DISCLAIMER: This data is not peer reviewed and is NOT professional advice.

Original Text Evaluated

If RGNEF fails agitate and regulate TDP-43 at the RGNEF NF242 Terminal, does this cause TDP-43 propteinopathy?

Plausibility Verdicts

Evaluation 1

Yes, evidence suggests that RGNEF and TDP-43 co-aggregate in ALS, and the NF242 domain of RGNEF is critical for regulating TDP-43. Dysfunction in this regulatory interaction is linked to disease progression.

Evaluation 2

The literature confirms that the NF242 fragment of RGNEF regulates TDP-43, and failure of this mechanism contributes to pathological protein accumulation.

Dataset Summary

Novel & Overlooked Insights

TDP-43 and RGNEF co-aggregation serves as a core pathogenic pathway, not just an incidental finding.
The N-terminal fragment of RGNEF (NF242) acts as a potential therapeutic agent by competing with RNA for TDP-43 binding sites.
Metabolic stress induces the formation of micronuclei where TDP-43 and RGNEF co-aggregate, potentially acting as a mechanism for inclusion formation.
RGNEF functions as a guanine nucleotide exchange factor (GEF) and an RNA-binding protein that destabilizes neurofilament light chain mRNA.
Genetic loss-of-function in ARHGEF28 (the RGNEF gene) is associated with ALS cases.
The interaction between TDP-43, FUS, and RGNEF is part of a complex regulatory network potentially managed by miRNAs like miR-b2122.
RGNEF inclusions also colocalize with other proteins including ubiquitin and p62/sequestosome-1.
RGNEF and TDP-43 co-localize not only in cytoplasmic inclusions but also within micronuclei, suggesting a nuclear-to-cytoplasmic pathogenic pathway.
The leucine-rich domain of RGNEF is critical for its localization in micronuclei during metabolic stress.
NF242 interaction with TDP-43 competes directly with RNA binding, proposing a "competitive inhibition" model of toxic aggregation.
Rare coding variants in ARHGEF28 are marginally enriched in sALS patients, pointing to a direct genetic susceptibility beyond protein-protein interaction.
MiR-b2122 acts as a central regulator of the TDP-43/FUS/RGNEF network, and its down-regulation in sALS patients may synchronize the failure of these proteins.
RGNEF also regulates the expression of axon guidance genes, suggesting that the clinical impact of its aggregation extends beyond neurofilament homeostasis.
RGNEF acts as a bi-functional protein, functioning as both a guanine nucleotide exchange factor and an RNA-binding protein.
RGNEF inclusions and TDP-43 inclusions co-localize in the spinal motor neurons of ALS patients.
The leucine-rich domain of RGNEF is critical for its interaction with TDP-43 and its localization within micronuclei.
Metabolic stress can induce the formation of TDP-43 inclusions within micronuclei, where they co-aggregate with RGNEF.
Genetic expression of the NF242 fragment in a fruit fly ALS model suppressed neuropathological phenotypes and increased lifespan.
Transcriptomic profiles of neuronal cells depleted of both TDP-43 and RGNEF show that these factors act antagonistically on axon guidance genes.
A novel miRNA, miR-b2122, down-regulates TARDBP, FUS/TLS, and RGNEF, suggesting a common regulatory network.
RGNEF binds low-molecular-weight neurofilament mRNA and regulates its stability via the 3' untranslated region.

Extracted Discoveries

Suggested Experiments

Quantify TDP-43 aggregation levels in cell lines where the RGNEF IPT/TIG domain is specifically deleted or mutated.
Determine the effect of NF242-mimetic peptide treatment on the solubility of phosphorylated TDP-43 in patient-derived iPSC motor neurons.
Assess the binding affinity of NF242 variants with mutations in the IPT/TIG domain to TDP-43 in cell-free systems.
Perform RNA-seq on motor neurons depleted of RGNEF in the presence or absence of exogenous NF242 to identify rescued axon guidance gene expression profiles.
Assess the binding affinity of mutated NF242 domains to TDP-43 using surface plasmon resonance (SPR).
Quantify the correlation between levels of endogenous NF242 and TDP-43 aggregate clearance in human iPSC-derived motor neurons.

Suggested Studies

Longitudinal study of ARHGEF28 genetic variants to determine correlation with early-onset TDP-43 proteinopathy.
Interaction mapping between the RGNEF N-terminal domain and phosphorylated vs. non-phosphorylated forms of TDP-43.
Longitudinal study of ARHGEF28 mutation carriers to determine the correlation between onset of TDP-43-positive inclusions and NF242 regulatory failure.
Comprehensive screening of miRNA-b2122 levels in FTD/ALS cohorts to determine if low expression correlates with RGNEF/TDP-43 co-aggregation patterns.
Longitudinal study comparing RGNEF fragment levels in CSF of pre-symptomatic vs. symptomatic ALS patients.
Comprehensive analysis of the RGNEF-TDP-43 regulatory axis in non-ALS TDP-proteinopathies.

Swansons Literature Based Discovery Candidates

RGNEF-mediated regulation of axonal transport may preserve the stability of the neuronal cytoskeleton in regions prone to TDP-43-dependent cryptic exon splicing.
RGNEF as a regulator of Rho-family GTPases and neurofilament mRNA stability (ID 22835604).
TDP-43-dependent regulation of axon guidance genes via long-intron removal and cryptic exon splicing (ID 39360635).
RNA-binding and regulation of neurofilament/axon guidance protein expression levels.
Both proteins co-aggregate and are critical for RNA metabolism. The combined loss of function may synergistically impair the translation of cytoskeletal proteins, thus accelerating neurodegeneration.
RGNEF-mediated regulation of axonal guidance mRNA stability is a upstream protective mechanism that, when disrupted by miRNA-b2122 deficiency, promotes axonal retraction prior to TDP-43 aggregation.
Role of RGNEF in axon guidance gene expression (39360635).
Down-regulation of miR-b2122 in ALS (28969660).
RGNEF (ARHGEF28) 3' UTR binding target.
Since miRNA-b2122 regulates RGNEF expression and RGNEF itself regulates axon guidance genes, the miRNA-induced down-regulation of RGNEF likely depletes the axonal mRNA stability pool, creating a vulnerable neuronal environment conducive to subsequent TDP-43 aggregation.
RGNEF-mediated NF242 availability acts as a sensor for metabolic stress in determining mitochondrial protein degradation.
RGNEF-TDP-43 interaction and NF242 regulatory role (ID: 38739752).
Cuproptosis and mitochondrial proteotoxic stress (ID: 42418063).
FDX1/LIPT1-related mitochondrial proteotoxic stress and protein aggregation.
Since NF242 prevents TDP-43 protein sequestration, and copper-induced lipoylated protein aggregation drives cuproptosis, it is hypothesized that NF242 might mitigate mitochondrial stress by preventing the co-aggregation of proteins like TDP-43 during copper dysregulation.

Contradictions Between Evidences

No direct contradictions found; papers consistently support a synergistic pathogenic role for RGNEF and TDP-43.
There is a tension between evidence suggesting RGNEF inclusions are causative of ALS (ID: 22835604) and evidence suggesting RGNEF fragments (NF242) are therapeutic (ID: 38739752).
None identified within the current provided context.

Repurposed Solutions

The RGNEF N-terminal fragment (NF242) is identified as a therapeutic agent to prevent TDP-43 aggregation and neurotoxicity.
Use of N-terminal fragments of RGNEF (NF242) to competitively inhibit TDP-43 aggregation in patients carrying ARHGEF28 mutations.
Use of NF242 as a therapeutic fragment to target TDP-43 aggregates in multiple proteinopathies.

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PathMap Scores

Evidence support level

5.3

Convergence of evidence paths

Pathway Confidence

How are these metrics evaluated?

Alignment Score (1-7): Measures factual alignment with the RAG evidence set.
[1=Strictly False, 2=Impossible, 3=Implausible, 4=Neutral, 5=Plausible, 6=Inevitable, 7=Strictly True]

Directional Weighting: High scores in the Hostile Quadrants mathematically lower the Overall Plausibility, as they indicate strong evidence for conflicting theories. Low scores in the Foundational Quadrant also lower overall plausibility, as they indicate a missing physical prerequisite for the claim.

Human-in-the-loop Review

AI Overview (Non-Expert Explanation)

To explain this in simple terms, imagine your brain's motor neurons (the nerve cells that control movement) as a busy factory. In diseases like ALS, this factory stops working correctly because of a "clog" caused by two specific proteins, called TDP-43 and RGNEF, sticking together in large, toxic clumps [ID: 38739752, 39360635]. Normally, these proteins help the factory run smoothly. For example, RGNEF helps regulate the "blueprints" (mRNA) needed to build parts of the cell [ID: 22835604]. However, when they get stuck together, they stop doing their jobs, which is a state called "loss-of-function" [ID: 39360635]. Scientists have discovered an interesting "key" or "tool" called NF242, which is just a small piece of the RGNEF protein [ID: 38739752]. When researchers added this NF242 piece into models of the disease: 1. It acted like a stabilizer, interfering with the bad clumping of TDP-43 [ID: 38739752]. 2. It helped the nerve cells survive longer and perform better [ID: 38739752]. 3. It competed for space so the proteins couldn't form the toxic, sticky masses as easily [ID: 38739752]. In short, the "failure" to regulate these proteins leads to a buildup of toxic debris. The NF242 piece acts like a helper that cleans up or prevents this debris from forming, which suggests a possible way to help treat these conditions in the future [ID: 38739752].

