin. Tissue was vulnerable to injury from human whole blood, and an innate immune response was initiated, resulting in increased cell death. Here we show that vascularised cerebral organoids demonstrate a novel model platform for investigating pathology associated with human whole blood insult in intracerebral haemorrhage.

Methylmalonic acidemia (MMA) is a recessive genetic disease caused by variants in the MMUT (mitochondrial enzyme methylmalonyl-CoA mutase) gene or by defects in transport or metabolism of MMUT cofactor (5 deoxyadenosylcobalamin), including variants in the MMAB gene. For the most recurrent pathogenic MMAB variant, c.556C>T (R186W), we identified a corrective editing strategy using adenine base editing. Deploying an adenine base editor mRNA and optimized hybrid guide RNA with lipid nanoparticles, we observed efficient in vitro corrective editing of the variant to wild-type, with minimized bystander editing and off-target editing in hepatocytes. These observations lay the groundwork for a gene editing therapy for patients with MMA resulting from at least one copy of the MMAB c.556C>T (R186W) variant, as well as a platform of similar therapies for patients with MMA caused by other variants amenable to adenine base editing.

Despite considerable advances, the emergence of treatment resistance to tyrosine kinase inhibitors (TKIs) therapy remains a significant challenge in chronic myeloid leukemia (CML). Here, we report the first clinical case of resistance to combined ponatinib and asciminib therapy in a CML patient who relapsed with B lymphoblastic blast crisis. While at presentation the patient harbored the canonical e13a2 BCR::ABL1 fusion, at relapse his disease harbored the T315I mutation together with a novel e6a3 BCR::ABL1 fusion, arisen by internal deletion in the original translocated allele. Structural modeling and biochemical analyses demonstrated that deletion of exon 2-encoded residues of ABL1 destabilizes the autoinhibited conformation, resulting in a hyperactive kinase with increased propensity for B-cell differentiation. Functional studies revealed that both BCR::ABL1e6a3 and BCR::ABL1e6a3/T315I conferred resistance to ponatinib and asciminib, alone or in combination. BCR::ABL1e6a3 demonstrated enhanced sensitivity to active-state selective inhibitors dasatinib and bosutinib, whereas BCR::ABL1e6a3/T315I remained resistant. Combined drug sensitivity assays showed that axitinib restored inhibitory activity when combined with ponatinib or asciminib. Strikingly, a combination of axitinib and asciminib with low dose ponatinib fully suppressed enzymatic activity of BCR::ABL1e6a3/T315I and cellular proliferation. These data show that treatment with asciminib and ponatinib can select for mutations with notably elevated enzymatic activity, effectively targeted by an axitinib-based triple combination. These data highlight the remarkable mutability of the BCR::ABL1 kinase, including through novel isoforms and provides a strong rationale for the clinical assessment of a triple inhibitor combination as a strategy to overcome resistance to dual ponatinib and asciminib therapy.

The mechanisms that drive myelin damage as seen in demyelinating disorders such as multiple sclerosis remain incompletely understood. Much of our current knowledge is derived from animal models, but interspecies differences limit their relevance in the context of human pathology and could explain why various promising preclinical therapies failed during clinical translation. Human post-mortem organotypic brain slice cultures provide a unique platform to study human myelin biology, as they preserve genetic, cytoarchitectural, pathological and species-specific context. Here, we evaluated myelin integrity in a human post-mortem brain organotypic slice culture model and experimentally induce focal myelin damage. Human post-mortem organotypic slices cultures retain key features throughout the culturing period, but exhibit gradual cellular and myelin loss over time. Myelin fibres within the white matter remain detectable and present preserved structural and chemical integrity up to 13 days in vitro, indicated by the conserved paranodal and nodal organization and stable myelin spectroscopic signature. Delivery of lysophosphatidylcholine using cryogel scaffolds enables focal drug administration throughout the full depth of the slice with minimal diffusion into surrounding tissue and induces localized demyelination after lysophosphatidylcholine application. Similar focal application of the selective Nav1.6 stimulator {beta}-mammal scorpion toxin Cn2 induces subtle myelin destabilization. Overall, our results demonstrate the suitability of a human post-mortem brain organotypic slice culture model as an adequate platform for studying myelin damage in a human disease context.

