Role of Epigenetics in the Planning of Surgeries, a Review and a Proposal to be Considered

Rafael Iñigo Pavlovich

Department of Musculoskeletal Diseases, Ti Orthopedica Institute, Mexico

*Correspondence to: Dr. Rafael Iñigo Pavlovich, Department of Musculoskeletal Diseases, Ti Orthopedica Institute, Mexico.

Copyright © 2018 Rafael Iñigo Pavlovich. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Beyond question, surgeries in general impose a stress on the patient, emotionally [1] and biological triggering chemical alarm systems, which can affect the results of the surgery [1-3].

A high level of oxidative stress is a very important factor in a low immunity and hence potential complications are generated. Toxic substances in sterile inflammations such as myeloperoxidase [4] can achieve a compromised immune system response; even antibiotics may generate reactive species of oxygen that causes oxidative stress, membranes and cellular DNA damage [5]. Patients with conditions such as diabetes [6], arthritis, autoimmune diseases [7], cellular senescence [8], excessive inflammation [9] already may suffer high levels of oxidative stress, bringing forth a statistic of higher complications, such as infections [10], scarring [8], increased mortality [11], among others.

Arthroscopic debridement of the degenerative knee was suggested to be considered in patients with symptomatic knee OA but without an extensively damaged articular surface. This procedure is relatively short and has a low postoperative morbidity. Therefore, it is readily available and has a potential for the early return to the normal daily non-highly demanding activities. Therefore, it might be reasonable to offer this type of surgical treatment in the mild cases of knee OA instead of definitive knee endoprosthetic arthroplasty [3]. There is a clinical impression that the less morbid procedure of arthroscopic knee joint lavage alone, without debridement, might be beneficial in reducing symptoms in patients with mild but symptomatic knee OA, at least in midterm follow up [4].

Apart from the typical pre-surgery exams, the internal medicine evaluation test, we must bethink in something more far reaching, all inclusive.

“Knowing the total cell number of the human body as well as of individual organs is important from a cultural, biological, medical and comparative modelling point of view. The presented cell count could be a starting point for a common effort to complete the total calculation.These partial data correspond to a total number of 3.72 × 10 [12]. (Bianconi et al. Ann Hum Biol. 2013 Nov-Dec; 40(6):463-71. An estimation of the number of cells in the human body.)

Damage to DNA due to environmental aggression and normal metabolic processes amounts to an estimated of 1,000 to 1,000,000 of molecular lesions per cell per day. While this hardly constitutes only a 0.000165% of the human genome, approximately 6 trillion bases (3 billions of base pairs), the unrepaired lesions in critical genes such as tumor suppressor genes may prevent the ability of the cell to avoid tumor formation (Lodish H, Berk A, et al. (2004), Molecular Biology of the Cell, p963, WH Freeman: New York, NY.), with this struggle of oxidation and molecular damage to DNA, we could advance in reaching an ideal approach to metabolic [13] homeostasis through the application of EPIGENETICS.

Epigenetics, a term coined in 1942 (Conrad Hal Waddington) refers to the changes heritable in the DNA and histones that don’t implicate alterations in the nucleotide sequence and modify the structure and condensation of chromatin, so they affect gene expression and phenotype. Epigenetic modifications are methylation of the DNA and histone modifications [14]; it’s important to envision epigenetics and the aspects that affect positively the performance of certain genes against external factors.

Nutrition is essential in the role of immunity by interfering with the synthesis of pro inflammatory cytokines, immune regulation, and gene expression. Polyphenols bring into play a variety of biological activities [15]; they are organic compounds of many phenol rings, they play a very important role in the plants, and their actions can be qualified in six aspects: release or suppression of Auxin growth hormones, protection against UV rays in the form of pigments, defense against herbivores and antimicrobial defenses (phytoalexins ), a process of maturation and growth. There is evidence that polyphenols affect the “Quorum sense of bacteria, affecting the genomic expression of invading agents [16].”

A significant percentage of the population in the western world and in developing countries show that they are not consuming enough polyphenols in their diet because of low devour of fruits and vegetables, even though there is much evidence that large quantities of polyphenols in the diet have a good effect [17]. Polyphenolic compounds (Phytoalexins) have many of them the particularity of achieving high expression of NEF2 a Zip Leucine master factor in the antioxidant response at the genomic level [18]. Therefore, we recommend reviewing the literature to administer certain compounds of standardized extracts prior to surgery, as are the extracts of Curcuma Longa and Camelia Sinensis, since we could expect an improvement in the immunological system through the favorable epigenetics of these compounds [15], particularly when patients are accompanied by diseases of high oxidative stress such as Diabetes Mellitus, which must be controlled and the patient aware of his responsibility for his health; on the other hand, doctors should consider the potential benefits that lavishes the addition of diets and supplements based on polyphenols, that can contribute in the repair and improvement of mitochondrial function [19-21].

