- Brown, Anna-Leigh;
- Wilkins, Oscar G;
- Keuss, Matthew J;
- Hill, Sarah E;
- Zanovello, Matteo;
- Lee, Weaverly Colleen;
- Bampton, Alexander;
- Lee, Flora CY;
- Masino, Laura;
- Qi, Yue A;
- Bryce-Smith, Sam;
- Gatt, Ariana;
- Hallegger, Martina;
- Fagegaltier, Delphine;
- Phatnani, Hemali;
- Newcombe, Jia;
- Gustavsson, Emil K;
- Seddighi, Sahba;
- Reyes, Joel F;
- Coon, Steven L;
- Ramos, Daniel;
- Schiavo, Giampietro;
- Fisher, Elizabeth MC;
- Raj, Towfique;
- Secrier, Maria;
- Lashley, Tammaryn;
- Ule, Jernej;
- Buratti, Emanuele;
- Humphrey, Jack;
- Ward, Michael E;
- Fratta, Pietro
Variants of UNC13A, a critical gene for synapse function, increase the risk of amyotrophic lateral sclerosis and frontotemporal dementia1-3, two related neurodegenerative diseases defined by mislocalization of the RNA-binding protein TDP-434,5. Here we show that TDP-43 depletion induces robust inclusion of a cryptic exon in UNC13A, resulting in nonsense-mediated decay and loss of UNC13A protein. Two common intronic UNC13A polymorphisms strongly associated with amyotrophic lateral sclerosis and frontotemporal dementia risk overlap with TDP-43 binding sites. These polymorphisms potentiate cryptic exon inclusion, both in cultured cells and in brains and spinal cords from patients with these conditions. Our findings, which demonstrate a genetic link between loss of nuclear TDP-43 function and disease, reveal the mechanism by which UNC13A variants exacerbate the effects of decreased TDP-43 function. They further provide a promising therapeutic target for TDP-43 proteinopathies.