Velvio therapeutics aim at CNS reconstitution to renew stem cell populations in bone marrow, muscle and CNS, to reactivate normal cell functions (anti-senescence), to reactivate autophagy and normalize immune communication, to enhance stem cell friendly milieu (extracellular matrix), and to reverse scarring and fibrosis. Velvio has developed selective biomarkers to monitor regained functionalities and to bridge the time gap between therapy and recovery - these include MRI imaging, inflammatory cyto- and chemo/kines, and stem cell markers in peripheral blood. ALS (Amyotrophic Lateral Sclerosis) is a grave disease with still limited treatment options and a median survival of approx. 16 to 24 months after diagnosis. Long-time pulsed G-CSF - BM stem cell mobilization is safe 1 and highly effective 2 in ALS: Clinical pilot data in N=36 ALS patients revealed significant slowing of disease progression and significantly increased survival. Disease modelling and a biomarker panel identified and validated 15 long-time survivors with median OS of 3.8 yrs from start of treatment and a very limited disease progression of -0,12 ALS-FRS-R loss / month with G-CSF therapy in contrast to -0,9 ALS-FRS-R loss / month with best standard care. Among many other modes of action for G-CSF, it was nicely shown 3 that bone marrow cells drive central nervous system regeneration, here after radiation injury. With this impressive therapeutic potential in mind, we want to initiate a prospective pivotal adaptive clinical trial of G-CSF to achieve regulatory approval for ‘early’ ALS patients. The architecture of such a trial and the related expenditure will be discussed in the light of the high unmet medical need and the opportunity of using a ‘repurposed’ therapeutic compound employed over decades in hemato-oncology and intensive care medicine. Velvio believes that healthcare investors and regulatory authorities should not miss the opportunity for such a shortcut to establish a very efficacious new treatment option for desperate ALS patients.