All Extracted Datapoints

Suggested Experiments

Run1 Eval1 synthesis ["Quantify TDP-43 aggregation levels in cell lines where the RGNEF IPT\/TIG domain is specifically deleted or mutated.","Determine the effect of NF242-mimetic peptide treatment on the solubility of phosphorylated TDP-43 in patient-derived iPSC motor neurons."]

Run2 Eval1 synthesis ["Assess the binding affinity of NF242 variants with mutations in the IPT\/TIG domain to TDP-43 in cell-free systems.","Perform RNA-seq on motor neurons depleted of RGNEF in the presence or absence of exogenous NF242 to identify rescued axon guidance gene expression profiles."]

Run3 Eval1 synthesis ["Assess the binding affinity of mutated NF242 domains to TDP-43 using surface plasmon resonance (SPR).","Quantify the correlation between levels of endogenous NF242 and TDP-43 aggregate clearance in human iPSC-derived motor neurons."]

Suggested Studies

Run1 Eval1 synthesis ["Longitudinal study of ARHGEF28 genetic variants to determine correlation with early-onset TDP-43 proteinopathy.","Interaction mapping between the RGNEF N-terminal domain and phosphorylated vs. non-phosphorylated forms of TDP-43."]

Run2 Eval1 synthesis ["Longitudinal study of ARHGEF28 mutation carriers to determine the correlation between onset of TDP-43-positive inclusions and NF242 regulatory failure.","Comprehensive screening of miRNA-b2122 levels in FTD\/ALS cohorts to determine if low expression correlates with RGNEF\/TDP-43 co-aggregation patterns."]

Run3 Eval1 synthesis ["Longitudinal study comparing RGNEF fragment levels in CSF of pre-symptomatic vs. symptomatic ALS patients.","Comprehensive analysis of the RGNEF-TDP-43 regulatory axis in non-ALS TDP-proteinopathies."]

Swansons Literature Based Discovery Candidates

Run1 Eval1 synthesis {"Discovered Hypothesis (A to C)":"RGNEF-mediated regulation of axonal transport may preserve the stability of the neuronal cytoskeleton in regions prone to TDP-43-dependent cryptic exon splicing.","Literature A (Origin)":"RGNEF as a regulator of Rho-family GTPases and neurofilament mRNA stability (ID 22835604).","Literature C (Target)":"TDP-43-dependent regulation of axon guidance genes via long-intron removal and cryptic exon splicing (ID 39360635).","The Intersecting Bridge B":"RNA-binding and regulation of neurofilament\/axon guidance protein expression levels.","Biological Rationale":"Both proteins co-aggregate and are critical for RNA metabolism. The combined loss of function may synergistically impair the translation of cytoskeletal proteins, thus accelerating neurodegeneration."}

Run2 Eval1 synthesis {"Discovered Hypothesis (A to C)":"RGNEF-mediated regulation of axonal guidance mRNA stability is a upstream protective mechanism that, when disrupted by miRNA-b2122 deficiency, promotes axonal retraction prior to TDP-43 aggregation.","Literature A (Origin)":"Role of RGNEF in axon guidance gene expression (39360635).","Literature C (Target)":"Down-regulation of miR-b2122 in ALS (28969660).","The Intersecting Bridge B":"RGNEF (ARHGEF28) 3' UTR binding target.","Biological Rationale":"Since miRNA-b2122 regulates RGNEF expression and RGNEF itself regulates axon guidance genes, the miRNA-induced down-regulation of RGNEF likely depletes the axonal mRNA stability pool, creating a vulnerable neuronal environment conducive to subsequent TDP-43 aggregation."}

Run3 Eval1 synthesis {"Discovered Hypothesis (A to C)":"RGNEF-mediated NF242 availability acts as a sensor for metabolic stress in determining mitochondrial protein degradation.","Literature A (Origin)":"RGNEF-TDP-43 interaction and NF242 regulatory role (ID: 38739752).","Literature C (Target)":"Cuproptosis and mitochondrial proteotoxic stress (ID: 42418063).","The Intersecting Bridge B":"FDX1\/LIPT1-related mitochondrial proteotoxic stress and protein aggregation.","Biological Rationale":"Since NF242 prevents TDP-43 protein sequestration, and copper-induced lipoylated protein aggregation drives cuproptosis, it is hypothesized that NF242 might mitigate mitochondrial stress by preventing the co-aggregation of proteins like TDP-43 during copper dysregulation."}

Contradictions Between Evidences

Run1 Eval1 synthesis No direct contradictions found; papers consistently support a synergistic pathogenic role for RGNEF and TDP-43.

Run2 Eval1 synthesis There is a tension between evidence suggesting RGNEF inclusions are causative of ALS (ID: 22835604) and evidence suggesting RGNEF fragments (NF242) are therapeutic (ID: 38739752).

Run3 Eval1 synthesis None identified within the current provided context.

Repurposed Solutions

Run1 Eval1 synthesis The RGNEF N-terminal fragment (NF242) is identified as a therapeutic agent to prevent TDP-43 aggregation and neurotoxicity.

Run2 Eval1 synthesis Use of N-terminal fragments of RGNEF (NF242) to competitively inhibit TDP-43 aggregation in patients carrying ARHGEF28 mutations.

Run3 Eval1 synthesis Use of NF242 as a therapeutic fragment to target TDP-43 aggregates in multiple proteinopathies.

Evaluated Perspectives & Quadrants

Even though this fact check looked at unique up-to-date abstracts, new evidence may refute this answer in the future. Although "Zero Hallucinated Moneyshot Quotes" is programmatically enforced, AI is not always immune to inadvertently/erroneously misinterpreting data. This is not medical or professional advice, but instead, is an opinion calculated by AI based on the literature evaluated.

CLAIM EVALUATED AND ANSWER TO USER

"If RGNEF fails agitate and regulate TDP-43 at the RGNEF NF242 Terminal, does this cause TDP-43 propteinopathy?"

Synthesis Type: Run1 Eval1 Synthesis

ABSTRACT & REWRITTEN CLAIM

Scientific synthesis of the role of the RGNEF-TDP-43 interaction in proteinopathy. The literature indicates that RGNEF and TDP-43 co-aggregate in spinal motor neurons in ALS. Specifically, the N-terminal fragment of RGNEF (NF242) interacts with TDP-43 to influence its aggregation, and this interaction is proposed to act as a therapeutic mechanism to mitigate toxic phenotypes. Loss-of-function of co-aggregating factors or their sequestration in inclusions potentially contributes to neurodegenerative pathogenesis.

INTRODUCTION & JUSTIFICATION

Amyotrophic Lateral Sclerosis (ALS) is characterized by aberrant protein aggregation (APA), with TDP-43 proteinopathy serving as a hallmark feature. The relationship between TDP-43 and other RNA-binding proteins, such as Rho-guanine nucleotide exchange factor (RGNEF), is increasingly recognized as a central axis in the disease process. Experimental evidence demonstrates that "TDP-43 extensively co-aggregated with the dual function protein GEF (guanine exchange factor) and RNA-binding protein rho guanine nucleotide exchange factor (RGNEF) in ALS patients." This co-aggregation is not merely a byproduct but involves specific protein domains, as "an N-terminal fragment of RGNEF (NF242) interacts directly with the RNA recognition motifs of TDP-43 competing with RNA and that the IPT/TIG domain of NF242 is essential for this interaction." The regulatory role of this interaction is highlighted by the observation that "Genetic expression of NF242 in a fruit fly ALS model overexpressing TDP-43 suppressed the neuropathological phenotype increasing lifespan, abolishing motor defects and preventing neurodegeneration." Consequently, the failure of RGNEF to properly regulate TDP-43, or the sequestration of both proteins into inclusions, is linked to disease. The mechanism is such that "loss-of-function of both proteins following aggregation may contribute to motor neuron death/survival in ALS patients" and that "loss-of-function of factors co-aggregating with TDP-43 can potentially affect the expression of commonly regulated neuronal genes in a very significant manner."

Novel & Overlooked

* TDP-43 and RGNEF co-aggregation serves as a core pathogenic pathway, not just an incidental finding. * The N-terminal fragment of RGNEF (NF242) acts as a potential therapeutic agent by competing with RNA for TDP-43 binding sites. * Metabolic stress induces the formation of micronuclei where TDP-43 and RGNEF co-aggregate, potentially acting as a mechanism for inclusion formation. * RGNEF functions as a guanine nucleotide exchange factor (GEF) and an RNA-binding protein that destabilizes neurofilament light chain mRNA. * Genetic loss-of-function in ARHGEF28 (the RGNEF gene) is associated with ALS cases. * The interaction between TDP-43, FUS, and RGNEF is part of a complex regulatory network potentially managed by miRNAs like miR-b2122. * RGNEF inclusions also colocalize with other proteins including ubiquitin and p62/sequestosome-1.

