title: Epigenetics:  time to translate into transplantation.
abstract: Substantial progress has been made in identifying genetic loci associated with multifactorial disorders, including variants that seem to impact outcomes following solid organ transplantation. Despite these advances, much of the heritability and susceptibility to chronic disease processes remains unexplained. Epigenetic modifications may exert their effect independently or complementary to genetic variants. Epigenetic modifications can change gene expression without altering the DNA sequence. These modifications are dynamic, potentially heritable, and can be induced by environmental stimuli or drugs. The impact of epigenetic phenomena on the outcomes of organ transplantation is currently poorly understood. Epigenetic modifications can occur during periods of illness; these may persist and potentially influence allograft outcomes. Epigenetic mechanisms influence the activation, proliferation, and differentiation of the immune cells involved in allograft rejection. The donor's epigenome may also impact transplant survival, and initial research has demonstrated that peritransplant conditions induce rapid epigenetic modification within the allograft. Further research will help to define the importance of epigenetic modifications in transplantation. This will potentially lead to the identification of useful biomarkers and the development of novel pharmacotherapies. This review explores the nature of epigenetic modification in disease and the emerging evidence for epigenetic influences on allograft survival.
authors.affiliation: Regional Nephrology Unit (Level 11), Belfast City Hospital, Lisburn Road, Belfast, Northern Ireland. jamccaughan@doctors.net.uk
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: McCaughan
authors.forename: Amy Jayne
authors.initials: AJ
authors.lastname: McKnight
authors.forename: Aisling E
authors.initials: AE
authors.lastname: Courtney
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Maxwell
mesh_terms: D000818:Animals; D019175:DNA Methylation; D044127:Epigenesis, Genetic; D057890:Epigenomics; D051858:Forkhead Transcription Factors / Q000235:genetics; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016377:Organ Transplantation; D014184:Transplantation, Homologous
chemical_list: C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors