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TDP-43 represses cryptic exon inclusion in the FTD-ALS gene UNC13A
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Abstract
A hallmark pathological feature of the neurodegenerative diseases amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) is the depletion of RNA-binding protein TDP-43 from the nucleus of neurons in the brain and spinal cord 1 . A major function of TDP-43 is as a repressor of cryptic exon inclusion during RNA splicing 2–4 . Single nucleotide polymorphisms in UNC13A are among the strongest hits associated with FTD and ALS in human genome-wide association studies 5,6 , but how those variants increase risk for disease is unknown. Here we show that TDP-43 represses a cryptic exon-splicing event in UNC13A . Loss of TDP-43 from the nucleus in human brain, neuronal cell lines and motor neurons derived from induced pluripotent stem cells resulted in the inclusion of a cryptic exon in UNC13A mRNA and reduced UNC13A protein expression. The top variants associated with FTD or ALS risk in humans are located in the intron harbouring the cryptic exon, and we show that they increase UNC13A cryptic exon splicing in the face of TDP-43 dysfunction. Together, our data provide a direct functional link between one of the strongest genetic risk factors for FTD and ALS ( UNC13A genetic variants), and loss of TDP-43 function.
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![Extended Data Fig. 1 Splicing analysis using MAJIQ demonstrates inclusion of cryptic exon between exon 20 and exon 21 of UNC13A. (a, b) Depletion of TDP-43 introduces two alternative 3′ splicing acceptors in the intron 20–21: one is near chr19:17642591(ΔΨ = 0.05246) and the other one is near chr19:17642541(ΔΨ = 0.49267). (c, d) An alternative 5′ splicing donor is also introduced near chr19:17642414 (ΔΨ = 0.7763). See Supplementary Note 2. (a, c) Splice graphs showing the inclusion of the cryptic exon (CE) between exon 20 and exon 21 of UNC13A. (b, d) Violin plots corresponding to (a and c) respectively. Each violin in (b and d) represents the posterior probability distribution of the expected relative inclusion (PSI or Ψ) for the color matching junction in the splice graph. The tails of each violin represent the 10th and 90th percentile. The box represents the interquartile range with the line in the middle indicating the median. The white circles mark the expected PSI (E[Ψ]). The change in the relative inclusion level of each junction between two conditions is referred to as ΔΨ or ΔPSI13. (e) The three versions of cryptic exons resulting from the loss of TDP-43. (f) Visualization of RNA-sequencing alignment between exon 20 and exon 21 in UNC13A (hg38). Libraries were generated as described in Fig. 1a. CE, cryptic exon. (g) iCLIP for TDP-43 (from Tollervey et al.17) indicates that TDP-43 binds to intron 20–21. The sequence shown is an example of a region in intron 20-21 that is frequently bound by TDP-43 (shown by mapped reads from ERR039843, ERR039845 and ERR039855).](/paper-figures/e09b8b1b7b414e2db64d4c2ce3b2a015/tdp-43-represses-cryptic-exon-inclusion-in-the-ftd-als-gene-unc13a-figure-5.jpg)


![Extended Data Fig. 4 Validation of additional splicing targets. (a–f) Depletion of TDP-43 introduces cryptic exons into KALRN mRNA and SYT7 mRNA; In RAPGEF6, TDP-43 depletion leads to a decrease in the usage of the exon AE (for alternative exon) between exon 21 and exon 22 of the isoform ENST0000509018.6. Exon AE does exist in some other isoforms of RAPGEF6, indicating the depletion of TDP-43 could lead to changes in isoform composition. (b, d, f) Violin plots corresponding to (a, c, e), respectively. Each violin in (b, d, f) represents the posterior probability distribution of the expected relative inclusion (PSI or Ψ) for the color matching junction in the splice graph. The tails of each violin represent the 10th and 90th percentile. The box represents the interquartile range with the line in the middle indicating the median. The white circles mark the expected PSI (E[Ψ]). The change in the relative inclusion level of each junction between two conditions is referred to as ΔΨ or ΔPSI13. (g–i) RT-qPCR analyses confirmed changes in exon usage upon TDP-43 depletion in iPSC-derived neurons. RPLP0 and GAPDH were used to normalize RT-PCR. (n = 3 independent cell culture experiments for each condition, two sided-Welch Two Sample t-test, mean ± s.e.m.). Source data](/paper-figures/6512f554878642428e6dace0f98cf27b/tdp-43-represses-cryptic-exon-inclusion-in-the-ftd-als-gene-unc13a-figure-8.jpg)






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“The most common genes identified in clinical practice include SOD1, C9ORF72, TARDBP, FUS, and OPTNTD-P43 (55–57, 73, 74).”
