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Glycogen debranching enzyme (GDE) deficiency, or glycogen storage disease type 3 (GSD 3), is a form of glycogen storage disease characterized by severe muscle weakness and hepatopathy.
Features include always present findings: Reduced muscle glycogen debrancher enzyme activity; and very common findings: Short stature, Hypoglycemia, Full cheeks, and Mild intellectual disability and others. 24 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Muscles | 3 | Myopathy, Reduced muscle glycogen debrancher enzyme activity, Muscle weakness |
Digestive system | 3 | Liver scarring (fibrosis) (hepatic fibrosis), Enlarged liver (hepatomegaly), Elevated circulating hepatic transaminase concentration |
Lab test results | 2 | Elevated creatine kinase (muscle enzyme) (elevated circulating creatine kinase concentration), Elevated circulating hepatic transaminase concentration |
Brain and nerves | 2 | Depressed nasal bridge, Mild intellectual disability |
Heart and blood vessels | 2 | Heart muscle disease (cardiomyopathy), Ventricular hypertrophy |
Growth and development | 1 | Short stature |
Metabolism | 1 | High blood fat levels (hyperlipidemia) |
Head and neck | 1 | Thin upper lip vermilion |
Blood and immune system | 1 | Immunodeficiency |
Glycogen storage disease type III (GSD III) is characterized by variable liver, skeletal muscle, and cardiac muscle involvement. GSD IIIa (~85% of all GSD III) is characterized by liver and muscle involvement, and GSD IIIb (~15% of all GSD III) is characterized by liver involvement only, typically present in childhood with hepatomegaly and ketotic hypoglycemia with markedly elevated liver transaminases and hypertriglyceridemia. Liver disease. The spectrum of presentation may include severe hypoglycemia or asymptomatic hepatomegaly. When euglycemia is maintained and ketosis is avoided, hepatomegaly regresses and other abnormal laboratory values (e.g.
Source: GeneReviews — "Glycogen Storage Disease Type III"
AGL encodes amylo-alpha-1,6-glucosidase and 4-alpha-glucanotransferase (1,532 aa). Multifunctional enzyme acting as 1,4-alpha-D-glucan:1,4-alpha-D-glucan 4-alpha-D-glycosyltransferase and amylo-1,6-glucosidase in glycogen degradation Highest expression in Muscle Skeletal (59.1 TPM) and Esophagus Muscularis (40.5 TPM).
Glycogen storage disease III is caused by mutations in the AGL gene on chromosome 1.
AGL is classified as a druggable target (Enzyme category) with score 0.0.
There is a clear genotype-phenotype correlation with at least two pathogenic variants in exon 3 ( and ) associated with GSD IIIb; both generate truncated proteins with few amino acids. It is thought that alternative exon or translation initiation in muscle isoforms does not require exon 3, thus leading to normal enzyme activity in the muscles of persons with GSD IIIb who have an exon 3 deletion . A possible explanation was proposed by in which the exon 3 pathogenic variant is bypassed using a downstream start codon, thus creating a fully functioning isoform without the exon 3 pathogenic variants. No clear genotype-phenotype correlations between other AGL pathogenic variants and disease severity have been reported.
Source: GeneReviews — "Glycogen Storage Disease Type III"
Glycogen storage disease type III (GSD III) should be suspected in individuals with any of the following clinical and laboratory findings.
Clinical findings
Hepatomegaly (presenting feature in ~98%, typically in infancy or early childhood)
Failure to thrive / short stature (presenting feature in ~49%)
Hepatic cirrhosis and hepatic adenomas (in adolescence and adulthood)
Weakness / myopathy
Exercise intolerance
Hypertrophic cardiomyopathy
Laboratory findings
Source: GeneReviews — "Glycogen Storage Disease Type III"
Findings in glycogen storage disease type III (GSD III) that may help distinguish it from other forms of GSD presenting with fasting intolerance-related signs and symptoms include the following:
Source: GeneReviews — "Glycogen Storage Disease Type III"
Genetic testing for AGL is available. Testing is considered confirmatory for diagnosis.
Biomarker and diagnostic research for glycogen storage disease III has been reported in the published literature.
No approved treatments are currently available for glycogen storage disease III. An additional 1 compound holds orphan drug designation.
While no drugs are FDA-approved specifically for glycogen storage disease III, some of the following designated compounds may be used off-label in clinical practice. Treatment decisions should be made in consultation with a specialist familiar with this condition.
The following drugs have received orphan drug designation from the FDA for glycogen storage disease III. Orphan designation reflects regulatory interest and does not indicate approval for treatment.
