ABSTRACT
OBJECTIVE: Physiological mechanical loading reduces inflammatory signalling in numerous cell types including articular chondrocytes however the mechanism responsible remains unclear. This study investigates the role of chondrocyte primary cilia and associated intraflagellar transport (IFT) in the mechanical regulation of interleukin-1ß (IL-1ß) signalling. DESIGN: Isolated chondrocytes and cartilage explants were subjected to cyclic mechanical loading in the presence and absence of the cytokine IL-1ß. Nitric oxide (NO) and prostaglandin E2 (PGE2) release were used to monitor IL-1ß signalling whilst Sulphated glycosaminoglycan (sGAG) release provided measurement of cartilage degradation. Measurements were made of HDAC6 activity and tubulin polymerisation and acetylation. Effects on primary cilia were monitored by confocal and super resolution microscopy. Involvement of IFT was analysed using ORPK cells with hypomorphic mutation of IFT88. RESULTS: Mechanical loading suppressed NO and PGE2 release and prevented cartilage degradation. Loading activated HDAC6 and disrupted tubulin acetylation and cilia elongation induced by IL-1ß. HDAC6 inhibition with tubacin blocked the anti-inflammatory effects of loading and restored tubulin acetylation and cilia elongation. Hypomorphic mutation of IFT88 reduced IL-1ß signalling and abolished the anti-inflammatory effects of loading indicating the mechanism is IFT-dependent. Loading reduced the pool of non-polymerised tubulin which was replicated by taxol which also mimicked the anti-inflammatory effects of mechanical loading and prevented cilia elongation. CONCLUSIONS: This study reveals that mechanical loading suppresses inflammatory signalling, partially dependent on IFT, by activation of HDAC6 and post transcriptional modulation of tubulin.
Subject(s)
Chondrocytes/metabolism , Histone Deacetylase 6/metabolism , Interleukin-1beta/metabolism , Stress, Mechanical , Tubulin/metabolism , Animals , Biomarkers/metabolism , Blotting, Western , Cartilage, Articular/metabolism , Cattle , Cells, Cultured , Cilia/metabolism , Dinoprostone/metabolism , Humans , Microscopy, Confocal , Nitric Oxide/metabolism , Sensitivity and Specificity , Signal TransductionABSTRACT
PURPOSE: Primary ciliary dyskinesia (PCD) is characterised by repeated upper and lower respiratory tract infections, neutrophilic airway inflammation and obstructive airway disease. Different ultrastructural ciliary defects may affect lung function decline to different degrees. Lung clearance index (LCI) is a marker of ventilation inhomogeneity that is raised in some but not all patients with PCD. We hypothesised that PCD patients with microtubular defects would have worse (higher) LCI than other PCD patients. METHODS: Spirometry and LCI were measured in 69 stable patients with PCD. Age at testing, age at diagnosis, ethnicity, ciliary ultrastructure, genetic screening result and any growth of Pseudomonas aeruginosa was recorded. RESULTS: Lung clearance index was more abnormal in PCD patients with microtubular defects (median 10.24) than those with dynein arm defects (median 8.3, p = 0.004) or normal ultrastructure (median 7.63, p = 0.0004). Age is correlated with LCI, with older patients having worse LCI values (p = 0.03, r = 0.3). CONCLUSION: This study shows that cilia microtubular defects are associated with worse LCI in PCD than dynein arm defects or normal ultrastructure. The patient's age at testing is also associated with a higher LCI. Patients at greater risk of obstructive lung disease should be considered for more aggressive management. Differences between patient groups may potentially open avenues for novel treatments.
