GNE and Distal myopathy, Nonaka type: In 2001 and 2002, it was reported that GNEM (Nonaka myopathy, distal myopathy with rimmed vacuoles) is associated with the GNE gene, which encoding the bifunctional enzyme, UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase (GNE) (Eisenberg et al., 2001; Nishino et al., 2002).