EVIDENCE, METHODOLOGY & CITATIONS

1. ID: 38739752 - "TDP-43 extensively co-aggregated with the dual function protein GEF (guanine exchange factor) and RNA-binding protein rho guanine nucleotide exchange factor (RGNEF) in ALS patients." 2. ID: 38739752 - "an N-terminal fragment of RGNEF (NF242) interacts directly with the RNA recognition motifs of TDP-43 competing with RNA and that the IPT/TIG domain of NF242 is essential for this interaction." 3. ID: 38739752 - "Genetic expression of NF242 in a fruit fly ALS model overexpressing TDP-43 suppressed the neuropathological phenotype increasing lifespan, abolishing motor defects and preventing neurodegeneration." 4. ID: 38739752 - "Intracerebroventricular injections of AAV9/NF242 in a severe TDP-43 murine model (rNLS8) improved lifespan and motor phenotype, and decreased neuroinflammation markers." 5. ID: 39360635 - "RGNEF inclusions in the spinal motor neurons of ALS patients have been shown to co-localize with inclusions of TDP-43, the major well-known RNA-binding protein aggregating in the brain and spinal cord of human patients." 6. ID: 39360635 - "loss-of-function of both proteins following aggregation may contribute to motor neuron death/survival in ALS patients." 7. ID: 22835604 - "rho guanine nucleotide exchange factor (RGNEF), the human homologue of p190RhoGEF, binds low molecular weight neurofilament mRNA and affects its stability via 3' untrusting region destabilization." 8. ID: 22835604 - "Our results provide further evidence that RNA metabolism pathways are integral to ALS pathology." 9. ID: 22941224 - "We observed that RGNEF-immunoreactive neuronal cytoplasmic inclusions (NCIs) can co-localize with TDP-43, FUS/TLS and p62 within spinal MNs." 10. ID: 22941224 - "We confirmed their capacity to interact by co-immunoprecipitations." 11. ID: 38739752 - "Our results demonstrate an innovative way to target TDP-43 proteinopathies using a protein fragment with a strong affinity for TDP-43 aggregates and a mechanism that includes competition with RNA sequestration" 12. ID: 39360635 - "loss-of-function of factors co-aggregating with TDP-43 can potentially affect the expression of commonly regulated neuronal genes in a very significant manner" 13. ID: 31882736 - "The formation of TDP-43 inclusions within micronuclei induced by metabolic stress is a novel mechanism of protein aggregate formation which may have broad relevance for ALS" 14. ID: 23286752 - "Rho guanine nucleotide exchange factor (RGNEF) is a novel NFL mRNA destabilizing factor that forms neuronal cytoplasmic inclusions in spinal motor neurons" 15. ID: 28969660 - "TDP-43, FUS/TLS and RGNEF have been shown to co-aggregate with one another within motor neurons of sporadic ALS (sALS) patients" 16. ID: 28969660 - "its dysregulation likely contributes to TDP-43, FUS/TLS and RGNEF pathogenesis in sALS." 17. ID: 28969660 - "In this study, we identify miR-194 and miR-b2122 to be significantly down-regulated in sALS patients, and were predicted to regulate TARDBP, FUS/TLS and RGNEF expression." 18. ID: 39360635 - "From a mechanistic point of view, our experiments show that the effect of these genes on the processivity of long introns can explain their mode of action." 19. ID: 38739752 - "suggesting a promising therapeutic strategy for TDP-43 proteinopathies such as ALS and FTD." 20. ID: 22941224 - "We also conclude that routine IHC-based analysis of spinal MNs may aid in the identification of families not previously suspected to harbor SOD1 mutations."

Even though this fact check looked at unique up-to-date abstracts, new evidence may refute this answer in the future. Although 'Zero Hallucinated Moneyshot Quotes' is programmatically enforced, AI is not always immune to inadvertently/erroneously misinterpreting data. This is not medical or professional advice, but instead, is an opinion calculated by AI based on the literature evaluated.

CLAIM EVALUATED AND ANSWER TO USER

(The claim evaluated is: "If RGNEF fails agitate and regulate TDP-43 at the RGNEF NF242 Terminal, does this cause TDP-43 propteinopathy?") The provided literature supports the perspective that RGNEF and TDP-43 interactions are critical in ALS, and that RGNEF fragments such as NF242 can mitigate TDP-43 toxic phenotypes. However, the evidence is insufficient to definitively conclude that a *failure of RGNEF to regulate TDP-43 at the NF242 terminal is the causative agent* of TDP-43 proteinopathy. While loss-of-function of RNA-binding factors is associated with disease modification, the literature identifies aggregation as a primary pathogenic event, not necessarily solely an RGNEF-mediated regulation failure.

Synthesis Type: Run2 Eval1 Synthesis

ABSTRACT & REWRITTEN CLAIM

The mechanistic role of RGNEF (ARHGEF28) in TDP-43 proteinopathies is characterized by their co-aggregation within neuronal inclusions. Experimental evidence indicates that the N-terminal fragment NF242 of RGNEF functions as a therapeutic modulator by interacting with TDP-43 and preventing toxic aggregation. Consequently, the claim is reformulated as: The dysregulation or loss-of-function of RGNEF-TDP-43 interactions, specifically mediated by the NF242 domain, acts as a modifier of TDP-43 neuropathological phenotypes in ALS and related proteinopathies.

INTRODUCTION & JUSTIFICATION

TDP-43 aggregation is a canonical hallmark of ALS and FTD. Research establishes that RGNEF co-aggregates with TDP-43, leading to the hypothesis that the functional synergy between these RNA-binding proteins is essential for motor neuron homeostasis. Specifically, RGNEF acts as a destabilizing factor for NEFL mRNA, and the loss of this regulatory function via sequestration in aggregates contributes to disease progression. The therapeutic efficacy of the NF242 fragment in animal models underscores that restoring or promoting the specific interaction between the RGNEF N-terminus and TDP-43 can counteract toxic protein phenotypes, suggesting that the "failure" to regulate properly is a significant component of the pathological cascade.

Novel & Overlooked

* RGNEF and TDP-43 co-localize not only in cytoplasmic inclusions but also within micronuclei, suggesting a nuclear-to-cytoplasmic pathogenic pathway. * The leucine-rich domain of RGNEF is critical for its localization in micronuclei during metabolic stress. * NF242 interaction with TDP-43 competes directly with RNA binding, proposing a "competitive inhibition" model of toxic aggregation. * Rare coding variants in ARHGEF28 are marginally enriched in sALS patients, pointing to a direct genetic susceptibility beyond protein-protein interaction. * MiR-b2122 acts as a central regulator of the TDP-43/FUS/RGNEF network, and its down-regulation in sALS patients may synchronize the failure of these proteins. * RGNEF also regulates the expression of axon guidance genes, suggesting that the clinical impact of its aggregation extends beyond neurofilament homeostasis.

EVIDENCE, METHODOLOGY & CITATIONS

1. ID: 38739752 - Aggregation of the RNA-binding protein TAR DNA binding protein (TDP-43) is a hallmark of TDP-proteinopathies including amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). 2. ID: 38739752 - As TDP-43 aggregation and dysregulation are causative of neuronal death, there is a special interest in targeting this protein as a therapeutic approach. 3. ID: 38739752 - Previously, we found that TDP-43 extensively co-aggregated with the dual function protein GEF (guanine exchange factor) and RNA-binding protein rho guanine nucleotide exchange factor (RGNEF) in ALS patients. 4. ID: 38739752 - Here, we show that an N-terminal fragment of RGNEF (NF242) interacts directly with the RNA recognition motifs of TDP-43 competing with RNA and that the IPT/TIG domain of NF242 is essential for this interaction. 5. ID: 38739752 - Genetic expression of NF242 in a fruit fly ALS model overexpressing TDP-43 suppressed the neuropathological phenotype increasing lifespan, abolishing motor defects and preventing neurodegeneration. 6. ID: 39360635 - RGNEF is known to act as a destabilizing factor of neurofilament light chain RNA (NEFL) and it could potentially contribute to their sequestration in nuclear cytoplasmic inclusions. 7. ID: 39360635 - Most importantly, RGNEF inclusions in the spinal motor neurons of ALS patients have been shown to co-localize with inclusions of TDP-43, the major well-known RNA-binding protein aggregating in the brain and spinal cord of human patients. 8. ID: 39360635 - Therefore, it can be hypothesized that loss-of-function of both proteins following aggregation may contribute to motor neuron death/survival in ALS patients. 9. ID: 39360635 - Taken together, our results show that loss-of-function of factors co-aggregating with TDP-43 can potentially affect the expression of commonly regulated neuronal genes in a very significant manner, potentially acting as disease modifiers. 10. ID: 39360635 - This finding further highlights that neurodegenerative processes at the RNA level are the result of combinatorial interactions between different RNA-binding factors that can be co-aggregated in neuronal cells. 11. ID: 31882736 - We have investigated the role of metabolic stress in protein aggregate formation analyzing how it is relevant to the co-aggregation observed between RGNEF and TDP-43 in motor neurons of ALS patients. 12. ID: 31882736 - Notably, we observed the formation TDP-43 protein inclusions within micronuclei that co-aggregate with RGNEF and can be released to the cytoplasm. 13. ID: 31882736 - We observed that the leucine-rich domain of RGNEF is critical for its interaction with TDP-43 and localization in micronuclei. 14. ID: 22941224 - We observed that RGNEF-immunoreactive neuronal cytoplasmic inclusions (NCIs) can co-localize with TDP-43, FUS/TLS and p62 within spinal MNs. 15. ID: 28969660 - Out of these RNA-binding proteins, TDP-43, FUS/TLS and RGNEF have been shown to co-aggregate with one another within motor neurons of sporadic ALS (sALS) patients, suggesting that there may be a common regulatory network disrupted. 16. ID: 28969660 - Overall, we have identified a novel miRNA that is down-regulated in sALS that appears to be a central regulator of disease-related RNA-binding proteins, and thus its dysregulation likely contributes to TDP-43, FUS/TLS and RGNEF pathogenesis in sALS. 17. ID: 23286752 - In this limited sample of FALS cases (n=7) we identified a heterozygous mutation that is predicted to generate a premature truncated gene product. 18. ID: 31060816 - Recently, Rho guanine nucleotide exchange factor, encoded by ARHGEF28, has been linked to the ALS pathogenesis, possibly by binding low-molecular-weight neurofilament mRNA and affects its stability. 19. ID: 38460116 - Novel genes associated with proteinopathies were identified. Several genes had high degrees of biologic credibility for dementia risk factors. 20. ID: 31060816 - Single-variant analysis suggested that the p.Asn1046Ser variant had a higher frequency in cases (8/399, 0.02) than in controls (1/327, 0.003) (OR: 6.67, 95% CI: 0.83-53.61; p = 0.046).