Subject(s)
Cilia/ultrastructure , Ciliary Motility Disorders/complications , Lung Diseases/etiology , Lung/physiopathology , Lung/ultrastructure , Microtubules/ultrastructure , Mucociliary Clearance , Adolescent , Adult , Age Factors , Child , Child, Preschool , Ciliary Motility Disorders/genetics , Ciliary Motility Disorders/pathology , Ciliary Motility Disorders/physiopathology , Female , Forced Expiratory Volume , Humans , Infant , Infant, Newborn , Lung Diseases/pathology , Lung Diseases/physiopathology , Male , Maximal Midexpiratory Flow Rate , Microscopy, Electron, Transmission , Risk Factors , Spirometry , Young AdultABSTRACT
Tissue engineering-based therapies targeting cartilage diseases, such as osteoarthritis, require in vitro expansion of articular chondrocytes. A major obstacle for these therapies is the dedifferentiation and loss of phenotype accompanying chondrocyte expansion. Recent studies suggest that manipulation of hedgehog signalling may be used to promote chondrocyte re-differentiation. Hedgehog signalling requires the primary cilium, a microtubule-based signalling compartment, the integrity of which is linked to the cytoskeleton. We tested the hypothesis that alterations in cilia expression occurred as consequence of chondrocyte dedifferentiation and influenced hedgehog responsiveness. In vitro chondrocyte expansion to passage 5 (P5) was associated with increased actin stress fibre formation, dedifferentiation and progressive loss of primary cilia, compared to primary (P0) cells. P5 chondrocytes exhibited ~50 % fewer cilia with a reduced mean length. Cilia loss was associated with disruption of ligand-induced hedgehog signalling, such that P5 chondrocytes did not significantly regulate the expression of hedgehog target genes (GLI1 and PTCH1). This phenomenon could be recapitulated by applying 24 h cyclic tensile strain, which reduced cilia prevalence and length in P0 cells. LiCl treatment rescued cilia loss in P5 cells, partially restoring hedgehog signalling, so that GLI1 expression was significantly increased by Indian hedgehog. This study demonstrated that monolayer expansion disrupted primary cilia structure and hedgehog signalling associated with chondrocyte dedifferentiation. This excluded the possibility to use hedgehog ligands to stimulate re-differentiation without first restoring cilia expression. Furthermore, primary cilia loss during chondrocyte expansion would likely impact other cilia pathways important for cartilage health and tissue engineering, including transforming growth factor (TGF), Wnt and mechanosignalling.
Subject(s)
Chondrocytes/cytology , Cilia/metabolism , Hedgehog Proteins/metabolism , Signal Transduction , Actins/metabolism , Animals , Cartilage, Articular/cytology , Cattle , Cell Dedifferentiation/drug effects , Cell Proliferation/drug effects , Chondrocytes/drug effects , Chondrocytes/metabolism , Ligands , Lithium Chloride/pharmacology , Phenotype , Polymerization , Signal Transduction/drug effects , Weight-BearingABSTRACT
... The limbs on the right side are stronger. [The] cause may be ... [that] ... motion, and abilities of moving, are somewhat holpen from the liver, which lieth on the right side. (Sir Francis Bacon, Sylva sylvarum (1627).)Fifty per cent of people with primary ciliary dyskinesia (PCD) (also known as immotile cilia syndrome or Siewert-Kartagener syndrome) have situs inversus, which is thought to result from absent nodal ciliary rotation and failure of normal symmetry breaking. In a study of 88 people with PCD, only 15.2% of 46 individuals with situs inversus, and 14.3% of 42 individuals with situs solitus, were left handed. Because cerebral lateralization is therefore still present, the nodal cilia cannot be the primary mechanism responsible for symmetry breaking in the vertebrate body. Intriguingly, one behavioural lateralization, wearing a wrist-watch on the right wrist, did correlate with situs inversus.
