Amyotrophic lateral sclerosis (ALS) remains a devastating neurodegenerative disorder with poorly understood pathogenesis. We conducted Mendelian randomization (MR) analyses integrating cardiovascular factors, gut microbiota (GM) composition, and immune cell phenotypes with transcriptomic profiling to establish causal relationships with ALS susceptibility. MR revealed causal associations between elevated low-density lipoprotein cholesterol, apolipoprotein B, systolic blood pressure, and increased ALS risk. GM analysis identified protective Alistipes species effects and detrimental Bacteroides associations. Multiple immune cell subsets demonstrated significant disease associations, particularly CD3 + T cell populations and CD62L+ monocytes. Colocalization studies identified 53 genes with shared genetic architecture, enabling differential expression analysis across datasets. Predictive modeling developed a five-gene biomarker panel achieving 96% training accuracy and 93% external validation. Quantitative PCR confirmed differential expression patterns for biomarkers in patient cohorts. This multi-omics investigation establishes ALS as a complex disorder with actionable cardiovascular and microbiome therapeutic targets, providing applications for risk stratification and prevention.

Hirschsprung’s disease (HSCR) is a congenital disorder characterized by intestinal aganglionosis. Despite evidence linking gut microbiota and immune