Resistance to tyrosine kinase inhibitors (TKIs) remains a critical challenge in chronic myeloid leukemia (CML), particularly when driven by mechanisms independent of BCR-ABL1 kinase-domain mutations. Building on the identification of the RNA-binding protein LIN28A as a driver of imatinib resistance, we evaluated emerging LIN28 inhibitors as potential sensitizing agents. Screening three small molecules in an imatinib-resistant (ImR) K562 model identified LIN28i-1632 as uniquely synergistic with imatinib (synergy score: 12.07), reducing cell proliferation by 71.15%. Quantitative DIA and TMT proteomics revealed that this synergy is characterized by significant proteomic remodelling, including the downregulation of the canonical LIN28 target HMGA1 and the activation of apoptotic and G2/M cell cycle checkpoint programs. Mechanistically, phosphoproteome and kinome profiling showed suppressed AKT/RPS6K and CDK signalling. We further demonstrate that LIN28i-1632 promotes sensitivity by reducing BCR-ABL protein abundance and attenuating the AKT survival axis through RICTOR downregulation and PTEN restoration. Collectively, our findings establish pharmacological LIN28 inhibition as a viable strategy to overcome TKI resistance by simultaneously engaging cell-cycle arrest and dismantling the AKT-mediated survival network.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is rapidly increasing worldwide, yet effective targeted therapies remain limited. To better understand the molecular mechanisms underlying MASLD, we performed an integrated proteogenomic analysis of human liver tissue. Using mass spectrometry, we quantified 2,744 proteins in 504 liver biopsies from the Quebec Obesity Biobank and examined changes across disease stages. To investigate causality, we integrated liver proteomics with RNA sequencing and genome-wide genotyping to map thousands of protein quantitative trait loci (pQTLs) and expression quantitative trait loci (eQTLs). These molecular data were combined with summary statistics from a meta-analysis of genome-wide association studies including 16,532 MASLD cases and 1,240,188 controls. Mendelian randomization and genetic colocalization analyses revealed that most proteins differentially expressed across MASLD stages were not causally implicated in disease risk, whereas several genetically predicted liver proteins showed evidence of causal effects. Among these, higher hepatic levels of the MTARC1 protein were causally associated with MASLD and hepatic fat accumulation. Phenome-wide analyses suggested that MTARC1 inhibition may reduce the risk of cirrhosis, hepatocellular carcinoma, and cholelithiasis while improving lipid profiles. Notably, the causal MTARC1 variant influenced liver protein levels but not gene expression. Genetic analyses also identified ERLIN1 and HSD17B13 as potential therapeutic targets. In contrast, eQTLs and pQTLs at other loci such as GCKR showed opposite effects on MASLD risk. These findings highlight the importance of integrating tissue proteomics with human genetics to distinguish biomarkers from causal drivers and to identify promising therapeutic targets for MASLD.

Oncogenic MYC transcription factors profoundly alter cellular programs, imposing dependencies that can be therapeutically exploited in MYC-driven cancers such as high-risk neuroblastoma. However, dissecting such synthetic lethal vulnerabilities using controlled, tunable gene expression within a uniform genetic background remains challenging. Widely used tetracycline-regulated systems rely on inducers known to perturb mitochondrial function, introducing significant off-target effects that may confound interpretation. To overcome this limitation, we established novel cumate (p-isopropylbenzoate)-inducible neuroblastoma models that enable physiologically unbiased regulation of MYC(N) expression. Functional validation demonstrated that cumate itself does not induce off-target effects on neuroblastoma cell viability, mitochondrial membrane potential, morphology, proteostasis, or stress signaling, even at the highest recommended dose. The developed SHEP-CuO-MYC and -MYCN models show efficient, titratable, and reversible upregulation of c-MYC and N-MYC, respectively, recapitulating the expression levels observed in MYC(N)-amplified neuroblastoma. As a proof-of-concept, we applied these models to mechanistically validate the recently proposed mitoribosomal synthetic lethality, providing fully unbiased evidence that elevated c-MYC/N-MYC levels sensitize neuroblastoma cells to inhibitors of mitochondrial gene expression. Although impairing mitochondrial translation activated mitochondrial integrated stress response in both MYC-on and MYC-off states, it led to dramatic MYC downregulation coupled with enhanced caspase-dependent cell death in MYC-on cells. These findings reveal that MYC(N) overexpression confers a selective, proliferation-independent mitochondrial vulnerability that can be therapeutically targeted by repurposing well-tolerated mitochondrial ribosome-targeting antibiotics. Collectively, our models provide a robust platform for studying the MYC-mitochondria interplay and can be directly adapted for drug repurposing screens targeting mitochondrial dependencies in neuroblastoma and, potentially, other MYC-driven tumors. HIGHLIGHTSO_LICumate shows no inducer-associated mitochondrial or cytotoxic off-target effects C_LIO_LICumate-inducible MYC models enable mechanistic studies of mitochondrial synthetic lethality C_LIO_LIMYC overexpression drives neuroblastoma sensitivity to mitochondrial translation inhibition C_LIO_LICommon ribosomal antibiotics trigger caspase-dependent cell death in MYC-driven tumor cells C_LIO_LIContext-specific MYC downregulation links mitochondrial stress to MYC synthetic lethality C_LI

