The role of physiotherapists is continually broadening, diversifying and evolving into new and previously uncharted territory. Epigenetics is the study of the mechanisms that determine changes in gene expression without changing the DNA sequence. Although at present the field of epigenetics has not generated any strong clinical implications for physiotherapists, with developments in sight, this field may be a game
changer regarding pain management and exercise therapy looking to the future.
It is suggested that by better understanding the mechanisms behind gene coding and how gene expression can be changed, it may be possible to contribute positively to genetic inactivation. This vein of research has contributed to breakthrough treatment innovation for leukaemia (Li and Ernest 2014). The theory relies on the epigenetic process of
methylation of DNA. The methylation process is effectively fixing genes into the “off” position via epigenetic signalling.
This research will assist in enhancing the evidence base behind existing interventions used by physiotherapists. For example, there is a correlation between methylation levels in certain genes and their association with strength training. Some of these genes have been shown to stay hypomethlyated for weeks following strength training and another group of genes have displayed an increased frequency of hypomethylation when muscles are re-loaded after the initial strength training program.
With further research, this evidence could enhance and expand the role of the physiotherapist in the prescription and provision of highly specified, genetically-tailored interventions and programs to optimise the prevention of disease and chronic pain conditions. It could facilitate a decrease in the prescription of opioids for pain management, direct validated pre-habilitation exercise protocols leading to improved post operative outcomes and assist in the early preventative management of chronic conditions in certain patient groups by identifying key epigenetic markers. Watch this space!
References
- Polli A, Ickmans K, Godderis L and Nijs J. Emerging field of epigenetic and its relevance for the physiotherapy profession. Journal of Physiotherapy 2019.
- Li BE, Ernst P. Two decades of leukemia oncoprotein epistasis: the MLL1 paradigm for epigenetic deregulation in leukemia. Exp Hematol. 2014;42:995-1012
- Shen N, Yan F, Pang J, Zhao N, Gangat N, Wu L, Bode AM, Al-Kali A, Litzow MR, Liu S. In–activation of receptor tyrosine kinases reverts aberrant DNA methylation in acute myeloid leukemia. Clinical Cancer Research. 2017 Oct 15;23(20):6254-66.