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Features include always present findings: Menorrhagia, Increased mean platelet volume, Bruising susceptibility, and Petechiae and others; and common findings: Increased megakaryocyte count and Epistaxis. 11 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Blood and immune system | 3 | Increased mean platelet volume, Anti-platelet antigen antibody positivity, Low platelet count (thrombocytopenia) |
GNE encodes glucosamine (UDP-N-acetyl)-2-epimerase/N-acetylmannosamine kinase (722 aa). Bifunctional enzyme that possesses both UDP-N-acetylglucosamine 2-epimerase and N-acetylmannosamine kinase activities, and serves as the initiator of the biosynthetic pathway leading to the production of N-acetylneuraminic acid (NeuAc), a critical precursor in the synthesis of sialic acids. Highest expression in Liver (33.4 TPM) and Minor Salivary Gland (24.0 TPM).
Thrombocytopenia 12 with or without myopathy is associated with mutations in the GNE gene on chromosome 9.
GNE is classified as a druggable target (Enzyme and Kinase categories) with score 0.0.
GNE myopathy should be suspected in individuals with the following findings.
Clinical findings
Myopathy presenting in young adults with bilateral foot drop caused by anterior tibialis weakness, followed by slowly progressive skeletal muscle weakness. Although there is relative sparing of the quadriceps, they may become affected at late stages of the disease. The clinical picture varies depending on the stage of disease progression at which individuals are evaluated .
No approved treatments are currently available for thrombocytopenia 12 with or without myopathy. The disease remains an area of unmet medical need.
Individuals with GNE myopathy are often evaluated and managed by a multidisciplinary team that includes clinical geneticists, neuromuscular specialists, physiatrists, physical and occupational therapists, and if needed, pulmonologists. Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with GNE myopathy, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended. Table 3. Recommended Evaluations Following Initial Diagnosis in Individuals with GNE Myopathy
Routine follow up with the multidisciplinary team is recommended annually, or more frequently as determined by managing physician . Table 5. Recommended Multidisciplinary Team Surveillance for Individuals with GNE Myopathy
No clinical trials have been registered for thrombocytopenia 12 with or without myopathy.
245 publications have been identified in PubMed for thrombocytopenia 12 with or without myopathy. Kisho has analyzed 147 by research type. Research spans Review / Meta-Analysis (50%), Basic Science / Preclinical (20%), and Case Report / Case Series (12%).
Research Type | Count | % of Total |
|---|---|---|
Research summaries | 73 | 50% |
Data assembled from 6 of 12 sources · Last updated Sep 19, 2026, 9:41 PM UTC
Online Mendelian Inheritance in Man
Lab test results | 2 | Anti-HLA antibody positivity, Anti-platelet antigen antibody positivity |
Bones and joints | 1 | Skeletal muscle atrophy |
Muscles | 1 | Skeletal muscle atrophy |
GNE myopathy is characterized by adult-onset slowly progressive myopathy typically presenting with bilateral foot drop, followed by distal-to-proximal lower-extremity weakness. The upper extremities, which are affected within five to ten years of disease onset, do not necessarily follow a distal-to-proximal progression, in contrast to the lower extremities. In advanced stages, neck and core muscles can also become affected. Onset. GNE myopathy typically presents in individuals age 20-40 years with foot drop caused by anterior tibialis weakness. Rarely, in case of muscle overuse, other muscles may be affected first . Progression.
Source: GeneReviews — "GNE Myopathy"
Because reports of GNE myopathy consist mainly of single individuals or relatively small series, correlations between genotype and phenotype are difficult.
Source: GeneReviews — "GNE Myopathy"
Penetrance of biallelic GNE pathogenic variants is likely close to 100%. Only two older individuals with biallelic GNE pathogenic variants have been reported to be asymptomatic: One (age 67 years) was homozygous for the common Middle Eastern variant and one (age 60 years) was homozygous for the common Japanese variant .
Source: GeneReviews — "GNE Myopathy"
Serum CK may be normal or up to four times the upper limit of normal.