Brand Name | Generic Name | Sponsor | Designated | Exclusivity End | Designation Status |
|---|---|---|---|---|---|
mRNA encoding the human glycogen debranching enzyme | mRNA encoding the human glycogen debranching enzyme | Ultragenyx Pharmaceutical Inc. | 2021 | — | Designated |
Based on the 2010 ACMG practice guidelines, the investigations summarized in are recommended to characterize the clinical phenotype and to adjust dietary treatment on an individual basis.
Table 3.
Recommended Evaluations Following Initial Diagnosis in Individuals with Glycogen Storage Disease Type III
System/Concern | Evaluation | Comment
| • Glucose, AST, ALT, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, international normalized ratio, albumin, bilirubin, creatinine
Consultation w/biochemical geneticist
Liver ultrasound to assess liver size structure
|
| • CK
Developmental assessment (incl gross fine motor assessment)
Neuromuscular consultation, incl strength, endurance, exercise tolerance, pain assessment
PT consultation
| • Neuromuscular assessment (e.g., muscle ultrasound, dynamometry) should be performed subsequently based on physical status, function, symptoms, or need.
Avoid the following:
High carbohydrate intake. Excess sugar is stored as glycogen, which cannot be broken down, resulting in hepatomegaly.
Steroid-based drugs, which interfere with glucose metabolism and utilization. Long-term steroid usage itself can cause failure to thrive and muscle weakness.
Growth hormone replacement therapy, which interferes with glucose metabolism and worsens ketosis. Growth hormone therapy has been associated with adenoma growth and complications in GSD I; therefore, growth hormone should only be used in individuals with documented growth hormone deficiency.
Medications that can cause rhabdomyolysis
Use the following with caution:
Hormonal (estrogen) contraceptives in women. Estrogen is known to contribute to both benign and malignant hepatocellular tumors.
Statins for control of hyperlipidemia. Use of statins requires CK monitoring because of the potential of exacerbating the muscle disease of GSD IIIa.
Beta blockers, which can cause hypoglycemia and mask the signs and symptoms associated with the adrenergic response during hypoglycemia
Source: GeneReviews — "Glycogen Storage Disease Type III"
Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions. Note: There may not be clinical trials for this disorder.
Source: GeneReviews — "Glycogen Storage Disease Type III"
1 trial found
Table 4.
Recommended Surveillance for Individuals with Glycogen Storage Disease Type III
System/Concern | Evaluation | Frequency
| AST, ALT, liver function as needed (e.g., albumin, bilirubin, ammonia, clotting studies), CK, lipid profile | Every 6-12 mos
Liver ultrasound FibroScan® (if possible) to screen for adenomas hepatic fibrosis | Every 6-12 mos in children; every 12-24 mos in adults
Liver MRI in those w/abnormal liver ultrasound | CT/MRI every 6-12 mos in older persons based on lab clinical findings
Glucose
homeostasis | • Measure blood glucose preprandially.1
Measure blood ketones on waking using a portable blood ketone meter OR measure urine ketones on waking w/urine dipsticks.2
Continuous glucose monitoring can be helpful for many.
| At least several times per month to identify periods of suboptimal metabolic control; goal is to maintain blood ketone/beta-OH-butyrate concentrations 0.3 mmol/L
Neuromuscular/
| • Direct functional neuromuscular assessment of strength endurance
Assessment of exercise tolerance pain
PT assessment in children incl gross fine motor skills
In adults: musculoskeletal assessment for alterations in alignment (hypermobility, width of base of support, anterior pelvic tilt, genu valgum recurvatum, hindfoot valgus, forefoot varus) assessment for adaptive equipment
| • Annual neuromuscular, PT, musculoskeletal assessments in adults based on signs/symptoms
Source: GeneReviews — "Glycogen Storage Disease Type III"
Phenotype severity distribution: 1 always present feature, 6 very common features, 1 common feature.
Estimated prevalence: Unknown (Unknown prevalence).
1 clinical trial registered, 1 recruiting. Interventions under study include other interventions. Research is primarily sponsored by academic and government institutions.
20 publications have been identified in PubMed for glycogen storage disease III. Research spans Case Report / Case Series (30%), Basic Science / Preclinical (25%), and Epidemiology / Natural History (15%).