From Modulation of the gut–brain axis via the gut microbiota: a new era in treatment of amyotrophic lateral sclerosis (2023) · cites this paper as [73]
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Parra-Torres, M., Dissanayake, K., Gray, J. A., Langlands, A. J., Kucuk, R., Gierliński, M., Troakes, C., King, A., & McGurk, L. (2025) · Life Science Alliance · doi:10.26508/lsa.202503297 · Cited by 1
Douglas, C. J., & Seath, C. P. (2025) · Molecular Omics · doi:10.1039/d5mo00160a
Theme 7 Pre-Clinical Therapeutic Strategies
(2025) · Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration · doi:10.1080/21678421.2025.2564557
Müller, F., Neuser, S., Shrestha, G., Neupane, N. P., Götze, K. J., Brunetti‐Pierri, N., Terrone, G., Reymond, A., van Gassen, K. L. I., Brilstra, E. H., et al. (2025) · Biochemistry and Biophysics Reports · doi:10.1016/j.bbrep.2025.102375
Cellular modifiers of TDP-43 phase transition and cytoplasmic aggregation
Chin, N. Y., Zhang, Q., Zou, J., Cheng, K. C.-C., Zheng, W., & Ye, Y. (2026) · eLife · doi:10.7554/elife.110172.4
Bridel, C., van Gils, J. H. M., Miedema, S. S. M., Hoozemans, J. J. M., Pijnenburg, Y. A. L., SMIT, A. B., Rozemüller, A. J. M., Abeln, S., & Teunissen, C. E. (2024) · Figshare · doi:10.6084/m9.figshare.26577173
Additional file 4 of Elevated nuclear TDP-43 induces constitutive exon skipping
Carmen‐Orozco, R. P., Tsao, W., Ye, Y., Sinha, I. R., Chang, K., Trinh, V., Chung, W., Bowden, K. D., Troncoso, J. C., Blackshaw, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26731618
Additional file 9 of Elevated nuclear TDP-43 induces constitutive exon skipping
Carmen‐Orozco, R. P., Tsao, W., Ye, Y., Sinha, I. R., Chang, K., Trinh, V., Chung, W., Bowden, K. D., Troncoso, J. C., Blackshaw, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26731633
Additional file 2 of TDP-43-regulated cryptic RNAs accumulate in Alzheimer’s disease brains
Estades Ayuso, V., Pickles, S. R., Todd, T. W., Yue, M., Jansen‐West, K. R., Song, Y., Bejarano, J. G., Rawlinson, B. D., Deture, M. A., Graff‐Radford, N. R., et al. (2023) · Figshare · doi:10.6084/m9.figshare.24002645
Self-citationAdditional file 8 of Elevated nuclear TDP-43 induces constitutive exon skipping
Carmen‐Orozco, R. P., Tsao, W., Ye, Y., Sinha, I. R., Chang, K., Trinh, V., Chung, W., Bowden, K. D., Troncoso, J. C., Blackshaw, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26731630
Additional file 3 of TDP-43-regulated cryptic RNAs accumulate in Alzheimer’s disease brains
Estades Ayuso, V., Pickles, S. R., Todd, T. W., Yue, M., Jansen‐West, K. R., Song, Y., Bejarano, J. G., Rawlinson, B. D., Deture, M. A., Graff‐Radford, N. R., et al. (2023) · Figshare · doi:10.6084/m9.figshare.24002648
Self-citationCalliari, A., Daughrity, L. M., Albagli, E. A., Otero, P. C., Yue, M., Jansen‐West, K. R., Islam, N. N., Caulfield, T., Rawlinson, B. D., Deture, M. A., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25495209
Self-citation恩田, 亜., Hasegawa-Ogawa, M., Matsuno, H., Shiraishi, T., Bono, K., Hiraki, H., Kanegae, Y., Iguchi, Y., & Okano, H. (2024) · Figshare · doi:10.6084/m9.figshare.26606713
