By their very nature, complex disease phenotypes are characterized by the dysregulation of multiple physiological systems, polygenic origins and various environmental triggers that result in patient populations with heterogeneous symptom profiles. Less than 10% of the heritability of complex phenotypes and disease traits are due to genetic variation, indicating that other factors play major roles in disease onset and progression [1]. Epigenetic modifications may partly account for this ‘missing heritability’ [2] through mechanisms that regulate transcriptional potential. These mechanisms appear to be, at least to some extent, responsive to environmental exposures or treatments. An improved understanding of the pathophysiology underlying complex phenotypes and new diagnostic tools can help refine and update classification criteria reliant on nonspecific or self-reported symptoms. Consequently, unraveling complex phenotypes depends to a large extent upon an ability to discriminate what are likely many distinct conditions. We and others have argued that epigenetic investigations integrate multiple levels of information (genetic, stochastic and environmental) to enable a better understanding of the dimensions of illness underlying complex phenotypes [2,3]. Here, we turn to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to illustrate progress and future directions in this regard.
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Source: de Vega WC, McGowan PO. The epigenetic landscape of myalgic encephalomyelitis/chronic fatigue syndrome: deciphering complex phenotypes. Epigenomics. 2017 Nov;9(11):1337-1340. doi: 10.2217/epi-2017-0106. Epub 2017 Oct 18. https://www.futuremedicine.com/doi/full/10.2217/epi-2017-0106 (Full article)