Abstract
INTRODUCTION:Neuronal ceroid lipofuscinosis (CLN) is a group of neurodegenerative diseases generally with onset in childhood, characterized by intracellular accumulation of autofluorescent storage material. In the last decade, 14 forms of CLN have been identified with mutations in 13 genes (CLN1-CLN14), in CLN9 the gene has not yet been identified. Patients with mutations in the CLN6 gene located on chromosome 15q21-23 present three types of clinical variants: late childhood CLN6, presenting between 18 months to 8 years, the Kufs type A and Kufs type B variants of onset in adolescents and adults.
CASE REPORT:We present the case of a male patient with generalized epilepsy of onset in adulthood, who was admitted for evaluation the first time, with brain magnetic resonance imaging with mild cortical atrophy; he started at age 14 with slowly progressive cognitive deficit, without visual compromise; with subsequent genetic identification of a pathogenic variant in the CLN6 gene, jointly presenting the clinical variant Kufs type A of neuronal ceroid lipofuscinosis 6 (CLN6).
DISCUSSION:This is the first report of CLN6 with Kufs type A clinical variant in Colombia. With the advent of genetic techniques, specific diagnoses of CLN6 can be made, based on the clinical and suspected diagnoses; using non-invasive methods.
References
Gao H, Rose-Mary N , Espinola J, Cotman S, Srinidhi L, Antonellis K, et al. Mutations in a novel CLN6-encoded transmembrane protein cause variant neuronal ceroid lipofuscinosis in man and mouse. Am J Hum Genet. 2002;70(2):324-35. doi: 10.1086/338190.
Chin J, Behnam B, Davids M, Sharma P, Zein W Wang C, et al. Novel mutations in CLN6 cause late-infantile neuronal ceroid lipofuscinosis without visual impairment in two unrelated patients . Mol Genet Metab . 2019;126(2):188-95. doi: 10.1016/j.ymgme.2018.12.001.
Mukherjee A, Appu A, Sadhukhan T, Sadhukhan T, Casey S, Mondal A, et al. Emerging new roles of the lysosome and neuronal ceroid lipofuscinoses . Mol Neurodegener . 2019 Jan 16;14(1):4. doi: 10.1186/s13024-018-0300-6.
Schulz A, Kohlschutter A, Mink J, Simonati A, Williams R. NCL diseases-clinical perspectives. Biochim Biophys Acta 2013;1832(11): 1801-6. doi: 10.1016/j.bbadis.2013.04.008.
Mole SE, Cotman SL. Genetics of the neuronal ceroid lipofus-cinoses (Batten disease). Biochim Biophys Acta 2015; 1852(10 Pt B): 2237-41. doi: 10.1016/j.bbadis.2015.05.011.
Radke J, Stenzel W, Goebel HH. Human NCL neuropathology. Biochim Biophys Acta 2015;1852(10 Pt B): 2262-6. doi: 10.1016/j.bbadis.2015.05.007.
Kohlschutter A, Schulz A, Bartsch U, Storch S. Current and emerging treatment strategies for neuronal ceroid lipofuscinoses. CNS Drugs . 2019;33(4):315-25. doi: 10.1007/s40263-019-00620-8.
Mole S, Williams R, Goebel H. Correlations between genotype, ultrastructural morphology and clinical phenotype in the neuronal ceroid lipofuscinoses. Neurogenetic. 2005;6(3):107-26. doi: 10.1007/s10048-005-0218-3.
Mole S, Anderson G, Band H, Berkovic S, Cooper J, Kleine Sophia-Martha, et al. Clinical challenges and future therapeutic approaches for neuronal ceroid lipofuscinosis. Lancet Neurol. 2019;18(1):107-16. doi: 10.1016/S1474-4422(18)30368-5.
Berkovic SF, Staropoli JF, Carpenter S, Oliver K, Kmoch S, Anderson G, et al. Diagnosis and misdiagnosis of adult neuronal ceroid lipofuscinosis (Kufs disease). Neurology 2016; 87(6): 579-84. doi: 10.1212/WNL.0000000000002943.
Das AK, Becerra CHR, Yi W, Lu J-Y, Siakotos AN, Wisniewski KE, et al. Molecular genetics of palmitoyl-protein thioesterase deficiency in the U.S. J Clin Invest.1998;102(2):361-70. doi: 10.1172/JCI3112
Arsov T, Smith KR, Damiano J, Franceschetti S, Canafoglia L, Catherine J, et al. Kufs disease, the major adult form of neuronal ceroid lipofuscinosis, caused by mutations in CLN6. Am J Hum Genet 2011;88(5):566-73. doi: 10.1016/j.ajhg.2011.04.004
Canafoglia L, Gilioli I, Invernizzi F, Sofia V, Fugnanesi V, Morbin M, et al. Electroclinical spectrum of the neuronal ceroid lipofuscinoses associated with CLN6 mutations. Neurology 2015;85(4):316-24. doi: 10.1212/WNL.0000000000001784
Cadieux-Dion M, Andermann E, Lachance-Touchette P, Ansorge O, Meloche C, Barnabpe A, et al. Recurrent mutations in DNAJC5 cause autosomal dominant Kufs disease. Clin Genet 2013;83(6):571-5. doi: 10.1111/cge.12020
Velinov M, Dolzhanskaya N, Gonzalez M, Powell E, Konidari I, Hulme W, et al. Mutations in the gene DNAJC5 cause autosomal dominant Kufs disease in a proportion of cases: study of the Parry family and 8 other families. PLoS One 2012;7(1):e29729. doi: 10.1371/journal.pone.0029729
Smith KR, Dahl HH, Canafoglia L, Anderman E, Damiano J, Morbin M, et al. Cathepsin F mutations cause type B Kufs disease, an adult-onset neuronal ceroid lipofuscinosis. Hum Mol Genet 2013;22(7):1417-23. doi: 10.1093/hmg/dds558
Di Fabio R, Moro F, Pestillo L, Meschini M, Pezzini F, Doccini S, et al. Pseudo-dominant inheritance of a novel CTSF mutation associated with type B Kufs disease. Neurology 2014;83(19):1769-70. doi: 10.1212/WNL.0000000000000953
Sharp J, Wheeler R, Parker A, Gardiner RM, Williams R, Mole S. Spectrum of CLN6 mutations in variant late infantile neuronal ceroid lipofuscinosis. Hum Mutat. 2003 22(1):35-42. doi: 10.1002/humu.10227
Elleder, M., Franc, J., Kraus, J., Nevšímalová, S., Sixtova, K., Zeman, J. Neuronal ceroid lipofuscinosis in the Czech Republic: Analysis of 57 cases Report of the 'Prague NCL group'. Eur J Paediatr Neurol. 1997;1(4),109-14. doi: 10.1016/s1090-3798(97)80041-4.
Das AK, Lu JY, Hofmann SL. Biochemical analysis of mutations in palmitoyl-protein thioesterase causing infantile and late-onset forms of neuronal ceroid lipofuscinosis. Hum Mol Genet. 2001;10(13):1431-9. doi: 10.1093/hmg/10.13.1431.
Salonen T, Heinonen-Kopra O, Vesa J, Jalanko. A Neuronal traficking of palmitoyl protein thioesterase provides an excellent model to study the effects of different mutations which cause infantile neuronal ceroid lipofuscinocis. Mol Cell Neurosci.2001;18(2):131-40. doi: 10.1006/mcne.2001.1010.

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