Subject(s)
Functional Laterality/physiology , Kartagener Syndrome/complications , Models, Biological , Situs Inversus/etiology , Humans , Logistic Models , Surveys and QuestionnairesABSTRACT
Primary ciliary dyskinesia (PCD) is a phenotypically and genetically heterogeneous condition in which three genetic mutations have already been identified. The primary defect is in the ultrastructure or function of cilia, highly complex organelles that are structurally related to the flagella of sperm and protozoa. The clinical features of PCD include recurrent sinopulmonary infections, subfertility and laterality defects; the latter due to ciliary dysfunction at the embryological node. Completion of the human genome sequence has accelerated the identification and characterisation of disease genes, and the current molecular strategy in PCD includes candidate gene analysis, positional cloning, model organism analysis and proteomic analysis. The identification of these genes will provide new insights into the molecular mechanisms involved in the assembly and function of cilia and the pathway that determines left-right axis in man. This may also allow the development of new methods for diagnosis, prevention and treatment of PCD.
Subject(s)
Genetic Predisposition to Disease , Kartagener Syndrome/genetics , Mutation , Animals , Child, Preschool , Cilia/physiology , Ciliary Motility Disorders/diagnosis , Ciliary Motility Disorders/genetics , Female , Genome, Human , Humans , Infant , Infant, Newborn , Kartagener Syndrome/diagnosis , Male , Molecular Biology , Phenotype , Rodentia , Sensitivity and SpecificitySubject(s)
Chromosomes, Human, Pair 15/genetics , Chromosomes, Human, Pair 16/genetics , Ciliary Motility Disorders/genetics , Genetic Heterogeneity , Chromosome Mapping , Ciliary Motility Disorders/epidemiology , Consanguinity , Female , Geography , Humans , Israel/epidemiology , Israel/ethnology , Lod Score , Male , Netherlands/ethnology , Norway/ethnology , Pedigree , Software , United Kingdom/ethnologyABSTRACT
In the past decade there have been significant advances in our understanding of the molecular genetic basis of the neuronal ceroid lipofuscinoses, a clinically and genetically heterogeneous group of childhood neurodegenerative storage disorders. Recent research progress is reviewed here, to summarize new disease gene identification, diagnostics, treatment, protein functional studies and investigations into the underlying molecular pathogenesis of these devastating disorders.
Subject(s)
Membrane Glycoproteins , Molecular Chaperones , Neuronal Ceroid-Lipofuscinoses/genetics , Animals , Child , Chromosome Mapping , Genotype , Humans , Infant , Membrane Proteins/genetics , Models, Genetic , Neuronal Ceroid-Lipofuscinoses/diagnosis , Neuronal Ceroid-Lipofuscinoses/therapy , Phenotype , Phosphoprotein Phosphatases/genetics , Proteins/genetics , Thiolester HydrolasesABSTRACT
Batten disease, the juvenile-onset form of neuronal ceroid lipofuscinosis (NCL), is a progressive neurodegenerative disorder of childhood with an age of onset of 5-10 years of age. JNCL is caused by mutations in the CLN3 gene which encodes a membrane protein of unknown function. Magnetic resonance imaging of the brain of juvenile NCL patients has revealed changes in signal intensity and tissue atrophy, predominantly in the cortex and cerebellum. A mouse model for Batten disease was created by targeted disruption of the murine Cln3 gene in order to further understanding of the pathophysiology of Batten disease and to evaluate potential therapeutic approaches. Several features of the disease are displayed by Cln3 mice including accumulation of characteristic storage material in neurons. The aim of this work was to investigate neurodegeneration in the Cln3 mouse model using high resolution magnetic resonance imaging to measure signal intensity ratios in selected regions of interest. Global changes were observed in the brains of 12-month-old mutant mice that mirror those seen in juvenile NCL patients. There is a decrease in signal intensity ratio in grey matter regions including cortex, hippocampus and cerebellum, tissues where neuronal storage accumulation and cell loss have been seen in the mouse model. The alterations seen in Cln3 mutant mice support the validity of further imaging studies and suggest that this method will have application in assessment of therapeutic approaches in the study of mutant mouse models of NCL including the Cln3 mouse.
