In all samples or PD-L1 low ones, Akk positivity upregulated genes related to amyotrophic lateral sclerosis (such as PSMB5, PFN1, SRSF3, NDUFS5, MT-CO2, MT-CYB, MT-ND2, MT-ND5, MT-CO1, MT-ND4, MT-ND1, MT-CO3, MT-ND4L, MT-ATP8) and oxidative phosphorylation (NDUFS5, MT-CO2, MT-CYB, MT-ND2, MT-ND5, MT-CO1, MT-ND4, MT-ND1, MT-CO3, MT-ND4L, MT-ATP8), while downregulating pathways linked to Ribosome biogenesis in eukaryotes, Ribosome, and spliceosome (HNRNPC, DDX5, RNVU1-7, RNU1-1, RNVU1-18, RNU1-2, RNU6-2, RNU1-4, RNU6-9, RNU1-3, LOC124904613). The gene discussed is NDUFS5; the disease is amyotrophic lateral sclerosis.