Pleural mesothelioma (PM) is a rare, aggressive cancer primarily caused by asbestos exposure and remains resistant to conventional chemotherapy. Although dual immune checkpoint inhibition (anti-PD-1/anti-CTLA-4) is now approved as first-line therapy, clinical benefit is limited to a small subset of patients, necessitating the need for alternative strategies. Oncolytic viruses (OVs) represent a promising approach as they selectively infect and lyse tumor cells while reprogramming the immunosuppressive tumor microenvironment (TME) into an immunostimulatory state. In PM, we previously showed that the attenuated Schwarz strain of measles virus (MV) oncolytic activity is mainly dependent on alterations in the type I interferon (IFN-I) pathway, rendering tumor cells sensitive to infection. Recently, we showed that monocytes/macrophages exposed to MV produce IFN-I, which protects PM cells via paracrine IFNAR signaling. This underscores the necessity of modeling the TME to accurately evaluate OV efficacy. Conventional rodent models are non-permissive to MV, and availability of fresh human PM tissue is scarce. We therefore developed a humanized 3D "vascularized mesothelioma-on-chip" (VMOC) model using microfluidic chips. It comprises two perfusable endothelial-lined parental vessels flanking a central secondary microvascular network (MVN), generated using human umbilical vein endothelial cells (HUVECs) embedded in fibrin and co-cultured alongside PM cells and primary human lung fibroblasts (hLFs). We characterized the integrity and functionality of the endothelial compartment as well as the cellular heterogeneity in VMOC using single-cell RNA sequencing. After administration of MV via the endothelial network, we observed infection and death of PM cells in addition to a strong activation of the type I interferon pathway and production of multiple inflammatory mediators. The VMOC model enables in vitro study of both MV infection and TME reprogramming, paving the way for a better understanding of the role of the TME in the response to treatment and for supporting the development of more personalized, targeted therapies for PM.

Mutations in the CDKL5 gene cause CDKL5 deficiency disorder (CDD), a severe neurodevelopmental encephalopathy characterized by a broad range of symptoms, including early-onset seizures, profound motor impairment and dysmorphic facial features. Current treatment options remain limited and largely focus on seizure management, which is often challenging to control, underscoring the critical need for new effective therapies. To identify potential novel candidate molecules for the treatment of CDD, we performed the first in vivo drug screening using a cdkl5 mutant zebrafish model. Recapitulating key features of the human disorder, cdkl5-/- larvae exhibit reduced locomotor behavior, providing a robust readout to assess therapeutic efficacy. By screening 170 compounds from MAPK Inhibitor and Histone Modification Libraries, both implicated in CDKL5 dysfunction, we identified 18 and 12 small molecules that partially or fully restored locomotor activity, respectively. Among these, fisetin, divalproex, resveratrol, and VX-702 were further evaluated for their capacity to rescue cdkl5-/- craniofacial defects and altered gene expression. Fisetin demonstrated the most consistent phenotypic improvement, including partial restoration of craniofacial abnormalities and normalization of gene expression levels. Future research aimed at elucidating the molecular mechanisms underlying the observed rescue effects will be critical to understand their mode of action. Overall, our study demonstrates the utility of this rapid and scalable zebrafish-based screening approach for therapeutic discovery in CDD and identifies promising therapeutic molecules that warrant further validation in complementary preclinical systems.