Additional file 6 of Elevated nuclear TDP-43 induces constitutive exon skipping
Carmen‐Orozco, R. P., Tsao, W., Ye, Y., Sinha, I. R., Chang, K., Trinh, V., Chung, W., Bowden, K. D., Troncoso, J. C., Blackshaw, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26731624
Additional file 1 of TDP-43-regulated cryptic RNAs accumulate in Alzheimer’s disease brains
Estades Ayuso, V., Pickles, S. R., Todd, T. W., Yue, M., Jansen‐West, K. R., Song, Y., Bejarano, J. G., Rawlinson, B. D., Deture, M. A., Graff‐Radford, N. R., et al. (2023) · Figshare · doi:10.6084/m9.figshare.24002642
Self-citationAdditional file 1 of Evidence of cerebellar TDP-43 loss of function in FTLD-TDP
Pickles, S. R., Gendron, T. F., Koike, Y. M., Yue, M., Song, Y., Kachergus, J. M., Shi, J., Deture, M. A., Thompson, E. A., Oskarsson, B., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20374469
Self-citation恩田, 亜., Hasegawa-Ogawa, M., Matsuno, H., Shiraishi, T., Bono, K., Hiraki, H., Kanegae, Y., Iguchi, Y., & Okano, H. (2024) · Figshare · doi:10.6084/m9.figshare.26606707
Additional file 2 of Elevated nuclear TDP-43 induces constitutive exon skipping
Carmen‐Orozco, R. P., Tsao, W., Ye, Y., Sinha, I. R., Chang, K., Trinh, V., Chung, W., Bowden, K. D., Troncoso, J. C., Blackshaw, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26000128
Additional file 7 of Elevated nuclear TDP-43 induces constitutive exon skipping
Carmen‐Orozco, R. P., Tsao, W., Ye, Y., Sinha, I. R., Chang, K., Trinh, V., Chung, W., Bowden, K. D., Troncoso, J. C., Blackshaw, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26731627
Additional file 1 of Elevated nuclear TDP-43 induces constitutive exon skipping
Carmen‐Orozco, R. P., Tsao, W., Ye, Y., Sinha, I. R., Chang, K., Trinh, V., Chung, W., Bowden, K. D., Troncoso, J. C., Blackshaw, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26000107
Additional file 3 of Elevated nuclear TDP-43 induces constitutive exon skipping
Carmen‐Orozco, R. P., Tsao, W., Ye, Y., Sinha, I. R., Chang, K., Trinh, V., Chung, W., Bowden, K. D., Troncoso, J. C., Blackshaw, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26731615
恩田, 亜., Hasegawa-Ogawa, M., Matsuno, H., Shiraishi, T., Bono, K., Hiraki, H., Kanegae, Y., Iguchi, Y., & Okano, H. (2024) · Figshare · doi:10.6084/m9.figshare.26606698
恩田, 亜., Hasegawa-Ogawa, M., Matsuno, H., Shiraishi, T., Bono, K., Hiraki, H., Kanegae, Y., Iguchi, Y., & Okano, H. (2024) · Figshare · doi:10.6084/m9.figshare.26606710
恩田, 亜., Hasegawa-Ogawa, M., Matsuno, H., Shiraishi, T., Bono, K., Hiraki, H., Kanegae, Y., Iguchi, Y., & Okano, H. (2024) · Figshare · doi:10.6084/m9.figshare.26606716
恩田, 亜., Hasegawa-Ogawa, M., Matsuno, H., Shiraishi, T., Bono, K., Hiraki, H., Kanegae, Y., Iguchi, Y., & Okano, H. (2024) · Figshare · doi:10.6084/m9.figshare.26606704
恩田, 亜., Hasegawa-Ogawa, M., Matsuno, H., Shiraishi, T., Bono, K., Hiraki, H., Kanegae, Y., Iguchi, Y., & Okano, H. (2024) · Figshare · doi:10.6084/m9.figshare.26606701