Subject(s)
Brain/pathology , Magnetic Resonance Imaging , Membrane Glycoproteins , Molecular Chaperones , Neuronal Ceroid-Lipofuscinoses/pathology , Proteins/genetics , Animals , Atrophy , Disease Models, Animal , Male , Mice , Mice, Mutant Strains , Neuronal Ceroid-Lipofuscinoses/geneticsABSTRACT
The transcription factor FOXJ1 (alias HFH-4 or FKHL13) of the winged-helix/forkhead family is expressed in cells with cilia or flagella, and seems to be involved in the regulation of axonemal structural proteins. The knockout mouse Foxj1(-/-) shows abnormalities of organ situs, consistent with random determination of left-right asymmetry, and a complete absence of cilia. The human FOXJ1 gene which maps to chromosome 17q, is thus an excellent candidate gene for Kartagener Syndrome (KS), a subphenotype of Primary Ciliary Dyskinesia (PCD), characterized by bronchiectasis, chronic sinusitis and situs inversus. We have collected samples from 61 PCD families, in 31 of which there are at least two affected individuals. Two families with complete aciliogenesis, and six families, in which the affected members have microsatellite alleles concordant for a locus on distal chromosome 17q, were screened for mutations in the two exons and intron-exon junctions of the FOXJ1 gene. No sequence abnormalities were observed in the DNAs of the affected individuals of the selected families. These results demonstrate that the FOXJ1 gene is not responsible for the PCD/KS phenotype in the families examined.
Subject(s)
Ciliary Motility Disorders/genetics , DNA-Binding Proteins , Mutation/genetics , Trans-Activators/genetics , Alleles , Amino Acid Sequence , Base Sequence , DNA Mutational Analysis , Databases as Topic , Exons/genetics , Forkhead Transcription Factors , Genotype , Humans , Introns/genetics , Kartagener Syndrome/genetics , Microsatellite Repeats/genetics , Molecular Sequence Data , Phenotype , Polymorphism, Genetic/geneticsABSTRACT
Primary ciliary dyskinesia is an autosomal recessive condition characterised by chronic sinusitis, bronchiectasis, and subfertility. Situs inversus occurs in 50% of cases (Kartagener syndrome). It has an estimated incidence of 1 in 20 000 live births. The clinical phenotype is caused by defective ciliary function associated with a range of ultrastructural abnormalities including absent dynein arms, absent radial spokes, and disturbed ciliary orientation. The molecular genetic basis is unknown. A genome scan was performed in five Arabic families. Using GENEHUNTER, a maximal multipoint lod score (HLOD) of 4.4 was obtained on chromosome 19q13.3-qter at alpha (proportion of linked families) = 0.7. A 15 cM critical region is defined by recombinations at D19S572 and D19S218. These data provide significant evidence for a PCD locus on chromosome 19q and confirm locus heterogeneity.
Subject(s)
Chromosomes, Human, Pair 19 , Ciliary Motility Disorders/genetics , Adult , Chromosome Mapping , Ciliary Body/ultrastructure , Ciliary Motility Disorders/physiopathology , Female , Humans , Male , Microsatellite Repeats , Pedigree , Sinusitis/etiology , Situs Inversus/etiologyABSTRACT
Deficiency in palmitoyl protein thioesterase (PPT) results in the rapid death of neocortical neurons in human. Very little is known about the developmental and cell-specific expression of this lysosomal enzyme. Here we show that PPT is expressed as a major 2.65 kb and a minor 1.85 kb transcript in the mouse brain. Transcript levels gradually increase between postnatal days 10 and 30. In situ hybridization analysis revealed that PPT transcripts are found widely but not homogeneously in the brain. The most intense signal was detected in the cerebral cortex (layers II, IV-V), hippocampal CA1-CA3 pyramidal cells, dentate gyrus granule cells and the hypothalamus. Immunostaining of PPT was localized in the cell soma, axons and dendrites, especially in the pyramidal and granular cells of the hippocampus, correlating well, both spatially and temporally, with the immunoreactivity of a presynaptic vesicle membrane protein, synaptophysin. In whole embryos, at embryonic day 8, the PPT mRNA expression was most apparent throughout the neuroepithelium, and from day 9 onwards it was seen in all tissues. The expression pattern of PPT suggests its general significance for the brain cells and reflects the response to maturation and growth of the neural networks. Strong PPT immunoreactivity in the axons and dentrites would imply that PPT may not be exclusively a lysosomal enzyme. A notable correlation with synaptophysin would suggest that PPT may have a role in the function of the synaptic machinery.
