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O'Neal M, Noher de Halac I, Aylward SC, Yildiz V, Zapanta B, Abreu N, de Los Reyes E. Natural History of Neuronal Ceroid Lipofuscinosis Type 6, Late Infantile Disease. Pediatr Neurol 2024; 154:51-57. [PMID: 38531163 DOI: 10.1016/j.pediatrneurol.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/07/2023] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Mutations in the CLN6 gene cause late infantile neuronal ceroid lipofuscinosis, a neurodegenerative lysosomal storage disease of childhood onset. Clinically, individuals present with progressive motor and cognitive regression, ataxia, and early death. The aim of this study is to establish natural history data of individuals with classic, late-infantile-onset (age less than five years) CLN6 disease. METHODS We analyzed the natural history of 25 patients with late-infantile-onset CLN6, utilizing the Hamburg motor-language scale to measure disease progression. The key outcomes were CLN6 disease progression, assessed by rate of decline in motor and language clinical domain summary scores (0 to 6 total points); onset and type of first symptom; onset of first seizure; and time from first symptom to complete loss of function. RESULTS Median age of total motor and language onset of decline was 42 months (interquartile range 36 to 48). The estimated rate of decline in total score was at a slope of -1.20 (S.D. 0.30) per year, after the start of decline. Complete loss of both motor and language function was found to be, on average, 88.1 months (S.D. 13.5). CONCLUSIONS To our knowledge, this is the largest international study that monitors the longitudinal natural history and progression of CLN6 disease. These data may serve as a template for future interventional trials targeted to slow the progression of this devastating disease.
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Affiliation(s)
- Matthew O'Neal
- Department of Pediatric Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Shawn C Aylward
- Department of Pediatric Neurology, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio
| | - Vedat Yildiz
- Biostatistics Resource at Nationwide Children's Hospital (BRANCH), Nationwide Children's Hospital, Columbus, Ohio; Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Bianca Zapanta
- Division of Molecular and Human Genetics, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Nicolas Abreu
- Department of Neurology, NYU Grossman School of Medicine, New York, New York
| | - Emily de Los Reyes
- Department of Pediatric Neurology, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio.
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Wang XQ, Chen CB, Zhao WJ, Fu GB, Zhai Y. Rare adult neuronal ceroid lipofuscinosis associated with CLN6 gene mutations: A case report. World J Clin Cases 2023; 11:3533-3541. [PMID: 37383919 PMCID: PMC10294197 DOI: 10.12998/wjcc.v11.i15.3533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/06/2023] [Accepted: 04/13/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Adult neuronal ceroid lipofuscinosis (ANCL) can be caused by compound heterozygous recessive mutations in CLN6. The main clinical features of the disease are neurodegeneration, progressive motor dysfunction, seizures, cognitive decline, ataxia, vision loss and premature death.
CASE SUMMARY A 37-year-old female presented to our clinic with a 3-year history of limb weakness and gradually experiencing unstable walking. The patient was diagnosed with CLN6 type ANCL after the identification of mutations in the CLN6 gene. The patient was treated with antiepileptic drugs. The patient is under ongoing follow-up. Unfortunately, the patient’s condition has deteriorated, and she is currently unable to care for herself.
CONCLUSION There is presently no effective treatment for ANCL. However, early diagnosis and symptomatic treatment are possible.
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Affiliation(s)
- Xue-Qiang Wang
- Department of Neurology, Sanya People’s Hospital, West China (Sanya) Hospital, Sichuan University, Sanya 572000, Hainan Province, China
| | - Chuan-Bi Chen
- Department of Pediatrics, Sanya Women and Children’s Hospital Managed by Shanghai Children's Medical Center, Sanya 572000, Hainan Province, China
| | - Wen-Jie Zhao
- Department of Neurology, The First Affiliated Hospital of Hainan Medical College, Haikou 570100, Hainan Province, China
| | - Guang-Bin Fu
- Department of Neurology, Hainan Western Central Hospital, Danzhou 571799, Hainan Province, China
| | - Yu Zhai
- Department of Neurology, Hainan Western Central Hospital, Danzhou 571799, Hainan Province, China
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Refeat MM, Naggar WE, Saied MME, Kilany A. Whole exome screening of neurodevelopmental regression disorders in a cohort of Egyptian patients. Neurogenetics 2023; 24:17-28. [PMID: 36435927 PMCID: PMC9823068 DOI: 10.1007/s10048-022-00703-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/05/2022] [Indexed: 11/28/2022]
Abstract
Developmental regression describes a child who begins to lose his previously acquired milestones skills after he has reached a certain developmental stage and though affects his childhood development. It is associated with neurodegenerative diseases including leukodystrophy and neuronal ceroid lipofuscinosis diseases (NCLs), one of the most frequent childhood-onset neurodegenerative disorders. The current study focused on screening causative genes of developmental regression diseases comprising neurodegenerative disorders in Egyptian patients using next-generation sequencing (NGS)-based analyses as well as developing checklist to support clinicians who are not familiar with these diseases. A total of 763 Egyptian children (1 to 11 years), mainly diagnosed with developmental regression, seizures, or visual impairment, were studied using whole exome sequencing (WES). Among 763 Egyptian children, 726 cases were early clinically and molecularly diagnosed, including 482 cases that had pediatric stroke, congenital infection, and hepatic encephalopathy; meanwhile, 192 had clearly dysmorphic features, 31 showed central nervous system (CNS) malformation, 17 were diagnosed by leukodystrophy, 2 had ataxia telangiectasia, and 2 were diagnosed with tuberous sclerosis. The remained 37 out of 763 candidates were suspected with NCLs symptoms; however, 28 were confirmed to be NCLs patients, 1 was Kaya-Barakat-Masson syndrome, 1 was diagnosed as infantile neuroaxonal dystrophy, and 7 cases required further molecular diagnosis. This study provided an NGS-based approach of the genetic causes of developmental regression and neurodegenerative diseases as it comprised different variants and de novo mutations with complex phenotypes of these diseases which in turn help in early diagnoses and counseling for affected families.
