The
neuronal ceroid-lipofuscinoses, a group of progressive
neurodegenerative diseases in children and in adults, have now been recognized for some 90 years, and the childhood forms represent one of the largest groups of progressive
neurodegenerative diseases in children. Apart from a core group of major clinical forms-the infantile, the late-infantile, the juvenile, and the adult forms--numerous atypical patients afflicted with
neuronal ceroid-lipofuscinosis have now been identified, constituting 10% to 20% of all patients with
neuronal ceroid-lipofuscinosis. These "atypical" patients have, over the past 10 years, prompted the suggestion of 15 atypical variants or minor syndromes, many of them displaying the
lipopigments of classic curvilinear and fingerprint ultrastructure, but others displaying granular osmiophilic deposits. The former
lipopigments contain the subunit C of the mitochondrial
adenosine triphosphate synthase, but
lipopigments of the granular osmiophilic deposits including the classic infantile type Santavuori-Haltia, apparently do not, the latter type exhibiting
sphingolipid activator proteins. The nosologic significance of both the subunit C of the
adenosine triphosphate synthase and the
sphingolipid activator proteins, although they make up a considerable amount of the crude auto-fluorescent
lipopigments in
neuronal ceroid-lipofuscinosis, is still unclear. In spite of numerous pathogenetic principles invoked, such as a defect in lipid peroxidation, abnormalities of
dolichols and
dolichol phosphates, and defects in
protease inhibitors, precise pathogenesis and etiology of the
neuronal ceroid-lipofuscinoses remain elusive. Recent promising molecular genetic studies have, however, revealed the gene for
infantile neuronal ceroid-lipofuscinosis, CLN1, on chromosome 1p32; the gene for
juvenile neuronal ceroid-lipofuscinosis, CLN3, on chromosome 16p12.1-11.2; and the gene for a Finnish variant of
late-infantile neuronal ceroid-lipofuscinosis, CLN5, on chromosome 13q31-32. The genes for classic
late-infantile neuronal ceroid-lipofuscinosis, CLN2, and for
adult neuronal ceroid-lipofuscinosis, CLN4, have not been located, the former having been excluded from chromosomes 1 and 16. However, the gene products of the normal allelic forms have not yet been identified. A considerable number of sporadic animal models is now available, largely equivalent to the juvenile and infantile forms of
neuronal ceroid-lipofuscinosis, with those of the English setter and the South Hampshire sheep evaluated best. Recently, several mouse models have been added to this list of autosomal-recessive models, again the one most thoroughly studied being the
motor-neuron disease mouse. Progress has also been made in the prenatal diagnosis of
neuronal ceroid-lipofuscinosis: now the infantile, late-infantile, and juvenile forms can be recognized prenatally by a combined genetic and electron microscopic approach.