Blocking RAN translation without altering repeat RNAs rescues C9ORF72-related ALS and FTD phenotypes

Science. 2026 Feb 5;391(6785):eadv2600. doi: 10.1126/science.adv2600. Epub 2026 Feb 5.

Abstract

GGGGCC (G4C2) repeat expansion in C9ORF72 is the most common genetic cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Toxicity is thought to result from the accumulation of either repeat RNAs and/or dipeptide repeat proteins (DPRs) translated from repeat-containing transcripts through repeat-associated non-AUG (RAN) translation. To disentangle RNA from DPR toxicity, we mutated a CUG codon predominantly used to initiate DPR translation from all three reading frames. This mutation disrupted DPR synthesis while preserving the expression of repeat-containing RNAs. Despite the accumulation of RNA foci, behavioral deficits and pathological abnormalities, including p-TDP-43 inclusions, STING activation, motor neuron loss, neuroinflammation, and increased plasma neurofilament concentration, were alleviated in C9ORF72 mice. Base editing of the CUG codon also improved molecular phenotypes and survival in patient induced pluripotent stem cell-derived neurons, which highlights the potential of therapeutically targeting DPR production rather than repeat RNAs.

MeSH terms

  • Amyotrophic Lateral Sclerosis* / genetics
  • Amyotrophic Lateral Sclerosis* / pathology
  • Amyotrophic Lateral Sclerosis* / therapy
  • Animals
  • C9orf72 Protein* / genetics
  • Codon
  • DNA Repeat Expansion*
  • DNA-Binding Proteins / metabolism
  • Dipeptides / genetics
  • Disease Models, Animal
  • Female
  • Frontotemporal Dementia* / genetics
  • Frontotemporal Dementia* / pathology
  • Frontotemporal Dementia* / therapy
  • HEK293 Cells
  • Humans
  • Induced Pluripotent Stem Cells
  • Male
  • Mice
  • Mice, Inbred C57BL
  • Motor Neurons / pathology
  • Mutation
  • Phenotype
  • Protein Biosynthesis*
  • RNA* / genetics
  • RNA* / metabolism
  • ran GTP-Binding Protein* / genetics

Substances

  • C9orf72 Protein
  • C9orf72 protein, human
  • C9orf72 protein, mouse
  • Codon
  • Dipeptides
  • DNA-Binding Proteins
  • ran GTP-Binding Protein
  • RNA