Mitochondrial (MT) dysfunction is a key driver of ALS pathology. Without a healthy MT system, motor neurons (MN) function at sub-optimal levels and die. In addition, other effects of ALS, like axon/dendrite degeneration, may occur from a pathophysiological cascade spurred by MT dysfunction. A phenotypic screen identified Dipyridamole (DPM), an FDA-approved and safe drug, as having extraordinary effects on ALS patient induced pluripotent stem cell (iPSC)-derived MNs. The drug prevented MT fragmentation, loss of MT content, impaired MT bioenergetics, axon/dendrite degeneration, and premature MN death, extending neuronal survival by more than fivefold. Importantly, its efficacy extended across iPSC-derived neurons representing two different familial forms of ALS (C9orf72, TDP43) and Alzheimers disease (PSEN1), implying broad neuroprotection across ALS forms and other neurodegenerative diseases. DPM increased MT respiration and pyruvate uptake in a mechanism requiring the Mitochondrial Pyruvate Carrier (MPC), mechanistically explaining its biological activities. Thus, DPM is a promising drug to repurpose or refine for treating neurodegenerative diseases or other diseases that would benefit by augmenting pyruvate uptake into MT. TeaserDipyridamole, an FDA-approved drug, restores mitochondrial function and protects neurons in ALS and Alzheimers disease.

Cardiovascular diseases (CVDs) remain the primary global health burden, motivating the search for robust, non-invasive risk biomarkers. We harness a foundation model pretrained on over 10 million recordings, to evaluate ECG-derived age deviation as a cross-cohort biomarker of CVD burden. A predictive model, trained exclusively on healthy subjects, achieved accurate age prediction. Diseased subjects exhibited significant positive age acceleration across multiple categories, with structural and ischemic heart diseases showing the largest effects. External validation in a hospital-based cohort (n=160,493) confirmed that age acceleration independently predicts all-cause mortality, with the strongest prognostic value in patients under 65 years. Furthermore, we demonstrated that disease discrimination and mortality prediction are preserved across 6-lead and single-lead configurations, supporting potential deployment in wearable or mobile devices. Our analysis also revealed a striking morphological confound from the complete left bundle branch block, leading us to propose absolute age deviation as a more robust, universal risk marker. These findings establish ECG-derived biological age deviation as a highly generalizable and clinically actionable biomarker for assessing cardiovascular risk. We have also developed a web application at https://bioinformatics.mdc-berlin.de/ECGage that allows users to easily test our framework.

PrP lowering is a validated therapeutic hypothesis in prion disease. To identify small molecules that reduce PrP levels, we performed phenotypic screening in cultured cells. To prioritize PrP specificity in our primary screen, we generated mouse N2a cells stably expressing GFP and used high content imaging analysis to select compounds that lowered PrP without affecting GFP signal or cell viability. Screening a curated library of 3,492 compounds with annotated mechanisms of action identified two small molecules, EYH (PubChem CID: 71678945) and LCZ (PubChem CID: 24970350), that selectively and dose-dependently lowered PrP. Proteomics on whole cell lysates identified PrP as the #1 or #2 most potently downregulated out of 8,722 proteins detected. Both compounds minimally affected Prnp mRNA, reduced expression of exogenously transfected PrP, and remained potent in non-dividing primary cells, consistent with a post-translational mechanism. Co-treatment with the proteasome inhibitor MG132 yielded accumulation of unglycosylated PrP, demonstrating proteasome clearance of PrP. However, both compounds showed limited or no activity in human cell lines, and failed to reduce PrP in vivo after 14 days of treatment. These findings highlight the challenges associated with mechanism-agnostic phenotypic screening for PrP-lowering compounds and support prioritizing compounds with known mechanisms of action.

Mitochondrial dysfunction is a central driver of neonatal hypoxic-ischaemic encephalopathy (HIE), yet the specific vulnerabilities of mitochondrial fusion machinery in the neonatal brain remain poorly defined. Here, we investigate Optic Atrophy (OPA)1 as a critical determinant of mitochondrial resilience during hypoxia-ischaemia (HI). Human developmental transcriptomics showed stable perinatal expression of mitochondrial dynamics genes, supporting their potential utility as therapeutic targets at birth. In a neonatal mouse model, HI induced rapid proteolytic processing of OPA1 in whole brain. In vitro, exposure of primary astrocytes to oxygen-glucose deprivation (OGD) mimicked the OPA1 sensitivity observed in whole brain, with aberrant processing and loss of expression. We genetically replicated this observation by knocking down OPA1 expression in primary astrocytes. The predicted mitochondrial fragmentation and impaired bioenergetics was also accompanied by increased vulnerability to hypoxia, revealing an OPA1dependent susceptibility under moderate metabolic stress. Transcriptomics analyses of these cells highlighted an OPA1-mediated depletion of mitochondrial DNA. This mtDNA depletion was also evident in OGD-treated astrocytes and ex vivo brain samples at 24h after HI in our rodent model. In contrast, mild OPA1 overexpression enhanced astrocyte survival following OGD and OPA1 overexpression in vivo markedly reduced tissue damage after neonatal HI. MtDNA levels in OPA1-overexpressing mice before and at 7 days after HI were significantly higher than in wild-type mice. These findings position OPA1 as a key mediator of mitochondrial impairment after HI and to our knowledge, is the first study showing that loss of mtDNA is a consequence of neonatal HI. Our data highlight that maintaining OPA1 expression is a promising therapeutic strategy for protecting the neonatal brain following birth asphyxia.