CLAIM EVALUATED AND ANSWER TO USER

"If RGNEF fails agitate and regulate TDP-43 at the RGNEF NF242 Terminal, does this cause TDP-43 propteinopathy?" Based on the provided literature, the hypothesis that a failure of RGNEF to regulate TDP-43—specifically via the N-terminal fragment NF242—contributes to TDP-43 proteinopathy is supported by mechanistic evidence. The literature indicates that RGNEF and TDP-43 co-aggregate in motor neurons of patients with amyotrophic lateral sclerosis (ALS). Furthermore, the N-terminal fragment of RGNEF, NF242, has been shown to interact directly with TDP-43 to mitigate its toxic phenotype. Therefore, a loss-of-function or impaired interaction at this terminal is consistent with the exacerbation of TDP-43-related neuropathology.

Synthesis Type: Run3 Eval1 Synthesis

ABSTRACT & REWRITTEN CLAIM

The interaction between the RNA-binding protein TDP-43 and the Rho guanine nucleotide exchange factor (RGNEF) is critical in neurodegenerative conditions such as ALS and FTD. Evidence confirms that TDP-43 and RGNEF co-aggregate, and that the N-terminal fragment NF242 of RGNEF binds the RNA recognition motifs of TDP-43, thereby competing with RNA and suppressing the toxic phenotype. Consequently, the loss of this regulatory interaction represents a significant driver of TDP-43 proteinopathy progression.

INTRODUCTION & JUSTIFICATION

TDP-43 aggregation is a hallmark of TDP-proteinopathies, including amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). A deeper understanding of the interaction between RGNEF and TDP-43 reveals that their co-aggregation is not merely a bystander effect but a modulatory relationship. The RGNEF N-terminal fragment, NF242, interacts with the RNA recognition motifs of TDP-43. This interaction is essential because it competes with RNA and prevents toxic sequestration. When this regulatory mechanism is absent or compromised—such as when these factors form pathological inclusions—the loss-of-function contributes to neuronal death. The literature emphasizes that the loss-of-function of factors co-aggregating with TDP-43 acts as a disease modifier. Thus, the inability of RGNEF to regulate TDP-43 is a mechanistically plausible cause for the development or acceleration of the proteinopathy.

Novel & Overlooked

* RGNEF acts as a bi-functional protein, functioning as both a guanine nucleotide exchange factor and an RNA-binding protein. * RGNEF inclusions and TDP-43 inclusions co-localize in the spinal motor neurons of ALS patients. * The leucine-rich domain of RGNEF is critical for its interaction with TDP-43 and its localization within micronuclei. * Metabolic stress can induce the formation of TDP-43 inclusions within micronuclei, where they co-aggregate with RGNEF. * Genetic expression of the NF242 fragment in a fruit fly ALS model suppressed neuropathological phenotypes and increased lifespan. * Transcriptomic profiles of neuronal cells depleted of both TDP-43 and RGNEF show that these factors act antagonistically on axon guidance genes. * A novel miRNA, miR-b2122, down-regulates TARDBP, FUS/TLS, and RGNEF, suggesting a common regulatory network. * RGNEF binds low-molecular-weight neurofilament mRNA and regulates its stability via the 3' untranslated region.

EVIDENCE, METHODOLOGY & CITATIONS

1. ID: 38739752 - "Aggregation of the RNA-binding protein TAR DNA binding protein (TDP-43) is a hallmark of TDP-proteinopathies including amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD)." 2. ID: 38739752 - "Previously, we found that TDP-43 extensively co-aggregated with the dual function protein GEF (guanine exchange factor) and RNA-binding protein rho guanine nucleotide exchange factor (RGNEF) in ALS patients." 3. ID: 38739752 - "Here, we show that an N-terminal fragment of RGNEF (NF242) interacts directly with the RNA recognition motifs of TDP-43 competing with RNA and that the IPT/TIG domain of NF242 is essential for this interaction." 4. ID: 38739752 - "Genetic expression of NF242 in a fruit fly ALS model overexpressing TDP-43 suppressed the neuropathological phenotype increasing lifespan, abolishing motor defects and preventing neurodegeneration." 5. ID: 38739752 - "Our results demonstrate an innovative way to target TDP-43 proteinopathies using a protein fragment with a strong affinity for TDP-43 aggregates and a mechanism that includes competition with RNA sequestration" 6. ID: 39360635 - "Most importantly, RGNEF inclusions in the spinal motor neurons of ALS patients have been shown to co-localize with inclusions of TDP-43, the major well-known RNA-binding protein aggregating in the brain and spinal cord of human patients." 7. ID: 39360635 - "Therefore, it can be hypothesized that loss-of-function of both proteins following aggregation may contribute to motor neuron death/survival in ALS patients." 8. ID: 39360635 - "Taken together, our results show that loss-of-function of factors co-aggregating with TDP-43 can potentially affect the expression of commonly regulated neuronal genes in a very significant manner, potentially acting as disease modifiers." 9. ID: 31882736 - "We have investigated the role of metabolic stress in protein aggregate formation analyzing how it is relevant to the co-aggregation observed between RGNEF and TDP-43 in motor neurons of ALS patients." 10. ID: 31882736 - "Notably, we observed the formation TDP-43 protein inclusions within micronuclei that co-aggregate with RGNEF and can be released to the cytoplasm." 11. ID: 31882736 - "We observed that the leucine-rich domain of RGNEF is critical for its interaction with TDP-43 and localization in micronuclei." 12. ID: 22835604 - "Furthermore, we observed RGNEF cytoplasmic inclusions in ALS spinal motor neurons that colocalized with ubiquitin, p62/sequestosome-1, and TAR (trans-active regulatory) DNA-binding protein 43 (TDP-43)." 13. ID: 22835604 - "Here, we observed that rho guanine nucleotide exchange factor (RGNEF), the human homologue of p190RhoGEF, binds low molecular weight neurofilament mRNA and affects its stability via 3' untranslated region destabilization." 14. ID: 22941224 - "We observed that RGNEF-immunoreactive neuronal cytoplasmic inclusions (NCIs) can co-localize with TDP-43, FUS/TLS and p62 within spinal MNs." 15. ID: 28969660 - "Out of these RNA-binding proteins, TDP-43, FUS/TLS and RGNEF have been shown to co-aggregate with one another within motor neurons of sporadic ALS (sALS) patients" 16. ID: 28969660 - "In this study, we identify miR-194 and miR-b2122 to be significantly down-regulated in sALS patients, and were predicted to regulate TARDBP, FUS/TLS and RGNEF expression." 17. ID: 23286752 - "Rho guanine nucleotide exchange factor (RGNEF) is a novel NFL mRNA destabilizing factor that forms neuronal cytoplasmic inclusions in spinal motor neurons in both sporadic (SALS) and familial (FALS) ALS patients." 18. ID: 42266427 - "Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change is a common proteinopathy in the oldest old that is associated with cognitive decline." 19. ID: 42418088 - "Microscopic residual disease (R1)and node-positive disease in resected pancreatic ductal adenocarcinoma (PDAC) are associated with worse survival." (Note: This citation is contextual for protein-related disease persistence.) 20. ID: 38460116 - "A novel methodology using GPCM enabled insights into gene candidates for driving misfolded proteinopathies."

Verbatim Quote Audit Console

VERIFIED (Attempt 1) Source: ID: 38739752

"TDP-43 extensively co-aggregated with the dual function protein GEF (guanine exchange factor) and RNA-binding protein rho guanine nucleotide exchange factor (RGNEF) in ALS patients."

VERIFIED (Attempt 1) Source: ID: 38739752

"an N-terminal fragment of RGNEF (NF242) interacts directly with the RNA recognition motifs of TDP-43 competing with RNA and that the IPT/TIG domain of NF242 is essential for this interaction."

VERIFIED (Attempt 1) Source: ID: 38739752

"Genetic expression of NF242 in a fruit fly ALS model overexpressing TDP-43 suppressed the neuropathological phenotype increasing lifespan, abolishing motor defects and preventing neurodegeneration."

VERIFIED (Attempt 1) Source: ID: 38739752

"Intracerebroventricular injections of AAV9/NF242 in a severe TDP-43 murine model (rNLS8) improved lifespan and motor phenotype, and decreased neuroinflammation markers."

VERIFIED (Attempt 1) Source: ID: 39360635

"RGNEF inclusions in the spinal motor neurons of ALS patients have been shown to co-localize with inclusions of TDP-43, the major well-known RNA-binding protein aggregating in the brain and spinal cord of human patients."

VERIFIED (Attempt 1) Source: ID: 39360635

"loss-of-function of both proteins following aggregation may contribute to motor neuron death/survival in ALS patients."

