Using Epigenetics as a Pharmacological Tool in Heart Regeneration

Heart failure (HF) is the ultimate outcome of many cardiovascular pathologies and the leading cause of morbidity and mortality worldwide. An exciting therapeutic strategy for HF is cardiac regeneration, whose feasibility is supported by the ability of the neonatal heart to regenerate following cardiac injury. However, the major limitation for the application of this strategy is the inability of adult cardiomyocytes to proliferate. This is a consequence of the gene expression program underlying cardiomyocyte differentiation that promotes silencing of proliferative genes. One mechanism that plays a key role in defining this gene expression program is epigenetics. Recent reports have shown that epigenetic mechanisms similar to those that govern gene expression in heart development govern the gene expression changes occurring in HF. This chapter provides an overview of the epigenetic mechanisms involved in cardiac development and disease and how they can influence cardiac reprogramming and regeneration.