Prodromal pathogenesis of CLN7 Batten Disease revealed by multimodal biomarkers in macaques

Neuronal ceroid lipofuscinosis type 7 (CLN7) is a devastating paediatric neurodegenerative disorder with no cure and limited natural history data to guide therapeutic development. Here, we present the first multimodal characterization of prodromal and early-stage CLN7 disease in Japanese macaques carrying a spontaneous <i>CLN7</i> ^-/- mutation. Using structural T ₂ -weighted MRI for volumetry, [ ¹⁸ F]FDG PET for glucose metabolism, and [ ¹¹ C]PBR28 PET for neuroinflammation, we observed region-dependent patterns in volumetric, molecular, and metabolic alterations. MRI confirmed the presence of disease-associated atrophy in many cortical and subcortical brain regions, consistent with human pathology, [ ¹⁸ F]FDG PET revealed early cortical and subcortical widespread hypometabolism, and [ ¹¹ C]PBR28 PET imaging detected progressive neuroinflammation in the same brain areas. CSF analyses further showed age-dependent increases in neurofilament light (NfL), providing convergent evidence for neurodegeneration. Together, these results define a prodromal trajectory in CLN7 disease, establish sensitive imaging and fluid biomarkers, and validate the macaque model as a powerful platform for testing interventions.