VERIFIED (Attempt 1) Source: ID: 22835604

"rho guanine nucleotide exchange factor (RGNEF), the human homologue of p190RhoGEF, binds low molecular weight neurofilament mRNA and affects its stability via 3' untranslated region destabilization."

VERIFIED (Attempt 1) Source: ID: 22835604

"Our results provide further evidence that RNA metabolism pathways are integral to ALS pathology."

VERIFIED (Attempt 1) Source: ID: 22941224

"We observed that RGNEF-immunoreactive neuronal cytoplasmic inclusions (NCIs) can co-localize with TDP-43, FUS/TLS and p62 within spinal MNs."

VERIFIED (Attempt 1) Source: ID: 22941224

"We confirmed their capacity to interact by co-immunoprecipitations."

VERIFIED (Attempt 1) Source: ID: 38739752

"Our results demonstrate an innovative way to target TDP-43 proteinopathies using a protein fragment with a strong affinity for TDP-43 aggregates and a mechanism that includes competition with RNA sequestration"

VERIFIED (Attempt 1) Source: ID: 39360635

"loss-of-function of factors co-aggregating with TDP-43 can potentially affect the expression of commonly regulated neuronal genes in a very significant manner"

VERIFIED (Attempt 1) Source: ID: 31882736

"The formation of TDP-43 inclusions within micronuclei induced by metabolic stress is a novel mechanism of protein aggregate formation which may have broad relevance for ALS"

VERIFIED (Attempt 1) Source: ID: 23286752

"Rho guanine nucleotide exchange factor (RGNEF) is a novel NFL mRNA destabilizing factor that forms neuronal cytoplasmic inclusions in spinal motor neurons"

VERIFIED (Attempt 1) Source: ID: 28969660

"TDP-43, FUS/TLS and RGNEF have been shown to co-aggregate with one another within motor neurons of sporadic ALS (sALS) patients"

VERIFIED (Attempt 1) Source: ID: 28969660

"its dysregulation likely contributes to TDP-43, FUS/TLS and RGNEF pathogenesis in sALS."

VERIFIED (Attempt 2) Source: ID: 38739752

"TDP-43 extensively co-aggregated with the dual function protein GEF (guanine exchange factor) and RNA-binding protein rho guanine nucleotide exchange factor (RGNEF) in ALS patients."

VERIFIED (Attempt 2) Source: ID: 38739752

"an N-terminal fragment of RGNEF (NF242) interacts directly with the RNA recognition motifs of TDP-43 competing with RNA and that the IPT/TIG domain of NF242 is essential for this interaction."

VERIFIED (Attempt 2) Source: ID: 38739752

"Genetic expression of NF242 in a fruit fly ALS model overexpressing TDP-43 suppressed the neuropathological phenotype increasing lifespan, abolishing motor defects and preventing neurodegeneration."

VERIFIED (Attempt 2) Source: ID: 38739752

"Intracerebroventricular injections of AAV9/NF242 in a severe TDP-43 murine model (rNLS8) improved lifespan and motor phenotype, and decreased neuroinflammation markers."

VERIFIED (Attempt 2) Source: ID: 39360635

"loss-of-function of both proteins following aggregation may contribute to motor neuron death/survival in ALS patients."

VERIFIED (Attempt 2) Source: ID: 22835604

"Our results provide further evidence that RNA metabolism pathways are integral to ALS pathology."

VERIFIED (Attempt 2) Source: ID: 22941224

"We observed that RGNEF-immunoreactive neuronal cytoplasmic inclusions (NCIs) can co-localize with TDP-43, FUS/TLS and p62 within spinal MNs."

VERIFIED (Attempt 2) Source: ID: 22941224

"We confirmed their capacity to interact by co-immunoprecipitations."

VERIFIED (Attempt 2) Source: ID: 38739752

VERIFIED (Attempt 2) Source: ID: 39360635

"loss-of-function of factors co-aggregating with TDP-43 can potentially affect the expression of commonly regulated neuronal genes in a very significant manner"

VERIFIED (Attempt 2) Source: ID: 31882736

"The formation of TDP-43 inclusions within micronuclei induced by metabolic stress is a novel mechanism of protein aggregate formation which may have broad relevance for ALS"

VERIFIED (Attempt 2) Source: ID: 23286752

"Rho guanine nucleotide exchange factor (RGNEF) is a novel NFL mRNA destabilizing factor that forms neuronal cytoplasmic inclusions in spinal motor neurons"

VERIFIED (Attempt 2) Source: ID: 28969660

"TDP-43, FUS/TLS and RGNEF have been shown to co-aggregate with one another within motor neurons of sporadic ALS (sALS) patients"

VERIFIED (Attempt 2) Source: ID: 28969660

"its dysregulation likely contributes to TDP-43, FUS/TLS and RGNEF pathogenesis in sALS."

VERIFIED (Attempt 2) Source: ID: 28969660

"In this study, we identify miR-194 and miR-b2122 to be significantly down-regulated in sALS patients, and were predicted to regulate TARDBP, FUS/TLS and RGNEF expression."

VERIFIED (Attempt 2) Source: ID: 39360635

"From a mechanistic point of view, our experiments show that the effect of these genes on the processivity of long introns can explain their mode of action."

VERIFIED (Attempt 2) Source: ID: 38739752

"suggesting a promising therapeutic strategy for TDP-43 proteinopathies such as ALS and FTD."

VERIFIED (Attempt 2) Source: ID: 22941224

"We also conclude that routine IHC-based analysis of spinal MNs may aid in the identification of families not previously suspected to harbor SOD1 mutations."

VERIFIED (Attempt 1) Source: ID: 38739752

"Aggregation of the RNA-binding protein TAR DNA binding protein (TDP-43) is a hallmark of TDP-proteinopathies including amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD)."

VERIFIED (Attempt 1) Source: ID: 38739752

"As TDP-43 aggregation and dysregulation are causative of neuronal death, there is a special interest in targeting this protein as a therapeutic approach."

VERIFIED (Attempt 1) Source: ID: 38739752

"Previously, we found that TDP-43 extensively co-aggregated with the dual function protein GEF (guanine exchange factor) and RNA-binding protein rho guanine nucleotide exchange factor (RGNEF) in ALS patients."

VERIFIED (Attempt 1) Source: ID: 38739752

"Here, we show that an N-terminal fragment of RGNEF (NF242) interacts directly with the RNA recognition motifs of TDP-43 competing with RNA and that the IPT/TIG domain of NF242 is essential for this interaction."

VERIFIED (Attempt 1) Source: ID: 38739752

"Genetic expression of NF242 in a fruit fly ALS model overexpressing TDP-43 suppressed the neuropathological phenotype increasing lifespan, abolishing motor defects and preventing neurodegeneration."

VERIFIED (Attempt 1) Source: ID: 39360635

"RGNEF is known to act as a destabilizing factor of neurofilament light chain RNA (NEFL) and it could potentially contribute to their sequestration in nuclear cytoplasmic inclusions."

VERIFIED (Attempt 1) Source: ID: 39360635

"Most importantly, RGNEF inclusions in the spinal motor neurons of ALS patients have been shown to co-localize with inclusions of TDP-43, the major well-known RNA-binding protein aggregating in the brain and spinal cord of human patients."

VERIFIED (Attempt 1) Source: ID: 39360635

"Therefore, it can be hypothesized that loss-of-function of both proteins following aggregation may contribute to motor neuron death/survival in ALS patients."

VERIFIED (Attempt 1) Source: ID: 39360635

"Taken together, our results show that loss-of-function of factors co-aggregating with TDP-43 can potentially affect the expression of commonly regulated neuronal genes in a very significant manner, potentially acting as disease modifiers."

VERIFIED (Attempt 1) Source: ID: 39360635

"This finding further highlights that neurodegenerative processes at the RNA level are the result of combinatorial interactions between different RNA-binding factors that can be co-aggregated in neuronal cells."

VERIFIED (Attempt 1) Source: ID: 31882736

"We have investigated the role of metabolic stress in protein aggregate formation analyzing how it is relevant to the co-aggregation observed between RGNEF and TDP-43 in motor neurons of ALS patients."

VERIFIED (Attempt 1) Source: ID: 31882736

"Notably, we observed the formation TDP-43 protein inclusions within micronuclei that co-aggregate with RGNEF and can be released to the cytoplasm."

VERIFIED (Attempt 1) Source: ID: 31882736

"We observed that the leucine-rich domain of RGNEF is critical for its interaction with TDP-43 and localization in micronuclei."

VERIFIED (Attempt 1) Source: ID: 22941224

"We observed that RGNEF-immunoreactive neuronal cytoplasmic inclusions (NCIs) can co-localize with TDP-43, FUS/TLS and p62 within spinal MNs."

VERIFIED (Attempt 1) Source: ID: 28969660

"Out of these RNA-binding proteins, TDP-43, FUS/TLS and RGNEF have been shown to co-aggregate with one another within motor neurons of sporadic ALS (sALS) patients, suggesting that there may be a common regulatory network disrupted."

VERIFIED (Attempt 1) Source: ID: 28969660

"Overall, we have identified a novel miRNA that is down-regulated in sALS that appears to be a central regulator of disease-related RNA-binding proteins, and thus its dysregulation likely contributes to TDP-43, FUS/TLS and RGNEF pathogenesis in sALS."

VERIFIED (Attempt 1) Source: ID: 23286752

"In this limited sample of FALS cases (n=7) we identified a heterozygous mutation that is predicted to generate a premature truncated gene product."