Research Type | Count | % of Total |
|---|---|---|
Patient case studies | 6 | 30% |
Laboratory research | 5 | 25% |
Disease patterns and progression | 3 | 15% |
Testing and diagnosis research | 2 | 10% |
Research summaries | 2 | 10% |
Other research | 1 | 5% |
Clinical study results | 1 | 5% |
Daghar H (2026). [PMID: 41577969](https://pubmed.ncbi.nlm.nih.gov/41577969/). *Communications biology*. [Basic Science / Preclinical]
Bustos-Sellers A (2026). [PMID: 40448669](https://pubmed.ncbi.nlm.nih.gov/40448669/). *Exp Physiol*. [Clinical Trial Publication]
Montalvo-Romeral V (2026). [PMID: 41659772](https://pubmed.ncbi.nlm.nih.gov/41659772/). *JHEP reports : innovation in hepatology*. [Basic Science / Preclinical]
Gorial FI (2025). [PMID: 40843042](https://pubmed.ncbi.nlm.nih.gov/40843042/). *Oxford medical case reports*. [Case Report / Case Series]
Puente-Ruiz N (2025). [PMID: 40606795](https://pubmed.ncbi.nlm.nih.gov/40606795/). *JIMD Rep*. [Case Report / Case Series]
Jakani M (2025). [PMID: 41389110](https://pubmed.ncbi.nlm.nih.gov/41389110/). *Molecular biology reports*. [Case Report / Case Series]
Llauradó A (2025). [PMID: 40398079](https://pubmed.ncbi.nlm.nih.gov/40398079/). *Mol Genet Metab*. [Case Report / Case Series]
Chien YH (2025). [PMID: 39927452](https://pubmed.ncbi.nlm.nih.gov/39927452/). *Genet Med*. [Epidemiology / Natural History]
Simoni C (2025). [PMID: 40064848](https://pubmed.ncbi.nlm.nih.gov/40064848/). *Nat Commun*. [Basic Science / Preclinical]
Yang M (2025). [PMID: 41070653](https://pubmed.ncbi.nlm.nih.gov/41070653/). *Zhonghua Yi Xue Yi Chuan Xue Za Zhi*. [Review / Meta-Analysis]
Data assembled from 10 of 12 sources · Last updated Sep 20, 2026, 3:04 PM UTC
Patient Advocacy Groups (PAGs) provide support, resources, and community for patients and caregivers.
Online Mendelian Inheritance in Man
European rare disease database
Genetic and Rare Diseases Info Center
Electromyography/nerve conduction tests in those w/suspected peripheral neuropathy
| • CK-MB, troponin I/T, NT-proBNP
Electrocardiogram
Echocardiogram
|
Nutrition/
| • Measure length/height, weight; BMI.
Eval of nutritional status
Assess optimize dietary intake for exercise activity levels.
|
| • Serum calcium 25(OH)-vitamin D
Bone mineral density
Orthopedic consultation as needed
|
| Assess for signs of hirsutism, hyperandrogenism, insulin-resistance. | • Females w/GSD III may develop polycystic ovaries from a y...
Source: GeneReviews — "Glycogen Storage Disease Type III"
AI-curated news mentioning glycogen storage disease III
Updated Sep 9, 2026
The FDA has approved Genglycos ... gene therapy, to reduce cornstarch dependence in patients eight and older with GSDIa, the first approved treatment to target the disease's underlying genetic cause. ... The FDA has granted accelerated approval to pariglasgene brecaparvovec-opnr (Genglycos) for adults and pediatric patients eight years of age and older with glycogen storage disease type Ia (GSDIa), a rare inherited disorder caused by ... The FDA has approved Genglycos (pariglasgene brecaparvovec-opnr), a one-time AAV8 gene therapy, to reduce cornstarch dependence in patients eight and older with GSDIa, the first approved treatment to target the disease's underlying genetic cause. ... The FDA has granted accelerated approval to pariglasgene brecaparvovec-opnr (Genglycos) for adults and pediatric patients eight years of age and older with glycogen storage disease type Ia (GSDIa), a rare inherited disorder caused by deficiency of the enzyme glucose-6-phosphatase.¹ Genglycos, formerly known in development as DTX401, is indicated to reduce daily cornstarch intake as an adjunct to nutritional management and is the first approved therapy for the condition.¹,² Ultragenyx announces U.S. FDA approval of Genglycos gene therapy, the first-ever FDA-approved treatment designed to treat the underlying cause of glycogen storage disease type Ia (GSDIa). News release. Ultragenyx Pharmaceutical Inc. Published August 19, 2026. Accessed August 20, 2026. RARE rises on completion of rolling submission for AAV gene therapy. "This accelerated approval reflects our confidence in the clinical evidence to date and our commitment to bringing innovative treatments to patients with rare genetic diseases while we continue to gather data to confirm long-term benefit." — Megha Kaushal, MD, MSc, acting deputy director, CBER Office of Therapeutic Products, US Food and Drug Administration · Genglycos is a one-time, AAV8-based gene therapy administered as a single intravenous infusion, designed to deliver a functional G6PC gene to liver cells to restore glucose-6-phosphatase activity and stabilize blood sugar during fasting Serious adverse reactions reported across two clinical studies included anaphylaxis, adrenal insufficiency, elevated lactate levels, and hypoglycemia, and the most common adverse reactions were increased liver transaminases, nausea, headache, constipation, and hyperglycemia.