Within the genome exists a specific subset of genes whose expression is controlled by epigenetic marks. These tags can be modified by lifestyle factors including diet, behavior, environment and social interactions. Differences in genetic expression, despite identical genes, is explained in part through metastable epialleles-alleles that, while genetically indistinguishable, are variably expressed as a function of epigenetic modification. As a group, these metastable epialleles have been given a unique descriptive name: the imprintome. This breakthrough in understanding genetic expression has led to a wider recognition that our genes are fundamentally controlled at two levels. One is the hardware of the genetic code, which is modified slowly by natural selection through mutational changes in the genome over centuries of time. The other is the software that controls the expression of our genetic code, converting nucleotide sequences into phenotype in response to the imprinting of our epigenome. Acting as a rapid translator for real time changes, the imprintome responds to environmental and lifestyle inputs by genomic methylation and histone modifications that affect promoter accessibility and transcription factor activity. In application, this understanding of the plasticity of the imprintome necessitates a rethinking of both health and disease states. It's a concept that cuts across all forms of healthcare: physical, metabolic, and cognitive-behavioral interventions. But at the same time, it is an aggregating concept-one that brings disciplines together to collaborate on the personalization of health and the delivery of truly individualized care. This article reviews the development of the concept of the imprintome, as well as clinical studies supporting its importance as a potential driver of change in global health care.
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