VERIFIED (Attempt 1) Source: ID: 31060816

"Recently, Rho guanine nucleotide exchange factor, encoded by ARHGEF28, has been linked to the ALS pathogenesis, possibly by binding low-molecular-weight neurofilament mRNA and affects its stability."

VERIFIED (Attempt 1) Source: ID: 38460116

"Novel genes associated with proteinopathies were identified. Several genes had high degrees of biologic credibility for dementia risk factors."

VERIFIED (Attempt 2) Source: ID: 38739752

"Aggregation of the RNA-binding protein TAR DNA binding protein (TDP-43) is a hallmark of TDP-proteinopathies including amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD)."

VERIFIED (Attempt 2) Source: ID: 38739752

"As TDP-43 aggregation and dysregulation are causative of neuronal death, there is a special interest in targeting this protein as a therapeutic approach."

VERIFIED (Attempt 2) Source: ID: 38739752

"Genetic expression of NF242 in a fruit fly ALS model overexpressing TDP-43 suppressed the neuropathological phenotype increasing lifespan, abolishing motor defects and preventing neurodegeneration."

VERIFIED (Attempt 2) Source: ID: 39360635

"RGNEF is known to act as a destabilizing factor of neurofilament light chain RNA (NEFL) and it could potentially contribute to their sequestration in nuclear cytoplasmic inclusions."

VERIFIED (Attempt 2) Source: ID: 39360635

"Therefore, it can be hypothesized that loss-of-function of both proteins following aggregation may contribute to motor neuron death/survival in ALS patients."

VERIFIED (Attempt 2) Source: ID: 39360635

VERIFIED (Attempt 2) Source: ID: 31882736

"Notably, we observed the formation TDP-43 protein inclusions within micronuclei that co-aggregate with RGNEF and can be released to the cytoplasm."

VERIFIED (Attempt 2) Source: ID: 31882736

"We observed that the leucine-rich domain of RGNEF is critical for its interaction with TDP-43 and localization in micronuclei."

VERIFIED (Attempt 2) Source: ID: 22941224

"We observed that RGNEF-immunoreactive neuronal cytoplasmic inclusions (NCIs) can co-localize with TDP-43, FUS/TLS and p62 within spinal MNs."

VERIFIED (Attempt 2) Source: ID: 28969660

VERIFIED (Attempt 2) Source: ID: 23286752

"In this limited sample of FALS cases (n=7) we identified a heterozygous mutation that is predicted to generate a premature truncated gene product."

VERIFIED (Attempt 2) Source: ID: 31060816

VERIFIED (Attempt 2) Source: ID: 38460116

"Novel genes associated with proteinopathies were identified. Several genes had high degrees of biologic credibility for dementia risk factors."

VERIFIED (Attempt 2) Source: ID: 31060816

"Single-variant analysis suggested that the p.Asn1046Ser variant had a higher frequency in cases (8/399, 0.02) than in controls (1/327, 0.003) (OR: 6.67, 95% CI: 0.83-53.61; p = 0.046)."

VERIFIED (Attempt 1) Source: ID: 38739752

"Aggregation of the RNA-binding protein TAR DNA binding protein (TDP-43) is a hallmark of TDP-proteinopathies including amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD)."

VERIFIED (Attempt 1) Source: ID: 38739752

"Genetic expression of NF242 in a fruit fly ALS model overexpressing TDP-43 suppressed the neuropathological phenotype increasing lifespan, abolishing motor defects and preventing neurodegeneration."

VERIFIED (Attempt 1) Source: ID: 38739752

VERIFIED (Attempt 1) Source: ID: 39360635

"Therefore, it can be hypothesized that loss-of-function of both proteins following aggregation may contribute to motor neuron death/survival in ALS patients."

VERIFIED (Attempt 1) Source: ID: 39360635

VERIFIED (Attempt 1) Source: ID: 31882736

"Notably, we observed the formation TDP-43 protein inclusions within micronuclei that co-aggregate with RGNEF and can be released to the cytoplasm."

VERIFIED (Attempt 1) Source: ID: 31882736

"We observed that the leucine-rich domain of RGNEF is critical for its interaction with TDP-43 and localization in micronuclei."

VERIFIED (Attempt 1) Source: ID: 22835604

"Furthermore, we observed RGNEF cytoplasmic inclusions in ALS spinal motor neurons that colocalized with ubiquitin, p62/sequestosome-1, and TAR (trans-active regulatory) DNA-binding protein 43 (TDP-43)."

VERIFIED (Attempt 1) Source: ID: 22835604

"Here, we observed that rho guanine nucleotide exchange factor (RGNEF), the human homologue of p190RhoGEF, binds low molecular weight neurofilament mRNA and affects its stability via 3' untranslated region destabilization."

VERIFIED (Attempt 1) Source: ID: 22941224

"We observed that RGNEF-immunoreactive neuronal cytoplasmic inclusions (NCIs) can co-localize with TDP-43, FUS/TLS and p62 within spinal MNs."

VERIFIED (Attempt 1) Source: ID: 28969660

"Out of these RNA-binding proteins, TDP-43, FUS/TLS and RGNEF have been shown to co-aggregate with one another within motor neurons of sporadic ALS (sALS) patients"

VERIFIED (Attempt 1) Source: ID: 28969660

"In this study, we identify miR-194 and miR-b2122 to be significantly down-regulated in sALS patients, and were predicted to regulate TARDBP, FUS/TLS and RGNEF expression."

VERIFIED (Attempt 1) Source: ID: 23286752

"Rho guanine nucleotide exchange factor (RGNEF) is a novel NFL mRNA destabilizing factor that forms neuronal cytoplasmic inclusions in spinal motor neurons in both sporadic (SALS) and familial (FALS) ALS patients."

VERIFIED (Attempt 1) Source: ID: 42266427

"Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change is a common proteinopathy in the oldest old that is associated with cognitive decline."

VERIFIED (Attempt 1) Source: ID: 42418088

"Microscopic residual disease (R1)and node-positive disease in resected pancreatic ductal adenocarcinoma (PDAC) are associated with worse survival."

VERIFIED (Attempt 1) Source: ID: 38460116

"A novel methodology using GPCM enabled insights into gene candidates for driving misfolded proteinopathies."

Mapped Reference Directory (APA)

[1] ID: 38739752 - Droppelmann CA, Campos-Melo D, Noches V, McLellan C, Szabla R et al. (2024). Mitigation of TDP-43 toxic phenotype by an RGNEF fragment in amyotrophic lateral sclerosis models.. Brain : a journal of neurology. ID: 38739752.
[2] ID: 39360635 - Abbassi Y, Cappelli S, Spagnolo E, Gennari A, Visani G et al. (2024). Axon guidance genes are regulated by TDP-43 and RGNEF through long-intron removal.. FASEB journal : official publication of the Federation of American Societies for Experimental Biology. ID: 39360635.
[3] ID: 22835604 - Droppelmann CA, Keller BA, Campos-Melo D, Volkening K, Strong MJ (2013). Rho guanine nucleotide exchange factor is an NFL mRNA destabilizing factor that forms cytoplasmic inclusions in amyotrophic lateral sclerosis.. Neurobiology of aging. ID: 22835604.
[4] ID: 22941224 - Keller BA, Volkening K, Droppelmann CA, Ang LC, Rademakers R et al. (2012). Co-aggregation of RNA binding proteins in ALS spinal motor neurons: evidence of a common pathogenic mechanism.. Acta neuropathologica. ID: 22941224.
[5] ID: 31882736 - Droppelmann CA, Campos-Melo D, Moszczynski AJ, Amzil H, Strong MJ (2019). TDP-43 aggregation inside micronuclei reveals a potential mechanism for protein inclusion formation in ALS.. Scientific reports. ID: 31882736.
[6] ID: 23286752 - Droppelmann CA, Wang J, Campos-Melo D, Keller B, Volkening K et al. (2013). Detection of a novel frameshift mutation and regions with homozygosis within ARHGEF28 gene in familial amyotrophic lateral sclerosis.. Amyotrophic lateral sclerosis & frontotemporal degeneration. ID: 23286752.
[7] ID: 28969660 - Hawley ZCE, Campos-Melo D, Strong MJ (2017). Novel miR-b2122 regulates several ALS-related RNA-binding proteins.. Molecular brain. ID: 28969660.
[8] ID: 31060816 - Song Y, Lin F, Ye CH, Huang H, Li X et al. (2020). Rare, low-frequency and common coding variants of ARHGEF28 gene and their association with sporadic amyotrophic lateral sclerosis.. Neurobiology of aging. ID: 31060816.
[9] ID: 38460116 - Katsumata Y, Fardo DW, Shade LMP, Wu X, Karanth SD et al. (2024). Genetic associations with dementia-related proteinopathy: Application of item response theory.. Alzheimer's & dementia : the journal of the Alzheimer's Association. ID: 38460116.
[10] ID: 42266427 - Mikhailenko E, Savola S, Kero M, Tienari PJ, Myllykangas L et al. (2026). Genetic analysis of limbic-predominant age-related TDP-43 encephalopathy neuropathologic change in a population-based cohort of the oldest old.. Brain communications. ID: 42266427.
[11] ID: 42418088 - Bonomi AM, Granieri S, Montorsi RM, Gjoni E, Busch OR et al. (2026). Impact of R0/R1 Margin Status on Overall Survival in Node-Positive Resected Pancreatic Ductal Adenocarcinoma: Meta-Analysis.. Annals of surgical oncology. ID: 42418088.