Muscle histopathology
Source: GeneReviews — "GNE Myopathy"
The differential diagnosis includes adult-onset distal myopathies and myopathies with rimmed vacuoles . Table 2. Genes of Interest in the Differential Diagnosis of GNE Myopathy
Gene | Disorder | MOI | Age at Onset (Years) | Initial Muscle Group Involved | Serum Creatine Kinase Concentration | Muscle Biopsy |
|---|---|---|---|---|---|---|
ANO5 | Miyoshi muscular dystrophy 3 (See ANO5 Muscle Disease.) | AR | 20-25 | Posterior lower legs; asymmetry | 10x ULN | Myopathic changes (rarely) necrotic fibers |
DNAJB6 | LGMD1D1 (OMIM 603511) | AD | 18-50 | Lower leg posterior anterior; ± dysphagia | Normal to 8x ULN | Myofibrillar myopathy2 rimmed vacuoles |
DYSF | Miyoshi distal myopathy (See Dysferlinopathy.) | AR | 15-30 | Posterior lower leg | 10x ULN | Myopathic changes |
LDB3 (ZASP) | Zaspopathy3 (myofibrillar myopathy 4) (OMIM 609452) | AD | 40-70 | Lower leg | Normal to 6x ULN | Myofibrillar myopathy2 ± rimmed vacuoles |
MATR3 | Amyotrophic lateral sclerosis 214 (OMIM 606070) | AD | 35-60 | Asymmetric lower leg ± hands; dysphagia; dysphonia | Normal to 8x ULN | Myopathic changes rimmed vacuoles |
MYH7 | Laing distal myopathy5 | AD | 0-50 | Anterior lower leg | Normal to 4x ULN | Type 1 fiber atrophy |
MYOT | Myotilinopathy6 (myofibrillar myopathy 3) (OMIM 609200) | AD | 40-70 | Lower leg post ant | Normal to 2x ULN | Myofibrillar myopathy2 ± rimmed vacuoles |
TIA1 | Welander distal myopathy7 (OMIM 604454) | AD | 40-60 | Finger extensors | Normal or slightly | Myopathic changes rimmed vacuoles |
TTN (exon 364) | Udd distal myopathy – tibial muscular dystrophy8 | AD | 35 | Anterior lower leg | Normal or slightly | Myopathic changes ± rimmed vacuoles |
TTN | Limb-girdle muscular dystrophy, autosomal recessive, 108 (LGMDR10) (OMIM 608807) | AR | 14-44 | Anterior lower leg | Normal to 8x ULN | Myopathic changes ± rimmed vacuoles |
VCP | Inclusion body myopathy, Paget disease frontotemporal dementia9; (IBMPFD) | AD | 35 | Hip girdle | Normal to 5x ULN | Myopathic changes rimmed vacuoles AD = autosomal dominant; AR = autosomal recessive; MOI = mode of inheritance; ULN = upper limit of normal; XL = X-linked 1. |
Source: GeneReviews — "GNE Myopathy"
Genetic testing for GNE is available. Testing is considered confirmatory for diagnosis.
Biomarker and diagnostic research for thrombocytopenia 12 with or without myopathy has been reported in the published literature.
System/Concern | Evaluation | Comment |
|---|---|---|
Musculoskeletal | Neuromuscular, physical medicine rehab/PT/OT evaluation | To determine extent of disease as determined by:; Muscle strength; Balance; Function; Fine motor skills; Impact on activities of daily living; Need for ongoing PT/OT; Need for AFOs, assistive ambulatory devices; Need for adaptive devices; Need for handicapped parking |
Respiratory | Respiratory function tests incl supine sitting spirometry, MIP, MEP | To evaluate for effects of muscle weakness on respiratory function esp in nonambulatory individuals |
Cardiac | Baseline echocardiogram | To evaluate for evidence of cardiac involvement Genetic |
counseling | By genetics professional1 | To review results of genetic testing to inform patients families about the nature, MOI, implications of GNE myopathy to facilitate medical personal decision making Family support resources |
Treatment of Manifestations in Individuals with GNE Myopathy Manifestation/Concern | Treatment | Considerations/Other |
Musculoskeletal | PT, rehab medicine | Ambulatory assistive devices, balanced physical activity,1 regular exercise as tolerated. Activities of |
daily living | PT | Transfers (e.g., from bed to wheelchair, wheelchair to car); Medical alert system for those unable to stand after a fall OT |
Respiratory | Respiratory function | A concern mostly in nonambulatory affected individuals OT = occupational therapy; PT = physical therapy 1. All affected individuals should consult their physician before beginning an exercise program. |
Recommended Multidisciplinary Team Surveillance for Individuals with GNE Myopathy System/Concern | Evaluation | Frequency |
Neuromuscular | Evaluate disease progression; coordinate care. | Rehab medicine; Muscle strength testing using a quantitative scale, e.g., MMT, hand-held dynamometry, or QMA1 to evaluate progressive muscle involvement; Physical function, e.g., 6-min walk test, AMAT2; Activities of daily living |
therapy | Evaluation management for balance need for AFOs, cane, walker, wheelchair, powerchair | At least annually, or more frequently based on needs Occupational |
therapy | Evaluation management of fine motor skills hand function, e.g., Jebsen Hand Function Test3 | At least annually |
Respiratory | PFTs incl supine sitting spirometry, MIP MEP on affected individuals at advanced stages of disease | As needed, if symptomatic or if abnormal PFTs Cardiac |
Source: GeneReviews — "GNE Myopathy"
It may be prudent to use medications/drugs with potential myotoxicity (e.g., colchicine, statins) with caution. It is strongly recommended that affected individuals have a healthy diet and exercise to avoid developing hypercholesterolemia, in an effort to reduce the risk associated with taking statins. Individuals with GNE myopathy should avoid lifting weights and performing repetitive activities that result in muscle pain.
