Beyond genes: a clinician's guide to epigenetics

Epigenetic mechanisms control how and when our genes are switched on or off. They are altered by chronic environmental exposures, like cigarette smoke or air pollution, contributing to disease development. Excitingly, they can also be manipulated with the potential to target disease. Thus, epigenetic signalling provides a novel angle for understanding how chronic lung diseases develop and identifying novel biomarkers and therapeutic targets for respiratory diseases. This educational review is meant as a guide for clinicians and other lung researchers interested in epigenetic regulation. We introduce the main epigenetic modifications and the general cellular machinery that introduces and removes them. We provide selected examples of epigenetic dysregulation in response to environmental exposures and in chronic lung diseases. Finally, we discuss the promise of epigenetic biomarkers and therapies for clinical practice, including new precision medicine epigenetic editing approaches.