Facioscapulohumeral muscular dystrophy (FSHD) is the third most common inherited muscular dystrophy that presents clinically with progressive weakness of the facial, scapular and humeral muscles, with later involvement of the trunk and lower extremities. FSHD is a unique disease with complex genetic and epigenetic aetiology and the underlying biological mechanisms are still not fully deciphered. FSHD1 is more frequent (95%) and is associated with the contraction of the D4Z4 macrosatellite repeat array located on a permissive 4qA chromosome combined with decreased methylation of cytosines at the 4q35‐linked D4Z4 units. D4Z4 contraction allows epigenetic derepression of the D4Z4 array allowing the expression of the toxic
DUX4
transcription factor encoded within the terminal D4Z4 repeat in skeletal muscles. FSHD2 associated with approximately 2–3% of the FSHD patients results from haploinsufficiency of the
SMCHD1
gene in individuals carrying a permissive 4qA allele and marked hypomethylation of 4q and 10q D4Z4, which leads to the derepression of
DUX4
hence
DUX4
appears to be a key player in both types of FSHD. Currently, there is no reliable treatment for this condition, therefore for the successful development of new treatments, an integration of clinical and pathogenetic information is vital.
Key Concepts
FSHD is the third most common inherited muscular dystrophy characterised by a typical phenotype and involvement of specific groups of muscles.
FSHD is characterised by a highly variable penetrance and clinical severity.
In most cases, FSHD involves shortening of a repetitive macrosatellite array.
The D4Z4 macrosatellite linked to FSHD encodes the DUX4 transcription factor.
A small proportion of FSHD patients carry mutation in the
SMCHD1
gene.
Epigenetic changes in FSHD are closely associated with molecular features.
FSHD is a unique disease with complex genetic and epigenetic aetiology and the underlying biological mechanisms are still not fully deciphered.
There is no reliable treatment for the disease.