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Affiliation(s)
- Miral M. Refeat
- Department of Medical Molecular Genetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Walaa El Naggar
- Faculty of Medicine, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Mostafa M. El Saied
- Department of Research On Children With Special Needs, Medical Research Institute, National Research Centre, Cairo, Egypt
| | - Ayman Kilany
- Department of Research On Children With Special Needs, Medical Research Institute, National Research Centre, Cairo, Egypt
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Guelbert G, Venier AC, Cismondi IA, Becerra A, Vazquez JC, Fernández EA, De Paul AL, Guelbert N, Noher I, Pesaola F. Neuronal ceroid lipofuscinosis in the South American-Caribbean region: An epidemiological overview. Front Neurol 2022; 13:920421. [PMID: 36034292 PMCID: PMC9412946 DOI: 10.3389/fneur.2022.920421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Neuronal ceroid lipofuscinoses (NCLs) comprise 13 hereditary neurodegenerative pathologies of very low frequency that affect individuals of all ages around the world. All NCLs share a set of symptoms that are similar to other diseases. The exhaustive collection of data from diverse sources (clinical, genetic, neurology, ophthalmology, etc.) would allow being able in the future to define this group with greater precision for a more efficient diagnostic and therapeutic approach. Despite the large amount of information worldwide, a detailed study of the characteristics of the NCLs in South America and the Caribbean region (SA&C) has not yet been done. Here, we aim to present and analyse the multidisciplinary evidence from all the SA&C with qualitative weighting and biostatistical evaluation of the casuistry. Seventy-one publications from seven countries were reviewed, and data from 261 individuals (including 44 individuals from the Cordoba cohort) were collected. Each NCL disease, as well as phenotypical and genetic data were described and discussed in the whole group. The CLN2, CLN6, and CLN3 disorders are the most frequent in the region. Eighty-seven percent of the individuals were 10 years old or less at the onset of symptoms. Seizures were the most common symptom, both at onset (51%) and throughout the disease course, followed by language (16%), motor (15%), and visual impairments (11%). Although symptoms were similar in all NCLs, some chronological differences could be observed. Sixty DNA variants were described, ranging from single nucleotide variants to large chromosomal deletions. The diagnostic odyssey was probably substantially decreased after medical education activities promoted by the pharmaceutical industry and parent organizations in some SA&C countries. There is a statistical deviation in the data probably due to the approval of the enzyme replacement therapy for CLN2 disease, which has led to a greater interest among the medical community for the early description of this pathology. As a general conclusion, it became clear in this work that the combined bibliographical/retrospective evaluation approach allowed a general overview of the multidisciplinary components and the epidemiological tendencies of NCLs in the SA&C region.
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Affiliation(s)
- Guillermo Guelbert
- Programa de Investigación Translacional de Lipofuscinosis Ceroidea Neuronal (NCL Program), Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina
- Servicio de Enfermedades Metabólicas Hereditarias, Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina
| | - Ana Clara Venier
- Programa de Investigación Translacional de Lipofuscinosis Ceroidea Neuronal (NCL Program), Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
| | - Ines Adriana Cismondi
- Programa de Investigación Translacional de Lipofuscinosis Ceroidea Neuronal (NCL Program), Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina
- Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Adriana Becerra
- Programa de Investigación Translacional de Lipofuscinosis Ceroidea Neuronal (NCL Program), Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina
- Servicio de Enfermedades Metabólicas Hereditarias, Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina
| | - Juan Carlos Vazquez
- Centro de Investigación y Desarrollo en Inmunología y Enfermedades Infecciosas, Universidad Católica de Córdoba, Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
| | - Elmer Andrés Fernández
- Centro de Investigación y Desarrollo en Inmunología y Enfermedades Infecciosas, Universidad Católica de Córdoba, Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
| | - Ana Lucía De Paul
- Centro de Microscopía Electrónica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Córdoba, Argentina
| | - Norberto Guelbert
- Programa de Investigación Translacional de Lipofuscinosis Ceroidea Neuronal (NCL Program), Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina
- Servicio de Enfermedades Metabólicas Hereditarias, Clínica Universitaria “Reina Fabiola”, Córdoba, Argentina
| | - Ines Noher
- Programa de Investigación Translacional de Lipofuscinosis Ceroidea Neuronal (NCL Program), Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina
- Universidad Nacional de Córdoba, Córdoba, Argentina
- *Correspondence: Ines Noher ;
| | - Favio Pesaola
- Programa de Investigación Translacional de Lipofuscinosis Ceroidea Neuronal (NCL Program), Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina
- Department of Pediatrics, Washington University in Saint Louis School of Medicine, St. Louis, MO, United States
- Favio Pesaola ;
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