Subject(s)
Aging/metabolism , Animals, Newborn/metabolism , Brain/embryology , Brain/metabolism , Fetus/metabolism , Thiolester Hydrolases/metabolism , Animals , Animals, Newborn/growth & development , Embryonic and Fetal Development , Fetus/physiology , Immunohistochemistry , In Situ Hybridization , Mice , Mice, Inbred Strains , RNA, Messenger/metabolism , Reference Values , Thiolester Hydrolases/genetics , Tissue DistributionABSTRACT
Batten disease, a degenerative neurological disorder with juvenile onset, is the most common form of the neuronal ceroid lipofuscinoses. Mutations in the CLN3 gene cause Batten disease. To facilitate studies of Batten disease pathogenesis and treatment, a murine model was created by targeted disruption of the Cln3 gene. Mice homozygous for the disrupted Cln3 allele had a neuronal storage disorder resembling that seen in Batten disease patients: there was widespread and progressive intracellular accumulation of autofluorescent material that by EM displayed a multilamellar rectilinear/fingerprint appearance. Inclusions contained subunit c of mitochondrial ATP synthase. Mutant animals also showed neuropathological abnormalities with loss of certain cortical interneurons and hypertrophy of many interneuron populations in the hippocampus. Finally, as is true in Batten disease patients, there was increased activity in the brain of the lysosomal protease Cln2/TPP-1. Our findings are evidence that the Cln3-deficient mouse provides a valuable model for studying Batten disease.
Subject(s)
Hippocampus/pathology , Membrane Glycoproteins , Molecular Chaperones , Neuronal Ceroid-Lipofuscinoses/pathology , Neurons/pathology , Proteins/genetics , Animals , Disease Models, Animal , Female , Genotype , Hippocampus/metabolism , Hippocampus/ultrastructure , Humans , Hypertrophy , Interneurons/pathology , Kidney/metabolism , Kidney/pathology , Male , Mice , Mice, Knockout , Neuronal Ceroid-Lipofuscinoses/genetics , Neuronal Ceroid-Lipofuscinoses/physiopathology , Neurons/metabolism , Neurons/ultrastructure , Proteins/physiology , Restriction Mapping , Reverse Transcriptase Polymerase Chain Reaction , Tripeptidyl-Peptidase 1ABSTRACT
The neuronal ceroid lipofuscinoses (NCLs), also referred to as Batten disease, are a group of neurodegenerative disorders characterised by the accumulation of an autofluorescent lipopigment in many cell types. Different NCL types are distinguished according to age of onset, clinical phenotype, ultrastructural characterisation of the storage material, and chromosomal location of the disease gene. At least eight genes underlie the NCLs, of which four have been isolated and mutations characterised: CLN1, CLN2, CLN3, CLN5. Two of these genes encode lysosomal enzymes, and two encode transmembrane proteins, at least one of which is likely to be in the lysosomal membrane. The basic defect in the NCLs appears to be associated with lysosomal function.
