• Ability to provide written informed consent.

• Adults \>18 years of age with a diagnosis of symptomatic ALS as determined by an ALS neurologist, and meets either the revised El Escorial Criteria (clinically possible, probable, probable lab-supported, or definite) or the Gold Coast Criteria.

• Available or pending CLIA certified ALS genetic panel report.

• Less than or equal to 24-months since onset of weakness attributed to ALS.

• Vital capacity (VC) of \> 65% predicted value for gender, height and age at screening.

• Clinically unremarkable Complete Blood Counts, including but not limited to Hemoglobin ≥ 9 g/dL, Platelets ≥ 150 x 109 cells/L.

• No clinically significant abnormalities in the Comprehensive Metabolic Panel per site/sub-investigator's judgment, including but not limited to:

∙ Serum alanine aminotransferase or aspartate aminotransferase \< 3× upper limit of normal, or serum total bilirubin \<1.5× upper limit of normal

‣ Estimated GFR (eGFR) of \> 30 mL/min/1.73m2

‣ Other clinically significant electrolyte and metabolic abnormalities

• Ability and willingness to complete all study procedures per the Site Investigator's clinical assessment.

• Negative pregnancy test within 7 days prior to first dose for women of child-bearing potential (WOCB), defined as a sexually mature woman who has not undergone a hysterectomy or who has not been naturally postmenopausal for at least 24 consecutive months (i.e., who has had menses any time in the preceding 24 consecutive months).

⁃ Individuals enrolling in the C9orf72 cohort of the trial must have CLIA certified ALS gene panel demonstrating \>31 repeats of C9orf72 hexanucleotide repeat expansion, deemed pathologic.