An ALS-associated TARDBP mutation drives cryptic exon inclusion and RNA dysregulation

TAR DNA-binding protein 43 (TDP-43) proteinopathy is a defining pathological feature of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD), yet the downstream molecular events linking TDP-43 dysfunction to neurodegeneration remain incompletely understood. Here, we model TDP-43 proteinopathy by introducing the ALS/FTD-associated TARDBP K181E mutation into human induced pluripotent stem cells and differentiating them into three-dimensional forebrain organoids. Organoids carrying the K181E mutation exhibit spontaneous TDP-43 hyperphosphorylation, cytoplasmic p-TDP43 accumulation, RNA dysregulation, pro-inflammatory signaling, and activation of apoptotic pathways without TDP-43 overexpression or external stress. Single-cell transcriptomics and enhanced crosslinking immunoprecipitation reveal that the K181E mutation alters TDP-43 RNA-binding specificity, causing widespread RNA mis-splicing including cryptic exon inclusion. Among affected targets, we identify cryptic exon inclusion in the transcription factor PRDM2. PRDM2 cryptic exon-derived peptide immunoreactivity was detected in ALS spinal motor neurons and associated with p-TDP-43 pathology. These findings identify PRDM2 mis-splicing as a candidate downstream event linking TDP-43 dysfunction relevant to ALS and FTD. One sentence summaryHuman brain organoids reveal how mutant TDP-43 disrupts RNA processing and causes neuronal stress.