From Patient to Pioneer: How FSHD Researchers Are Redefining a Rare Disease Through Epigenetics and CRISPR
Key Insights
Facioscapulohumeral muscular dystrophy (search) (FSHD) affects up to one million people globally, yet remains widely underdiagnosed due to its complex epigenetic origins rather than a simple genetic mutation.
Researchers at UNR Med and Stanford are advancing both diagnostics and therapeutics, including a $70 saliva-based test and CRISPR-based gene therapy strategies targeting the DUX4 (search) gene.
The Jones Lab has developed the first disease-relevant FSHD mouse model (FLExDUX4) and is proposing to redefine FSHD based on epigenetic state, which could expand diagnosis to previously excluded patients.
In laboratories at Stanford University and the University of Nevada, Reno School of Medicine (search) (UNR Med), a rare disease that many people have never heard of is driving globally significant discoveries — changing how it is diagnosed, studied and, one day, treated.
Facioscapulohumeral muscular dystrophy (search) (FSHD) is one of the most common types of muscular dystrophy, causing gradual muscle weakness typically starting in the face, shoulders and upper arms. About one in every 8,000 people experience it, with up to one million people affected worldwide. In the United States alone, FSHD is estimated to affect between 16,000 and 32,000 people, though researchers believe the true number may be closer to 100,000 due to underdiagnosis. There is still no cure.
A disease of gene regulation
Unlike many genetic diseases, FSHD is not caused by a simple mutation that can be easily identified. Instead, it is an epigenetic disorder — a disease of gene regulation. In people without FSHD, a gene known as DUX4 (search) is turned off in muscle cells. In those with the disease, that "off switch" fails.
"The gene itself isn't different," explained Peter Jones, Ph.D., the Mick Hitchcock, Ph.D., Endowed Chair in Medical Biochemistry at UNR Med. "What's different is whether it's active or not."
Because DUX4 (search) is a transcription factor, it instructs other genes to begin producing proteins, which then deteriorate muscle. In order to activate genes, DUX4 needs to attach to DNA. This mechanism has become the central target for emerging therapeutic strategies.
A patient-driven research revolution
The Jones Lab's journey into FSHD began with a single student. In 2002, while Peter Jones was a junior faculty member studying a different neurodevelopmental disorder, a graduate student named Ryan Wuebbles approached him with an unexpected request: he wanted to study FSHD. He had recently been diagnosed himself.
"At the time, I had never even heard of it," Peter recalled. "But Ryan said, 'You work on epigenetics — this might be an epigenetic disease.' So I thought, what the heck — let's try it."
That simple exchange would redirect the lab's focus and ultimately help reshape the field. In 2006, the lab received the first National Institutes of Health (NIH) R01 grant ever awarded specifically for FSHD research, a milestone that signaled growing recognition of the disease as a serious scientific priority.
"Everything we've done in FSHD traces back to one patient who decided to do something about his condition," Peter said. "That's the lesson: by speaking up and advocating for themselves, patients can change the direction of science and the prospects for therapy. One person can make a difference."
Building breakthroughs: from mouse models to diagnostics
After years building their research program at institutions including Boston Biomedical Research Institute and UMass Chan Medical School, the Jones Lab made a pivotal move in 2017 to the University of Nevada, Reno School of Medicine (search). There, the lab found an environment where innovation was encouraged, with state-of-the-art resources including a top-tier animal research facility.
The lab's progress has come through a series of breakthroughs. In 2014, Takako Jones, Ph.D., research associate professor, published a pioneering epigenetic diagnostic approach for FSHD. In 2015, the lab demonstrated that epigenetic state plays a critical role in determining disease severity. That same year, Takako developed the FLExDUX4 mouse — the first disease-relevant animal model for FSHD — which has since become the most widely used FSHD model in the world by both academic laboratories and pharmaceutical companies.
"Nobody had been able to make a proper mouse model for FSHD for years," Peter said. "Takako did it. The field needed a large animal model of FSHD for translating therapies to clinic, so Takako created the FSHD minipig. People said you couldn't create a sequence-based diagnostic for FSHD — she did that too."
