The UNC13A cryptic exon associates with cognitive impairment in Alzheimer's disease
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Madison M Reeves Sara Aviles Carpintero Matteo Zanovello Karen Jansen-West Mei Yue Anna Calliari Yuping Song Judith Dunmore Candela Maroto Cidfuentes Sophie Ball Jennifer M Kachergus Heather E Killeen Bailey Rawlinson Erica Engelberg-Cook Michael DeTure Gregory S Day Neill R Graff-Radford Bradley F Boeve David S Knopman Ronald C Petersen Melissa Murray Aubrey E Thompson Dennis W Dickson Pietro Fratta Leonard Petrucelli Keith A Josephs Mercedes Prudencio
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Abstract
BACKGROUND: TAR DNA-binding protein of 43 kDa (TDP-43) is often found in the brains of patients with Alzheimer's disease (AD), where it co-occurs with amyloid β plaques and tau neurofibrillary tangles, and associates with accelerated cognitive decline and brain atrophy. TDP-43's function of repressing the inclusion of cryptic exons (CEs) during RNA splicing is compromised in AD. A single-nucleotide polymorphism (SNP) located within the CE in the UNC13A gene [rs12973192 (C > G)] is associated with higher disease risk and reduced survival in amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) by weakening TDP-43 binding promoting CE inclusion. OBJECTIVE: To investigate the influence of the rs12973192 UNC13A CE SNP and UNC13A cryptic splicing on TDP-43 pathology, survival and cognitive impairment in AD. METHODS: We evaluated the UNC13A CE SNP in a cohort of 1,672 AD, including 643 AD brains with available cognitive measurements and 73 AD cases for which we measured cryptic RNA levels in the amygdala. We also evaluated a cohort of 466,517 from the UK Biobank to determine associations between the UNC13A CE SNP and dementia diagnosis. RESULTS: In AD, the UNC13A CE SNP associated significantly with cognitive decline, but not with TDP-43 pathology or with survival. UNC13A cryptic RNA levels in the amygdala were a better predictor of cognitive decline than the UNC13A CE SNP itself, while STMN2-another well-known CE target-exhibited no such association. CONCLUSIONS: These findings point to UNC13A cryptic splicing as a specific driver of cognitive decline in AD, outperforming both genetic risk and other cryptic targets.
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Journal
Alzheimer's Research and Therapy
Volume
18
Pages
187
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10.1186/s13195-026-02157-7
Europe PubMed Central
42596024
Pubmed
42596024
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