Farrell, K.; Humphrey, J.; Chang, T.; Zhao, Y.; Leung, Y. Y.; Kuksa, P. P.; Patil, V.; Lee, W.-P.; Kuzma, A. B.; Valladares, O.; Cantwell, L. B.; Wang, H.; Ravi, A.; De Sanctis, C.; Han, N.; Christie, T. D.; Whitney, K.; Krassner, M. M.; Walsh, H.; Kim, S.; Dangoor, D.; Iida, M. A.; Casella, A.; Walker, R. H.; Nirenberg, M. J.; Renton, A. E.; Babrowicz, B.; Coppola, G.; Raj, T.; Hoglinger, G. U.; Golbe, L. I.; Morris, H. R.; Hardy, J.; Revesz, T.; Warner, T. T.; Jaunmuktane, Z.; Mok, K. Y.; Rademakers, R.; Dickson, D. W.; Ross, O. A.; Wang, L.-S.; Goate, A.; Schellenberg, G.; Geschwind, D. H.;

Progressive supranuclear palsy (PSP) is a rare Parkinsonian disorder characterized by problems with movement, balance, cognition, and other symptoms. PSP differs from Alzheimer disease (AD) and other neurodegenerative diseases displaying abnormal forms of the microtubule-associated protein tau (tauopathies) by the presence of pathology not only in neurons, but also in astrocytes and oligodendrocytes. Genetic contributors may mediate these differences, however much of PSP genetics remains unexplained. Here we conducted the largest genome-wide association study (GWAS) of PSP to date including 2,779 cases (2,595 neuropathologically-confirmed) and 5,584 controls and identified six independent PSP susceptibility loci with genome-wide significant (p < 5e10-8) associations including five known (MAPT, MOBP, STX6, RUNX2, SLCO1A2) and one novel locus (C4A). Integration with cell type-specific epigenomic annotations revealed a unique oligodendrocytic signature that distinguishes PSP from AD and Parkinsons disease. Candidate PSP risk gene prioritization using expression quantitative trait loci (eQTLs) identified oligodendrocyte-specific effects on gene expression in half of the genome-wide significant loci, as well as an association with elevated C4A expression in bulk brain tissue which may be driven by increased C4A copy number in PSP cases. Finally, histological studies demonstrated abnormal tau aggregates in oligodendrocytes that colocalize with C4 (complement) deposition. Integrating GWAS with functional studies including epigenomic and eQTL analyses, we identified potential causal roles for variation in MOBP, STX6, RUNX2, SLCO1A2, and C4A in the pathogenesis of PSP.