Additional file 10 of Elevated nuclear TDP-43 induces constitutive exon skipping
Carmen‐Orozco, R. P., Tsao, W., Ye, Y., Sinha, I. R., Chang, K., Trinh, V., Chung, W., Bowden, K. D., Troncoso, J. C., Blackshaw, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26731636
Additional file 5 of Elevated nuclear TDP-43 induces constitutive exon skipping
Carmen‐Orozco, R. P., Tsao, W., Ye, Y., Sinha, I. R., Chang, K., Trinh, V., Chung, W., Bowden, K. D., Troncoso, J. C., Blackshaw, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26731621
CRYPTID-exon : streamlined detection of cryptic exons from RNA-seq dataPreprint
Khokhar, E. S., Brokaw, K., Kartje, Z. J., Krykbaeva, M., Calvo-Roitberg, E., Hedger, A. K., Lee, J., Wagh, A. A., Watts, J. K., & Pai, A. A. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2025.12.17.694983
A CAR-T Cell-Based Strategy for Eliminating Pathogenic Microglia in ALSPreprint
Cicardi, M. E., Tejada-Martínez, D., Markandaiah, S. S., Krishnamurthy, K., Scopa, C., Oza, B., Serra, I. M., Feci, A., Manca, E., Snook, A. E., et al. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2025.12.29.696307
Wang, F., Zhang, K., Zhu, L., Li, W., Wu, Y., Gao, X., Ma, X., Yin, X., Wu, J., Ye, X., et al. (2026) · Advanced Science · doi:10.1002/advs.202512149
Self-citationAn R83W mutation in Rab3A causes autosomal-dominant cerebellar ataxia
Miyamoto, R., Sakane, A., Morino, H., Kume, K., Matsubara, T., Fukumoto, T., Osaki, Y., Oki, R., Hanada, K., Tachibana, K., et al. (2026) · Human Molecular Genetics · doi:10.1093/hmg/ddaf186
Differential TDP-43 interactomes between the cortex and cerebellum in the mousePreprint
Baldacchino, T., Lynham, S., Tacconelli, S., Vance, C. A., & Mitchell, J. C. (2026) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2026.01.16.699854
Pathological TDP-43 filaments accumulate at synapses and cause synaptic dysfunctionPreprint
Chen, R., Stockwell, I., Pierce, J. C., Peak‐Chew, S., Huang, M., Newell, K. L., Ghetti, B. F., Cousin, M. A., Greger, I. H., & Falcon, B. (2026) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2026.01.27.701787
Bostock, M. P., Gonzalez, K. L., Lentjes, C., Uddin, S., Almagro, L. O., Hamid, F., & Houart, C. (2026) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2026.01.30.702498
Transcriptomic profiling uncovers mis-splicing and fusion transcripts in ALSPreprint
Xu, H., Petrozziello, T., Boudi, A., Shibata, S., Huntress, S. S., Granucci, E. J., Shahryari, A., Zhao, X., Kesavan, M., Torres, A. L. C., et al. (2026) · medRxiv · doi:10.64898/2026.02.05.26345503
Metadata
- Authors
- Ma, X. R., Prudencio, M., Koike, Y., Vatsavayai, S. C., Kim, G., Harbinski, F., Briner, A., Rodriguez, C. M., Guo, C., Akiyama, T., Schmidt, H. B., Cummings, B. B., Wyatt, D. W., Kurylo, K., Miller, G., Mekhoubad, S., Sallee, N., Mekonnen, G., Ganser, L., Rubien, J. D., Jansen-West, K., Cook, C. N., Pickles, S., Oskarsson, B., Graff-Radford, N. R., Boeve, B. F., Knopman, D. S., Petersen, R. C., Dickson, D. W., Shorter, J., Myong, S., Green, E. M., Seeley, W. W., Petrucelli, L., & Gitler, A. D.
