Epigenetics in medicine. The current state of the problem

Epigenetics, which studies heritable changes in gene expression that do not involve alterations in the deoxyribonucleic acid nucleotide sequence, is one of the key areas of modern biomedical research. This review systematizes fundamental epigenetic mechanisms, including deoxyribonucleic acid methylation, posttranslational histone modifications, and the regulation by non-coding micro-ribonucleic acids, and analyzes their role in the development of pathological processes in socially significant diseases: arterial hypertension, type 2 diabetes mellitus, bronchial asthma, and oncological processes. It has been shown that epigenetic changes induced by environmental factors (stress, nutritional deficiency, exposure to toxins) contribute to the formation of stable pathological phenotypes. In particular, hypermethylation of the promoters of the HSD11B2, AGTR1, and TLR2 genes is associated with the development of arterial hypertension, while hypomethylation of PPARGC1A and TCF7L2 correlates with insulin resistance in type 2 diabetes mellitus. In bronchial asthma, alterations in the methylation of cytokine genes (IL4, IL13) have been identified, while in oncology, global hypomethylation alongside localized hypermethylation of tumor suppressors (p16, BRCA) has been observed.Special attention is given to the potential of epigenetic therapy, including deoxyribonucleic acid methyltransferase inhibitors (azacitidine) and histone deacetylase inhibitors (vorinostat), as well as the prospects of using micro-ribonucleic acids as biomarkers and therapeutic targets. The reversibility of epigenetic modifications is emphasized, opening new possibilities for preventive medicine and personalized treatment.

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