Promoter region and its activity. a, Nucleotides within the 501-bp intergene region separating the start sites of CTNS and CARKL. The number on the left shows the distance from the CTNS start site. The Sp-1, AP-4, and CAAT-binding protein (CBP) motifs are underlined and in boldface. The mutations in patients 1 and 2 are boxed. The 41 nucleotides in uppercase font may contribute to both expression of CTNS and expression of CARKL. b, CAT activities of CTNS promoter constructs. Nucleotide +1 represents the transcription start site. The constructs portrayed on the left were inserted upstream of pbCAT. The pSV40—that is, the promoterless CAT control—plasmid, which contains both an SV40 enhancer and an SV40 promoter, served as a positive control, and pbCAT served as a negative control. CAT activity was determined for each construct after transient transfection into HeLa cells. A vector carrying the gene for β-galactosidase was cotransfected as a control, for transfection efficiency. The bars represent means ± SD for three determinations of CAT activity. c, CAT activities of CARKL promoter constructs. Nucleotide +1 represents the transcription start site of CARKL.