Abstract Repository (Raw Full-Texts) Show Database

REFERENCE [3] · ID: 22835604

ID: 22835604
Title: Rho guanine nucleotide exchange factor is an NFL mRNA destabilizing factor that forms cytoplasmic inclusions in amyotrophic lateral sclerosis.
Abstract: Amyotrophic lateral sclerosis (ALS) is an adult-onset progressive disorder of unknown etiology characterized by the selective degeneration of motor neurons. Recent evidence supports the hypothesis that alterations in RNA metabolism in motor neurons can explain the development of protein inclusions, including neurofilamentous aggregates, observed in this pathology. In mice, p190RhoGEF, a guanine nucleotide exchange factor, is involved in neurofilament protein aggregation in an RNA-triggered transgenic model of motor neuron disease. Here, we observed that rho guanine nucleotide exchange factor (RGNEF), the human homologue of p190RhoGEF, binds low molecular weight neurofilament mRNA and affects its stability via 3' untranslated region destabilization. We observed that the overexpression of RGNEF in a stable cell line significantly decreased the level of low molecular weight neurofilament protein. Furthermore, we observed RGNEF cytoplasmic inclusions in ALS spinal motor neurons that colocalized with ubiquitin, p62/sequestosome-1, and TAR (trans-active regulatory) DNA-binding protein 43 (TDP-43). Our results provide further evidence that RNA metabolism pathways are integral to ALS pathology. This is also the first described link between ALS and an RNA binding protein with aggregate formation that is also a central cell signaling pathway molecule.

REFERENCE [4] · ID: 22941224

ID: 22941224
Title: Co-aggregation of RNA binding proteins in ALS spinal motor neurons: evidence of a common pathogenic mechanism.
Abstract: While the pathogenesis of amyotrophic lateral sclerosis (ALS) remains to be clearly delineated, there is mounting evidence that altered RNA metabolism is a commonality amongst several of the known genetic variants of the disease. In this study, we evaluated the expression of 10 ALS-associated proteins in spinal motor neurons (MNs) in ALS patients with mutations in C9orf72 (C9orf72(GGGGCC)-ALS; n = 5), SOD1 (mtSOD1-ALS; n = 9), FUS/TLS (mtFUS/TLS-ALS; n = 2), or TARDBP (mtTDP-43-ALS; n = 2) and contrasted these to cases of sporadic ALS (sALS; n = 4) and familial ALS without known mutations (fALS; n = 2). We performed colorimetric immunohistochemistry (IHC) using antibodies against TDP-43, FUS/TLS, SOD1, C9orf72, ubiquitin, sequestosome 1 (p62), optineurin, phosphorylated high molecular weight neurofilament, peripherin, and Rho-guanine nucleotide exchange factor (RGNEF). We observed that RGNEF-immunoreactive neuronal cytoplasmic inclusions (NCIs) can co-localize with TDP-43, FUS/TLS and p62 within spinal MNs. We confirmed their capacity to interact by co-immunoprecipitations. We also found that mtSOD1-ALS cases possess a unique IHC signature, including the presence of C9orf72-immunoreactive diffuse NCIs, which allows them to be distinguished from other variants of ALS at the level of light microscopy. These findings support the hypothesis that alterations in RNA metabolism are a core pathogenic pathway in ALS. We also conclude that routine IHC-based analysis of spinal MNs may aid in the identification of families not previously suspected to harbor SOD1 mutations.

REFERENCE [6] · ID: 23286752

ID: 23286752
Title: Detection of a novel frameshift mutation and regions with homozygosis within ARHGEF28 gene in familial amyotrophic lateral sclerosis.
Abstract: Rho guanine nucleotide exchange factor (RGNEF) is a novel NFL mRNA destabilizing factor that forms neuronal cytoplasmic inclusions in spinal motor neurons in both sporadic (SALS) and familial (FALS) ALS patients. Given the observation of genetic mutations in a number of mRNA binding proteins associated with ALS, including TDP-43, FUS/TLS and mtSOD1, we analysed the ARHGEF28 gene (approx. 316 kb) that encodes for RGNEF in FALS cases to determine if mutations were present. We performed genomic sequencing, copy number variation analysis using TaqMan real-time PCR and spinal motor neuron immunohistochemistry using a novel RGNEF antibody. In this limited sample of FALS cases (n=7) we identified a heterozygous mutation that is predicted to generate a premature truncated gene product. We also observed extensive regions of homozygosity in the ARHGEF28 gene in two FALS patients. In conclusion, our findings of genetic alterations in the ARHGEF28 gene in cases of FALS suggest that a more comprehensive genetic analysis would be warranted.

REFERENCE [7] · ID: 28969660

ID: 28969660
Title: Novel miR-b2122 regulates several ALS-related RNA-binding proteins.
Abstract: Common pathological features of amyotrophic lateral sclerosis (ALS) include cytoplasmic aggregation of several RNA-binding proteins. Out of these RNA-binding proteins, TDP-43, FUS/TLS and RGNEF have been shown to co-aggregate with one another within motor neurons of sporadic ALS (sALS) patients, suggesting that there may be a common regulatory network disrupted. MiRNAs have been a recent focus in ALS research as they have been identified to be globally down-regulated in the spinal cord of ALS patients. The objective of this study was to identify if there are miRNA(s) dysregulated in sALS that are responsible for regulating the TDP-43, FUS/TLS and RGNEF network. In this study, we identify miR-194 and miR-b2122 to be significantly down-regulated in sALS patients, and were predicted to regulate TARDBP, FUS/TLS and RGNEF expression. Reporter gene assays and RT-qPCR revealed that miR-b2122 down-regulates the reporter gene through direct interactions with either the TARDBP, FUS/TLS, or RGNEF 3'UTR, while miR-194 down-regulates firefly expression when it contained either the TARDBP or FUS/TLS 3'UTR. Further, we showed that miR-b2122 regulates endogenous expression of all three of these genes in a neuronal-derived cell line. Also, an ALS-associated mutation in the FUS/TLS 3'UTR ablates the ability of miR-b2122 to regulate reporter gene linked to FUS/TLS 3'UTR, and sALS samples which showed a down-regulation in miR-b2122 also showed an increase in FUS/TLS protein expression. Overall, we have identified a novel miRNA that is down-regulated in sALS that appears to be a central regulator of disease-related RNA-binding proteins, and thus its dysregulation likely contributes to TDP-43, FUS/TLS and RGNEF pathogenesis in sALS.

REFERENCE [8] · ID: 31060816

ID: 31060816
Title: Rare, low-frequency and common coding variants of ARHGEF28 gene and their association with sporadic amyotrophic lateral sclerosis.
Abstract: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Over 90% of cases are sporadic (sALS) and 5%-10% are familial (fALS). So far, more than 20 genes/loci have been linked to ALS. C9orf72, SOD1, TARDBP, and FUS are noted as the most common ALS genes; however, mutations of these genes explain <10% of sALS cases. Recently, Rho guanine nucleotide exchange factor, encoded by ARHGEF28, has been linked to the ALS pathogenesis, possibly by binding low-molecular-weight neurofilament mRNA and affects its stability. However, a systemic screening of ARHGEF28 mutations in ALS is lacking. In this study, we sequenced the entire coding sequence of ARHGEF28 in a Chinese cohort of 399 sporadic ALS and 327 elderly controls. A total of 73 coding variants were identified, including 26 synonymous and 47 nonsynonymous. Among the nonsynonymous variants, 33 were rare (minor allele frequency [MAF]<0.01), in which 18 were only identified in cases and 12 were only in controls. Three loss-of-function mutations were identified, including 2 truncations (p.Arg231Ter and p.Ser561Ter) and a frameshift deletion (p.Lys1070fs) in 2 cases and 1 control subject. The frequency of total and case-only rare variants was 7.5% (30/399) and 5.0% (20/399), respectively, in the patients. SKAT-O test suggested that the novel coding variants were marginally enriched in the cases (p = 0.049). Single-variant analysis suggested that the p.Asn1046Ser variant had a higher frequency in cases (8/399, 0.02) than in controls (1/327, 0.003) (OR: 6.67, 95% CI: 0.83-53.61; p = 0.046). By contrast, none of the low-frequency (MAF: 0.01-0.05) or common (MAF > 0.05) variants was associated with ALS (p > 0.05). Among all patients, 9 (2.3%) carried rare variants predicted to be deleterious, and the age at onset of these carriers (45.6 ± 10.9 years) was marginally younger than noncarriers (51.9 ± 10.7 years) (p = 0.11). Our results supported a possible genetic contribution of rare but not low-frequency and common coding variants to ALS. These data may have implications in the mechanisms and genetic counseling of the disease.

REFERENCE [5] · ID: 31882736

ID: 31882736
Title: TDP-43 aggregation inside micronuclei reveals a potential mechanism for protein inclusion formation in ALS.
Abstract: Amyotrophic lateral sclerosis (ALS) is a devastating progressive neurodegenerative disease with no known etiology. The formation of pathological protein inclusions, including RNA-binding proteins such as TDP-43 and rho guanine nucleotide exchange factor (RGNEF) are a hallmark of ALS. Despite intensive research, the mechanisms behind protein aggregate formation in ALS remains unclear. We have investigated the role of metabolic stress in protein aggregate formation analyzing how it is relevant to the co-aggregation observed between RGNEF and TDP-43 in motor neurons of ALS patients. Metabolic stress was able to induce formation of micronuclei, small nuclear fragments, in cultured cells. Notably, we observed the formation TDP-43 protein inclusions within micronuclei that co-aggregate with RGNEF and can be released to the cytoplasm. We observed that the leucine-rich domain of RGNEF is critical for its interaction with TDP-43 and localization in micronuclei. Finally, we described that micronuclei-like structures can be found in brain and spinal cord of ALS patients. This work is the first description of protein inclusion formation within micronuclei which also is linked with a neurodegenerative disease. The formation of TDP-43 inclusions within micronuclei induced by metabolic stress is a novel mechanism of protein aggregate formation which may have broad relevance for ALS and other neurodegenerative diseases.

