Summary:
Neuronal ceroid lipofuscinoses represent a group of diseases which has until quite recently resis-
ted definite elucidation of the underlying defect(s) on the molecular level. The common feature of
all the NCLs is a serious and progressive neurological disorder, accompanied, with only few
exceptions, by retinal degeneration. Visceral symptoms, despite the presence of the storage pro-
cess, are absent, or minimal. There are many clinical variants of the disease process, among
which a set of standard, historical phenotypes exists found to be linked to specific genotypes. The
disorder is inherited and transmitted as an autosomal recessive trait. At the cellular level, it is
featured by lyzosomal storage of autofluorescent hydrophobic material, the substantial part of
which consists of hydrophobic proteins and esterified dolichol. The dominant protein is the
subunit c of mitochondria ATP synthase. In one NCL type (NCL1) the dominant proteins are
saposins A and D. Ultrastructural appearance is membranous with several relatively specific
patterns with some tendency to condensation or, namely in NCL3 to vacuolar distension. Amor-
phous appearance is associated with NCL1. The impact of the disease process on the cell biology
differs substantially depending on the cell type. The brain neurons are most seriously affected
and degenerate, whereas other cell types mostly survive without detectable deterioration. Patho-
genesis at the molecular level is now being elucidated using the modern molecular biology techni-
ques, which have already enabled unravelling of a set of genes controlling majority of the
standard historical phenotypes. The original infantile form of NCL (NCL1) is now defined as
palmitoyl protein thioesterase deficiency (gen at the 1p32 locus), the late infantile form (NCL2) as
pepstatin resistent proteinase deficiency (gen at the 11p15.5 locus) and the original juvenile form
(NCL3) as a defect of the specific gene (locus 16p11.2-12.3), the product of which, the NCL3 prote-
in, still lacks functional characterization. Two gene loci have been identified in the so-called early
juvenile, or variant late infantile NCL. One of them is in the 13q21 locus (NCL5 or Finnish variant
late infantile form), the second is in the 15q21-23 one (NCL6). Kufs form remains the least defined
form of NCL. Recently two novel NCL variants were described with specific loci. Thanks to
introduction of molecular genetic based diagnosis it was possible to recognize, besides the standard phenotype, existence of further phenotypic variants. The phenotype based scheme of NCL
has thus been definitely substituted by classification based on genotype and biochemistry.
Key words:
neuronal ceroid lipofuscinosis - lysosomal storage - molecular pathogenesis - classifica-
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