International Journal of Molecular Medical Science, 2024, Vol.14, No.2, 132-143 http://medscipublisher.com/index.php/ijmms 139 Figure 1 The Epigenetic Mechanisms in Heart Failure (Adopted from Liu and Tang, 2019) Image caption: The figure describes DNA methylation, post-translational modifications of histones (such as acetylation and methylation), ATP-dependent chromatin conformation and remodeling, and the regulatory mechanisms of non-coding RNAs (such as long non-coding RNAs). Specifically, the figure illustrates that in non-failing hearts, adult cardiac genes (such as MYH6) are normally expressed, while genes associated with cardiac hypertrophy (such as NPPA and CTGF) are silenced. However, in failing hearts, these hypertrophy-associated genes are reactivated, indicating that epigenetic modifications play a crucial role in the pathological changes of the heart (Adopted from Liu and Tang, 2019) Another challenge is the inter-individual variability in epigenetic responses due to genetic background, age, sex, and environmental exposures. Such variability can affect the generalizability of findings and the development of universal biomarkers. Additionally, the reversible nature of epigenetic modifications, while advantageous for
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