Source: GeneReviews — "GNE Myopathy"
N-acetylmanossamine (ManNAc) is the only therapy currently in clinical development for GNE myopathy [, , , ]. Ultragenyx discontinued the clinical development of extended-release sialic acid (Ace-ER) in 2017 following a Phase III trial that failed to detect clinical efficacy . Preclinical studies are ongoing to advance gene therapy as a potential therapy for GNE myopathy. 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.
Source: GeneReviews — "GNE Myopathy"
View trials for thrombocytopenia 12 with or without myopathy
Evaluation |
|---|
Frequency |
|---|
Neuromuscular | Evaluate disease progression; coordinate care. | Rehab medicine; Muscle strength testing using a quantitative scale, e.g., MMT, hand-held dynamometry, or QMA1 to evaluate progressive muscle involvement; Physical function, e.g., 6-min walk test, AMAT2; Activities of daily living |
therapy | Evaluation management for balance need for AFOs, cane, walker, wheelchair, powerchair | At least annually, or more frequently based on needs Occupational |
therapy | Evaluation management of fine motor skills hand function, e.g., Jebsen Hand Function Test3 | At least annually |
Respiratory | PFTs incl supine sitting spirometry, MIP MEP on affected individuals at advanced stages of disease | As needed, if symptomatic or if abnormal PFTs Cardiac |
Source: GeneReviews — "GNE Myopathy"
Phenotype severity distribution: 6 always present features, 2 common features.
Laboratory research |
30 |
20% |
Patient case studies | 17 | 12% |
Disease patterns and progression | 10 | 7% |
Clinical study results | 7 | 5% |
Testing and diagnosis research | 5 | 3% |
New treatment approaches | 3 | 2% |
Other research | 2 | 1% |
Zhou W (2026). [PMID: 41951012](https://pubmed.ncbi.nlm.nih.gov/41951012/). *Biochim Biophys Acta Mol Basis Dis*. [Review / Meta-Analysis]
Isfort M (2026). [PMID: 41766074](https://pubmed.ncbi.nlm.nih.gov/41766074/). *J Clin Neuromuscul Dis*. [Review / Meta-Analysis]
Esper ME (2026). [PMID: 40825664](https://pubmed.ncbi.nlm.nih.gov/40825664/). *Cold Spring Harb Perspect Biol*. [Review / Meta-Analysis]
Alshaikhi OA (2026). [PMID: 41622814](https://pubmed.ncbi.nlm.nih.gov/41622814/). *Hematology*. [Case Report / Case Series]
Acurio K (2026). [PMID: 41766081](https://pubmed.ncbi.nlm.nih.gov/41766081/). *J Clin Neuromuscul Dis*. [Review / Meta-Analysis]
Bossola M (2026). [PMID: 41954147](https://pubmed.ncbi.nlm.nih.gov/41954147/). *Acta Myol*. [Review / Meta-Analysis]
Hoang D (2026). [PMID: 41766076](https://pubmed.ncbi.nlm.nih.gov/41766076/). *J Clin Neuromuscul Dis*. [Case Report / Case Series]
Merlet AN (2026). [PMID: 41307411](https://pubmed.ncbi.nlm.nih.gov/41307411/). *J Neuropathol Exp Neurol*. [Basic Science / Preclinical]
de Santa Barbara P (2026). [PMID: 41981708](https://pubmed.ncbi.nlm.nih.gov/41981708/). *Neurogastroenterol Motil*. [Review / Meta-Analysis]
Mariano JM (2025). [PMID: 40569690](https://pubmed.ncbi.nlm.nih.gov/40569690/). *JCI Insight*. [Epidemiology / Natural History]