¹ Genglycos-treated patients also showed a higher rate of hypertriglyceridemia than placebo-treated patients (29% versus 8%).¹ The prescribing information carries warnings for anaphylaxis, liver toxicity, adrenal insufficiency, and tumorigenicity risk, and the therapy should not be used during pregnancy.¹ "Today's approval is a great milestone in using a gene therapy to treat this disease and improve the quality of life for people with this condition," said Karim Mikhail, B Pharm, MS, acting director of the FDA's Center for Biologics Evaluation and Research.¹
Duchenne Cell Therapy Decision Slips to November After FDA Labels New Arm Function Data a Major Amendment · Hunter Syndrome Gene Therapy Halted by FDA After Spine Scans Show Small Masses in Five Children · Gene Therapy for Glycogen Storage Disease Type Ia Wins Accelerated Approval Priced at 2.7 Million Dollars · What are inborn errors of immunity? A group of more than 500 rare genetic disorders... Duchenne Cell Therapy Decision Slips to November After FDA Labels New Arm Function Data a Major Amendment · Hunter Syndrome Gene Therapy Halted by FDA After Spine Scans Show Small Masses in Five Children · Gene Therapy for Glycogen Storage Disease Type Ia Wins Accelerated Approval Priced at 2.7 Million Dollars · What are inborn errors of immunity? A group of more than 500 rare genetic disorders, also called primary immunodeficiencies, in which a faulty gene leaves the immune system unable to work properly. Mayo Clinic joined the federal AEGIS project to build CRISPR treatments for children with inherited immune disorders. Here is what is real. Mayo Clinic has signed on as one of three clinical sites for a federally funded project that aims to do something no gene therapy program has managed yet: build a single, reusable system to treat children with rare inherited immune disorders, rather than developing an expensive therapy for each mutation one at a time. The project is called AEGIS, short for Affordable Gene Editing Therapies for Immune System Diseases of Children. It is funded by an award of up to $27.7 million from the Advanced Research Projects Agency for Health, the federal agency created to pursue high-risk medical research, and it is part of the agency's THRIVE program, which targets hereditary rare diseases with in vivo genetic medicines.
The FDA approved Genglycos (pariglasgene brecaparvovec-opnr) to reduce daily cornstarch intake in patients aged 8 years and older with glycogen storage disease type Ia. Known as Von Gierke disease, GSDIa is a rare metabolic disorder caused by a mutation in the G6PC gene. This genetic variation leads to a deficiency in glucose-6-phosphatase (G6Pase), an enzyme needed to release glucose into the bloodstream. Without this enzyme, the body cannot properly maintain blood glucose levels, causing severe hypoglycemia and other serious metabolic complications · Pariglasgene brecaparvovec is an adeno-associated virus (AAV) serotype 8 based gene therapy that delivers a functional copy of the G6PC gene into liver cells, enabling the production of normally functioning G6Pase. Ultragenyx stated that as part of its postmarketing commitments to the FDA, the Company will provide 2 years of clinical data from open-label commercial treatment of 50 patients and 20 control patients through its existing GSDIa Disease Monitoring Program. ... Ultragenyx announces US FDA approval of Genglycos™ gene therapy, the first-ever FDA-approved treatment designed to treat the underlying cause of glycogen storage disease type Ia (GSDIa). “The reduced reliance on cornstarch, experienced by patients in our clinical studies, demonstrates this gene therapy’s ability to establish the normal breakdown of glycogen to produce glucose during fasting or episodes of metabolic stress. This ability to regulate glucose has alleviated the disease burden and has the potential to mitigate the risk of severe or life-threatening hypoglycemia for these patients.” Close more info about First Gene Therapy Approved for Glycogen Storage Disease Type la
The clearance of Genglycos for a rare glycogen storage disease gives Ultragenyx a sellable voucher and momentum ahead of an eagerly anticipated study readout.
The accelerated greenlight for Ultragenyx’s gene therapy for glycogen storage disease has raised analyst expectations for approval of UX111, which the FDA rejected last summer and is currently reviewing for a second time. A decision is expected by mid-September.