Tandem repeat expansions in DAPK1, ANK3, and RPL14 are associated with diverse neurodegenerative diseases

Tandem repeat expansions (TREs) cause over 50 neurological conditions, yet their contribution to neurodegenerative disease risk at a population scale remains incompletely characterized. We performed a TRE association study across 6,539 short tandem repeat loci in 276,411 individuals from the UK Biobank and 44,370 individuals from the All of Us Research Program, using two composite neurodegenerative phenotypes to increase statistical power and capture pleiotropic effects. Meta-analysis across the two cohorts identified associations at eight established pathogenic TRE loci, including C9orf72, DMPK, HTT, ATXN2, ATXN3, CACNA1A, CNBP, and PPP2R2B, recovering known disease-associated expansions from short-read sequencing data at biobank scale. We also identified candidate associations at three additional loci. An intronic AATAA expansion in DAPK1 reached significance (q = 0.0045), with fine-mapping and conditional analysis supporting the repeat as the likely variant underlying the association. An intronic ATTTT expansion in ANK3 (q = 0.034) was observed exclusively in individuals of African and Latino/admixed American ancestry, underscoring the importance of ancestrally diverse cohorts for genetic discovery. An exonic polyalanine expansion in RPL14 was also significant (q = 0.039), where longer alleles were consistently associated with reduced RPL14 expression across independent datasets. Together, these findings identify candidate risk loci for neurodegenerative disease that may expand the contribution of TREs to neurodegenerative disease beyond known repeat expansion disorders.