REFERENCE [9] · ID: 38460116

ID: 38460116
Title: Genetic associations with dementia-related proteinopathy: Application of item response theory.
Abstract: Although dementia-related proteinopathy has a strong negative impact on public health, and is highly heritable, understanding of the related genetic architecture is incomplete. We applied multidimensional generalized partial credit modeling (GPCM) to test genetic associations with dementia-related proteinopathies. Data were analyzed to identify candidate single nucleotide variants for the following proteinopathies: Aβ, tau, α-synuclein, and TDP-43. Final included data comprised 966 participants with neuropathologic and WGS data. Three continuous latent outcomes were constructed, corresponding to TDP-43-, Aβ/Tau-, and α-synuclein-related neuropathology endophenotype scores. This approach helped validate known genotype/phenotype associations: for example, TMEM106B and GRN were risk alleles for TDP-43 pathology; and GBA for α-synuclein/Lewy bodies. Novel suggestive proteinopathy-linked alleles were also discovered, including several (SDHAF1, TMEM68, and ARHGEF28) with colocalization analyses and/or high degrees of biologic credibility. A novel methodology using GPCM enabled insights into gene candidates for driving misfolded proteinopathies. Latent factor scores for proteinopathies were estimated using a generalized partial credit model. The three latent continuous scores corresponded well with proteinopathy severity. Novel genes associated with proteinopathies were identified. Several genes had high degrees of biologic credibility for dementia risk factors.

REFERENCE [1] · ID: 38739752

ID: 38739752
Title: Mitigation of TDP-43 toxic phenotype by an RGNEF fragment in amyotrophic lateral sclerosis models.
Abstract: Aggregation of the RNA-binding protein TAR DNA binding protein (TDP-43) is a hallmark of TDP-proteinopathies including amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). As TDP-43 aggregation and dysregulation are causative of neuronal death, there is a special interest in targeting this protein as a therapeutic approach. Previously, we found that TDP-43 extensively co-aggregated with the dual function protein GEF (guanine exchange factor) and RNA-binding protein rho guanine nucleotide exchange factor (RGNEF) in ALS patients. Here, we show that an N-terminal fragment of RGNEF (NF242) interacts directly with the RNA recognition motifs of TDP-43 competing with RNA and that the IPT/TIG domain of NF242 is essential for this interaction. Genetic expression of NF242 in a fruit fly ALS model overexpressing TDP-43 suppressed the neuropathological phenotype increasing lifespan, abolishing motor defects and preventing neurodegeneration. Intracerebroventricular injections of AAV9/NF242 in a severe TDP-43 murine model (rNLS8) improved lifespan and motor phenotype, and decreased neuroinflammation markers. Our results demonstrate an innovative way to target TDP-43 proteinopathies using a protein fragment with a strong affinity for TDP-43 aggregates and a mechanism that includes competition with RNA sequestration, suggesting a promising therapeutic strategy for TDP-43 proteinopathies such as ALS and FTD.

REFERENCE [2] · ID: 39360635

ID: 39360635
Title: Axon guidance genes are regulated by TDP-43 and RGNEF through long-intron removal.
Abstract: Rho guanine nucleotide exchange factor (RGNEF) is a guanine nucleotide exchange factor (GEF) mainly involved in regulating the activity of Rho-family GTPases. It is a bi-functional protein, acting both as a guanine exchange factor and as an RNA-binding protein. RGNEF is known to act as a destabilizing factor of neurofilament light chain RNA (NEFL) and it could potentially contribute to their sequestration in nuclear cytoplasmic inclusions. Most importantly, RGNEF inclusions in the spinal motor neurons of ALS patients have been shown to co-localize with inclusions of TDP-43, the major well-known RNA-binding protein aggregating in the brain and spinal cord of human patients. Therefore, it can be hypothesized that loss-of-function of both proteins following aggregation may contribute to motor neuron death/survival in ALS patients. To further characterize their relationship, we have compared the transcriptomic profiles of neuronal cells depleted of TDP-43 and RGNEF and show that these two factors predominantly act in an antagonistic manner when regulating the expression of axon guidance genes. From a mechanistic point of view, our experiments show that the effect of these genes on the processivity of long introns can explain their mode of action. Taken together, our results show that loss-of-function of factors co-aggregating with TDP-43 can potentially affect the expression of commonly regulated neuronal genes in a very significant manner, potentially acting as disease modifiers. This finding further highlights that neurodegenerative processes at the RNA level are the result of combinatorial interactions between different RNA-binding factors that can be co-aggregated in neuronal cells. A deeper understanding of these complex scenarios may lead to a better understanding of pathogenic mechanisms occurring in patients, where more than one specific protein may be aggregating in their neurons.

REFERENCE [10] · ID: 42266427

ID: 42266427
Title: Genetic analysis of limbic-predominant age-related TDP-43 encephalopathy neuropathologic change in a population-based cohort of the oldest old.
Abstract: Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change is a common proteinopathy in the oldest old that is associated with cognitive decline. Although the genetic basis of limbic-predominant age-related TDP-43 encephalopathy neuropathologic change remains largely unknown, TMEM106B, GRN and APOE loci are frequently implicated. Here, we examined nine previously reported limbic-predominant age-related TDP-43 encephalopathy neuropathologic change risk loci (ARHGEF28, APOE, GRN, KAZN, LHX1, TPCN1, TMEM106B, UNC13C and WWOX) in a population cohort of 262 individuals from the Vantaa 85 + study. We also tested whether Alzheimer's disease polygenic risk score without APOE was associated with limbic-predominant age-related TDP-43 encephalopathy neuropathologic change. Using ordinal logistic regression models, GRN rs5848 (odds ratio = 2.45, 95% confidence interval: 1.71-3.52, adjusted P = 5.75 × 10-6), APOE ε4 dose (odds ratio = 1.73, 95% confidence interval: 1.07-2.80, adjusted P = 0.030) and KAZN rs72643142 (odds ratio = 2.38, 95% confidence interval: 1.38-4.11, adjusted P = 0.0048) were associated with higher limbic-predominant age-related TDP-43 encephalopathy neuropathologic change stage. Additionally, Alzheimer's disease polygenic risk score without APOE was associated with limbic-predominant age-related TDP-43 encephalopathy neuropathologic change after adjusting for age, sex, Alzheimer's disease pathology and APOE ε4 dose (odds ratio = 1.36, 95% confidence interval: 1.06-1.75, adjusted P = 0.027). Our findings contribute to the understanding of limbic-predominant age-related TDP-43 encephalopathy neuropathologic change genetics and suggest shared biological processes between limbic-predominant age-related TDP-43 encephalopathy neuropathologic change and Alzheimer's disease.

REFERENCE [11] · ID: 42418088

ID: 42418088
Title: Impact of R0/R1 Margin Status on Overall Survival in Node-Positive Resected Pancreatic Ductal Adenocarcinoma: Meta-Analysis.
Abstract: Microscopic residual disease (R1)and node-positive disease in resected pancreatic ductal adenocarcinoma (PDAC) are associated with worse survival. Some have suggested that obtaining an R0 resection is no longer relevant when patients have node-positive disease. A meta-analysis confirming this hypothesis is lacking. A systematic review including studies with at least 50 patients with resected node-positive PDAC was conducted in PubMed, Embase, and Web of Science (inception to March 2025). Patients with node-negative disease were excluded. Primary outcome was overall survival (OS), comparing R0N+ and R1N+ resections. Hazard ratios (HR) with 95% confidence intervals (CI) represented outcome measures. Subgroup analysis included: application of the Royal College of Pathology protocol (RCP: standardized margin inking, axial slicing, and "1-mm rule") and receipt of neoadjuvant/adjuvant therapy. Overall, 19,206 patients with resected node-positive PDAC from 16 retrospective studies were included. Most patients underwent upfront resection (96.3%), primarily pancreatoduodenectomy (84.2%). The overall R0N+ rate was 61.1%, differing significantly by application of RCP (yes [R1 = tumor within 1 mm of margin]: nine studies, 52.1%; unclear: four studies, 80.5%; no [R1 = tumor at margin ink only]: three studies, 61.5%; p = 0.0019). Overall, R1 negatively impacted OS (HR: 1.38; 95% CI: 1.21-1.59). RCP-only subgroup analysis confirmed worse OS in R1N+ resections (HR 1.25; 95% CI 1.10-1.42). Subgroup analysis by neoadjuvant/adjuvant therapy was not feasible. Among patients with node-positive PDAC treated with upfront surgery, R1 resection remains associated with worse survival. In these patients, R0 resection should not be dismissed as a viable treatment goal until stronger RCP-compliant evidence emerges.

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If RGNEF fails agitate and regulate TDP-43 at the RGNEF NF242 Terminal, does this cause TDP-43 propteinopathy?

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