- Affiliations
- Stanford Medicine (US)
- Mayo Clinic (US)
- University of California, San Francisco (US)
- Maze (United States) (US)
- The University of Queensland (AU)
- Johns Hopkins University (US)
- University of Pennsylvania (US)
- Mayo Clinic in Florida (US)
- Corresponding author
- Petrucelli, Leonard
- Gitler, Aaron D.
- ORCID
- Ma, X. Rosa
- Prudencio, Mercedes
- Koike, Yuka
- Vatsavayai, Sarat C.
- Kim, Garam
- Briner, Adam
- Rodriguez, Caitlin M.
- Guo, Caiwei
- Akiyama, Tetsuya
- Schmidt, H. Broder
- Cummings, Beryl B.
- Wyatt, David W.
- Kurylo, Katherine
- Miller, Georgiana
- Ganser, Laura
- Rubien, Jack D.
- Cook, Casey N.
- Pickles, Sarah
- Oskarsson, Björn
- Boeve, Bradley F.
- Knopman, David S.
- Petersen, Ronald C.
- Dickson, Dennis W.
- Shorter, James
- Myong, Sua
- Green, Eric M.
- Seeley, William W.
- Petrucelli, Leonard
- Gitler, Aaron D.
- Venue
- Nature
- Published
- 2022-02-23
- Volume
- 603
- Issue
- 7899
- Pages
- 124-130
- ISSN
- 0028-0836 (ISSN-L)
- 1476-4687
- PMC
- PMC8891019
- OpenAlex
- W4213441627
- Cited by
- 574
- References
- 53
- Citations by year
- 2026: 126 · 2025: 151 · 2024: 121 · 2023: 107 · 2022: 57
- FWCI
- 57.66
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Nature (publishedVersion, cc-by)
- bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- ALS Association
- BrightFocus Foundation (A2020279F)
- Takeda Science Foundation
- Johns Hopkins University
- Target ALS
- Rainwater Charitable Foundation
- National Institutes of Health (W81XWH)
- University of California, San Francisco (P30AG062422, P01AG019724)
- Wu Tsai Neurosciences Institute, Stanford University
- Stanford Research Computing Center, Stanford University
- National Institute on Aging (RF1AG064690, R01AG063780, U01AG057195, U01AG006786, RF1AG071326, T32AG047126, U19AG063911, P01AG019724, P30AG062422, P30AG062677)
- National Human Genome Research Institute (T32HG000044)
- National Institute of General Medical Sciences (F32GM139268, T32GM007231)
- National Institute of Neurological Disorders and Stroke (F32NS116208, P01NS084974, R01NS104437, RF1NS120992, RF1NS113636, R35NS097273, R35NS097263, U54NS123743)
- Robert Packard Center for ALS Research, Johns Hopkins University
- Topics
- Health Sciences › Medicine › Clinical Neurology › Amyotrophic Lateral Sclerosis Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › RNA Research and Splicing
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Keywords
- TDP-43, UNC13A, RNA splicing, amyotrophic lateral sclerosis, frontotemporal dementia, single nucleotide polymorphisms, genetic risk factors, RNA-binding proteins, motor neurons, intronic variants, induced pluripotent stem cells
- MeSH terms
- Amyotrophic Lateral Sclerosis, DNA-Binding Proteins, Exons, Humans, Motor Neurons, Nerve Tissue Proteins, Genome-Wide Association Study, Frontotemporal Dementia
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