Subject(s)
Membrane Glycoproteins , Membrane Proteins/genetics , Molecular Chaperones , Neuronal Ceroid-Lipofuscinoses/enzymology , Peptide Hydrolases/genetics , Proteins/genetics , Thiolester Hydrolases/genetics , Aminopeptidases , DNA Mutational Analysis , Databases, Factual , Dipeptidyl-Peptidases and Tripeptidyl-Peptidases , Endopeptidases , Humans , Hydrogen-Ion Concentration , Intracellular Membranes/metabolism , Lipofuscin/metabolism , Lysosomal Membrane Proteins , Lysosomes/enzymology , Lysosomes/genetics , Lysosomes/metabolism , Mutation , Neuronal Ceroid-Lipofuscinoses/genetics , Peptide Hydrolases/metabolism , Polymorphism, Genetic , Serine Proteases , Thiolester Hydrolases/metabolism , Tripeptidyl-Peptidase 1ABSTRACT
Two distinct clinical subtypes of neuronal ceroid lipofuscinosis caused by mutations in the PPT gene, INCL and vJNCL/GROD, occur at a high frequency in the central region of Scotland. In this paper we summarize the clinical details and the molecular basis underlying the disease in the Scottish patients. Comparison of the combination of mutations in the different clinical types reveals a clear genotype-phenotype correlation.
Subject(s)
Neuronal Ceroid-Lipofuscinoses/etiology , Neuronal Ceroid-Lipofuscinoses/genetics , Adolescent , Adult , Age of Onset , Child , Child, Preschool , Codon, Terminator , DNA Mutational Analysis , Genotype , Humans , Infant , Phenotype , ScotlandABSTRACT
JNCL is a neurodegenerative disease of childhood caused by mutations in the CLN3 gene. A mouse model for JNCL was created by disrupting exons 1-6 of Cln3, resulting in a null allele. Cln3 null mice appear clinically normal at 5 months of age; however, like JNCL patients, they exhibit intracellular accumulation of autofluorescent material. A second approach will generate mice in which exons 7 and 8 of Cln3 are deleted, mimicking the common mutation in JNCL patients.
Subject(s)
Cyclins , Disease Models, Animal , Neuronal Ceroid-Lipofuscinoses/genetics , Saccharomyces cerevisiae Proteins , Animals , Brain/anatomy & histology , Exons , Fluorescence , Fungal Proteins/metabolism , Gene Library , Gene Targeting , Humans , Membrane Glycoproteins/metabolism , Mice , Models, Genetic , Molecular Chaperones/metabolismABSTRACT
OBJECTIVE: To correlate the phenotypes with the genotypes of 10 Finnish juvenile neuronal ceroid lipofuscinosis (JNCL; late-onset Batten disease) patients who all are compound heterozygotes for the major 1.02-kb deletion in the CLN3 gene. METHODS: The mutations on the non-1.02-kb deletion chromosomes were screened in 6 patients; in the other 4 patients the mutations were known (one affecting a splice site, two missense mutations, and one deletion of exons 10 through 13). Clinical features were examined, and MRI, MRS, somatosensory evoked magnetic field (SEF), and overnight polysomnography (PSG) studies were performed. RESULTS: A novel deletion of exons 10 through 13 was found in 6 patients belonging to three families. In the patients carrying the deletions of exons 10 through 13 the clinical course of the disease was fairly similar. Variation was greatest in the time course to blindness. In these patients the mental and motor decline was slower than in classic JNCL, but more severe than in the two patients with missense mutations in exons 11 and 13. MRI showed brain atrophy in 4 patients. One patient had hyperintense periventricular white matter, otherwise brain signal intensities were normal. SEFs were enhanced in patients older than 14 years, whereas in PSG all but the youngest 6-year-old patient showed epileptiform activity in slow-wave sleep. CONCLUSIONS: JNCL can manifest as at least three different phenotypes: classic, delayed classic, and protracted JNCL with predominantly ocular symptoms. Finnish compound heterozygotes have the delayed classic or the protracted form of JNCL.