Hepatocellular carcinoma (HCC) remains a lethal malignancy with limited therapeutic options. While Poly (ADP-ribose) polymerase inhibitors (PARPi) exploit synthetic lethality in tumors with DNA repair defects, their clinical utility in HCC is hindered by the low prevalence of canonical repair gene mutations and the enhancing DNA repair capacity. Through proteomic analysis of two independent cohorts (n=260), we identified the THO complex component THOC2 as a master regulator of DNA damage response (DDR) via mRNA nuclear export control. Clinically, THOC2 overexpression predicted poor survival (HR=2.68-6.84, P<0.001) and correlated with enhanced DDR gene expression. Mechanistically, THOC2 chaperones mRNA nuclear export of DDR effectors (MDC1, PRKDC, MSH6) and proliferation drivers (TOP2A), thereby establishing a dual pro-repair/pro-growth program. Targeting this vulnerability, THOC2 knockdown induced synthetic lethality with PARPi, reducing Olaparib IC50 by up to 61% and suppressing tumor growth by 76% (P<0.001). Our study illuminates mRNA transport as a druggable DDR modulator and establishes THOC2 as both a prognostic biomarker and a therapeutic target to overcome PARPi resistance in HCC. This work pioneers a strategy to expand synthetic lethality beyond genetic defects by targeting post-transcriptional regulation.

Leptospirosis is a reemerging neglected zoonotic disease causing 1 million cases and 60,000 deaths annually. Antibiotic treatment can trigger a detrimental inflammatory Jarisch-Herxheimer reaction (JHR). We investigated the effects and mechanisms of different antibiotics and consequences of JHR in leptospirosis. In a mouse model of severe infection and in healthy human whole-blood infected with bioluminescent Leptospira interrogans, we compared bactericidal {beta}-lactams (amoxicillin, ceftriaxone) with bacteriostatic agents (azithromycin, doxycycline). We assessed bacterial survival, cytokine levels, pathophysiology, and JHR mechanism using neutralizing antibodies and Toll-like receptor (TLR) knockout mice. {beta}-lactams induced profound pro-inflammatory cytokine release whereas bacteriostatic antibiotics did not, despite effective killing. Progressive {beta}-lactam dosing and corticosteroids mitigated inflammation. In humans, this inflammation was largely dependent on TLR2 (the lipoprotein receptor) and TLR5 (the flagellin receptor). In mice, amoxicillin exacerbated disease severity within hours, notably worsening myocarditis. Only the stealthy virulent clinical isolates of Leptospira interrogans induced JHR, which was also observed with Borrelia burgdorferi. These findings demonstrate that {beta}-lactam-induced JHR is driven by TLR recognition of released spirochaetal components, worsening outcomes, evoking a cytokine storm. They challenge the World Health Organizations recommendations favouring {beta}-lactams as first-line therapy, advocating instead for bacteriostatic antibiotics to prevent JHR and improve patient outcomes worldwide.

Aberrant neuronal activity is an early pathological feature of numerous neurodegenerative disorders, including tauopathy, and is thought to play a role in disease progression. However, the mechanism underlying abnormal neuronal activity remains elusive. Here, we reveal a relationship between DNA double-strand break (DSB)/p53 pathway activation and aberrant neuronal activity. Activating p53 as part of the DNA damage response via DSB induction, or by preventing MDM2-mediated p53 degradation, causes aberrant activity in both mouse and human neurons. p53 activation induces the expression of genes regulating synaptic transmission, and p53-responsive gene upregulation is overrepresented in postmortem human Alzheimers disease neurons burdened with neurofibrillary tangles (NFTs). Using a human iPSC-based cerebral organoid model of frontotemporal dementia that exhibits relevant pathologies including elevated DSBs, aberrant neuronal activity, and NFTs, we show that inhibiting p53 transcriptional activity with a small molecule ameliorates aberrant calcium fluctuations in neurons. Together, our findings highlight p53 inhibition as a novel therapeutic strategy to counter aberrant neuronal activity in neurodegenerative diseases characterized by tauopathy.

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.