“…Notably, two major 4q subtelomeric allelic variants exist (4qA and 4qB), but only the 4qA allele provides a polymorphic DUX4 polyadenylation signal, which makes it permissive for DUX4 expression in skeletal muscle [ 63 , 64 ]. As described below, in FSHD, DUX4 has been associated with activation of pathways toxic to muscle tissue [ 50 , 65 , 66 ], including oxidative stress and DNA damage [ 67 , 68 ], inhibition of myogenic differentiation [ 67 , 69 , 70 , 71 ], impaired transcript quality control [ 54 , 72 , 73 ] and inflammation [ 40 ], leading to muscle cell apoptosis [ 67 , 74 , 75 ].…”