Subject(s)
Heterozygote , Neuronal Ceroid-Lipofuscinoses/genetics , Adolescent , Adult , Age of Onset , Case-Control Studies , Child , Chromosome Deletion , Evoked Potentials, Somatosensory/physiology , Exons , Female , Genotype , Humans , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Magnetoencephalography , Male , Mutation, Missense , Phenotype , PolysomnographyABSTRACT
A subtype of neuronal ceroid lipofuscinosis (NCL) is well recognized which has a clinical course consistent with juvenile NCL (JNCL) but the ultrastructural characteristics of infantile NCL (INCL): granular osmiophilic deposits (GROD). Evidence supporting linkage of this phenotype, designated vJNCL/GROD, to the INCL region of chromosome 1p32 was demonstrated (pairwise lod score with D1S211 , Z max = 2.63, straight theta = 0.00). The INCL gene, palmitoyl-protein thioesterase (PPT ; CLN1), was therefore screened for mutations in 11 vJNCL/GROD families. Five mutations in the PPT gene were identified: three missense mutations, Thr75Pro, Asp79Gly, Leu219Gln, and two nonsense mutations, Leu10STOP and Arg151STOP. The missense mutation Thr75Pro accounted for nine of the 22 disease chromosomes analysed and the nonsense mutation Arg151STOP for seven. Nine out of 11 patients were shown to combine a missense mutation on one disease chromosome with a nonsense mutation on the other. Mutations previously identified in INCL were not observed in vJNCL/GROD families. Thioesterase activity in peripheral blood lymphoblast cells was found to be markedly reduced in vJNCL/GROD patients compared with controls. These results demonstrate that this subtype of JNCL is allelic to INCL and further emphasize the correlation which exists between genetic basis and ultrastructural changes in the NCLs.
Subject(s)
Neuronal Ceroid-Lipofuscinoses/genetics , Neurons/ultrastructure , Point Mutation , Thiolester Hydrolases/genetics , Age of Onset , Alleles , Child , Cytoplasmic Granules/ultrastructure , DNA Mutational Analysis , Europe/epidemiology , Exons/genetics , Female , Genetic Heterogeneity , Genotype , Humans , Lymphocytes/enzymology , Male , Neuronal Ceroid-Lipofuscinoses/classification , Neuronal Ceroid-Lipofuscinoses/epidemiology , Neuronal Ceroid-Lipofuscinoses/pathology , North America/epidemiology , Polymerase Chain Reaction , RNA, Messenger/genetics , Sequence Analysis, DNA , Thiolester Hydrolases/deficiencyABSTRACT
Batten disease (juvenile-onset neuronal ceroid lipofuscinosis [JNCL]) is an autosomal recessive condition characterized by accumulation of lipopigments (lipofuscin and ceroid) in neurons and other cell types. The Batten disease gene, CLN3, was recently isolated, and four disease-causing mutations were identified, including a 1.02-kb deletion that is present in the majority of patients (The International Batten Disease Consortium 1995). One hundred eighty-eight unrelated patients with JNCL were screened in this study to determine how many disease chromosomes carried the 1.02-kb deletion and how many carried other mutations in CLN3. One hundred thirty-nine patients (74%) were found to have the 1.02-kb deletion on both chromosomes, whereas 49 patients (41 heterozygous for the 1.02-kb deletion) had mutations other than the 1.02-kb deletion. SSCP analysis and direct sequencing were used to screen for new mutations in these individuals. Nineteen novel mutations were found: six missense mutations, five nonsense mutations, three small deletions, three small insertions, one intronic mutation, and one splice-site mutation. This report brings the total number of disease-associated mutations in CLN3 to 23. All patients homozygous for mutations predicted to give rise to truncated proteins were found to have classical JNCL. However, a proportion of the patients (n = 4) who were compound heterozygotes for a missense mutation and the 1.02-kb deletion were found to display an atypical phenotype that was dominated by visual failure rather than by severe neurodegeneration. All missense mutations were found to affect residues conserved between the human protein and homologues in diverse species.