Charis Himeda, Ph.D., research associate professor and longtime collaborator, pioneered a CRISPR-inhibition approach for FSHD, introducing a novel gene therapy strategy designed to silence expression of the disease-causing gene activity. Between 2024 and 2025, Himeda developed next-generation gene therapy components and cargos, including compact regulatory systems and all-in-one CRISPR vectors. Most recently, in 2026, Takako introduced D4Z4caster, a further advancement in epigenetic diagnostics.
"I've never worked with such fearless scientists," Himeda said. "Peter and Takako are truly driven by the most important questions and problems in the field, and if a necessary tool or model doesn't exist, they make it."
Expanding access to diagnosis
Perhaps the most immediate impact of the lab's work has been in diagnostics. Historically, FSHD testing required fresh blood samples, specialized equipment, and cost between $2,000 and $6,000 — often without insurance coverage. The Jones Lab made the process simpler and far less expensive, developing a saliva-based test that costs about $70.
"We realized there's an often-overlooked economic barrier in rare disease," Peter said. "It comes down to access to knowledge — just figuring out what's wrong."
The lab now provides confidential, no-cost testing through MyFSHD.org, a non-profit founded by Peter and Takako. To date, the program has reached more than 4,000 individuals across 78 countries and territories. The team is now proposing that FSHD be redefined based on epigenetic state rather than traditional genetic criteria — a change that could ensure patients previously excluded from diagnosis are finally recognized.
A student's race against time
At Stanford, Heloise Hoffmann '26 is pursuing a parallel path — one driven by personal stakes. Hoffmann has FSHD herself. Diagnosed at age 13 after years of specialists across the country, she was told to stop playing sports immediately because her muscles would no longer be able to heal from heavy use.
"I felt like they shattered any vision of what I thought my future life might look like," she said.
When Hoffmann arrived at Stanford, she realized she had access to state-of-the-art genetic engineering tools that might lead to a cure. She majored in bioengineering and, with seven other undergraduates, formed a team for the global iGEM (International Genetically Engineered Machine) competition. There, Hoffmann and her team proposed a way to solve FSHD that won them the gold medal.
The therapy targets DUX4 (search). Hoffmann and her team engineered a version of DUX4 that binds to DNA but is inactive, preventing the harmful proteins from being made by outcompeting the mutated DUX4 to attach to DNA.
She and two teammates later pitched their therapy to the Undergraduate Entrepreneurship Program hosted by Stanford's Sarafan ChEM-H, winning a $50,000 grant to develop their project. Hoffmann now spends hours of research per day in the Stanley Qi Lab, which specializes in using CRISPR-based technology to engineer medical therapies.
"She's already on the way to become a very promising successful physician-scientist," said Stanley Qi, Ph.D., associate professor of bioengineering at Stanford. To Qi, Hoffmann represents a unique type of scientist because she combines "scientific literacy with a very precise, urgent personal mission."
"We're racing against time," Qi said about the effort.
Hoffmann, who received a Terman Award given to the top 30 graduating students from the School of Engineering, plans to apply to and attend an MD/Ph.D. program to continue the work she has started. She will spend the coming year working full-time in the Qi Lab, sights set on bringing her FSHD therapies to human trials.
"Although I have FSHD, it does not have me," Hoffmann said.
From discovery to impact
In 2019, Peter Jones, Takako Jones, Charis Himeda and Mick Hitchcock launched Renogenyx, Inc. (search), with the goal of bringing CRISPR-inhibition gene therapies to the clinic. Their tools are used by researchers and companies around the world, and their models enable the testing of new therapies.
The challenges remain — no cure, limited treatments and unequal access to care. But progress is undeniable. From a single student's request in 2002 to a globally recognized research program, from costly and inaccessible diagnostics to affordable testing available worldwide, the field is moving forward. And in laboratories at Stanford and Reno, that progress is accelerating.