What causes FSHD?

Although the exact genetic defect in FSHD is known, it remains unclear how this defect results in muscle wasting and weakness.

In most genetic diseases, a mutation occurs in the sequence (code) of a particular gene which is then either unable to make an essential protein it codes for or makes a defective protein.  In FSHD on the other hand, the genetic defect does not alter the sequence (code) of a particular gene.  Instead, the defect is a loss of several copies of identical pieces of DNA (known as D4Z4 repeats) that cluster in large numbers on the tip of chromosome 4.  If the number of D4Z4 repeats falls below 11, it results in FSHD.   It is known that clusters similar to D4Z4 repeats may regulate when certain genes are turned on or turned off. Current research in FSHD is focused on three main possibilities: