Integrated Multi-omics Prioritizes Ribosomal-targeting Omacetaxine Mepesuccinate for Optic Neuritis Therapy

Background: Optic neuritis (ON), an acute demyelinating disorder often preceding multiple sclerosis, lacks therapies preventing neurodegeneration despite corticosteroid use. Methods: We combined GWAS (FinnGen cohort, finn-b-H7_OPTNEURITIS), immune-specific eQTL analysis (CAGE.sparse microglia/astrocytes), and network pharmacology. SMR-HEIDI filtering (p_HEIDI>0.05; FDR<0.05) validated causal genes. Results: 46 ON-associated genes identified, with HLA-DRB1 as top risk locus (OR=3.297, FDR<0.01).Functional enrichment revealed antigen presentation dysregulation (GO:0002483, FDR=0.0025) and phagosome activation (hsa04145, FDR=0.0468), confirming microglial-astrocytic pathology. Omacetaxine mepesuccinate prioritized as sole repurposing candidate (FDR=0.0467) targeting ribosomal proteins RPL3/RPL2-mechanistically linked to glial protein synthesis suppression in demyelination. Conclusions: This first multi-omics analysis of ON bridges HLA-mediated autoimmunity with repurposed ribosomal-targeted therapy, proposing omacetaxine for neuroprotection.