Bibliography

1. Gil, J. A., Goodman, A. D. & Mulcahey, M. K. (2018). Psychological Factors Affecting Outcomes After Elective Shoulder Surgery. J Am Acad Orthop Surg., 26(5), e98-e104.
2. Daubs, M. D., Hung, M., Adams, J. R. et al. (2014). Clinical predictors of psychological distress in patients presenting for evaluation of a spinal disorder. Spine J., 14(9), 1978-1983.
3. Sullivan, E. & Hudson, J. (2017). The Cure That Lies Within: The Mind-Body Connection in Orthopaedics. Orthop Nurs., 36(2), 153-158.
4. Strzepa, A., Pritchard, K. A. & Dittel, B. N. (2017). Myeloperoxidase: A new player in autoimmunity. Cell Immunol., 317, 1-8.
5. Kohanski, M. A., Tharakan, A., London, N. R., Lane, A. P. & Ramanathan, M. (2017). Bactericidal antibiotics promote oxidative damage and programmed cell death in sinonasal epithelial cells. Int Forum Allergy Rhinol., 7(4), 359-364.
6. de Oliveira, A. A., Webb, R. C. & Nunes, K. P. (2018). Toll-Like Receptor 4 and Heat-Shock Protein 70: is it a New Target Pathway for Diabetic Vasculopathies. Curr Drug Targets., 20(1), 51-59.
7. Arida, A., Protogerou, A. D., Kitas, G. D. & Sfikakis, P. P. (2018). Systemic Inflammatory Response and Atherosclerosis: The Paradigm of Chronic Inflammatory Rheumatic Diseases. Int J Mol Sci., 19(7).
8. Wei, W. & Ji, S. (2018). Cellular senescence: Molecular mechanisms and pathogenicity. J Cell Physiol., 233(12), 9121-9135.
9. Valacchi, G., Virgili, F., Cervellati, C. & Pecorelli, A. (2018). OxInflammation: From Subclinical Condition to Pathological Biomarker. Front Physiol., 9, 858.
10. Giri, B., Dey, S., Das, T., Sarkar, M., Banerjee, J. & Dash, S. K. (2018). Chronic hyperglycemia mediated physiological alteration and metabolic distortion leads to organ dysfunction, infection, cancer progression and other pathophysiological consequences: An update on glucose toxicity. Biomed Pharmacother., 107, 306-328.
11. Xuan, Y., Gào, X., Holleczek, B., Brenner, H. & Schöttker, B. (2018). Prediction of myocardial infarction, stroke and cardiovascular mortality with urinary biomarkers of oxidative stress: Results from a large cohort study. Int J Cardiol., 273, 223-229.
12. Falay, M., Senes, M., Korkmaz, S., et al. (2018). Biological variation estimates of prothrombin time, activated partial thromboplastin time, and fibrinogen in 28 healthy individuals. Int J Lab Hematol., 40(6), 721-725.
13. Xu, Y., Zhang, Y. & Ye, J. (2018). IL-6: A Potential Role in Cardiac Metabolic Homeostasis. Int J Mol Sci., 19(9), 2474.
14. Bultmann, S. & Stricker, S. H. (2018). Entering the post-epigenomic age: back to epigenetics. Open Biol., 8(3), 180013.
15. Ding, S., Jiang, H. & Fang, J. (2018). Regulation of Immune Function by Polyphenols. J Immunol Res., 2018(1264074).
16. Lattanzio, V., Lattanzio, V. M. T. & Cardinali, A. (2006). Role of phenolics in the resistance mechanisms of plants against fungal pathogens and insects. Phytochemistry: Advances in Research, 661(2), 23-67.
17. Ming Hu (2007). Commentary: bioavailability of flavonoids and polyphenols: call to arms. Mol Pharm., 4(6), 803-806.
18. Priftis, A., Goutzourelas, N., Halabalaki, M., et al. (2018). Effect of polyphenols from coffee and grape on gene expression in myoblasts. Mech Ageing Dev., 172, 115-122.
19. Margina, D., Gradinaru, D., Manda, G., Neagoe, I. & Ilie, M. (2013). Membranar effects exerted in vitro by polyphenols - quercetin, epigallocatechin gallate and curcumin - on HUVEC and Jurkat cells, relevant for diabetes mellitus. Food Chem Toxicol., 61, 86-93.
20. Denis, M. C., Desjardins, Y., Furtos, A., et al. (2015). Prevention of oxidative stress, inflammation and mitochondrial dysfunction in the intestine by different cranberry phenolic fractions. Clin Sci (Lond)., 128(3), 197-212.
21. Qi, G., Mi, Y., Fan, R., Zhao, B., Ren, B. & Liu, X. (2017). Tea polyphenols ameliorates neural redox imbalance and mitochondrial dysfunction via mechanisms linking the key circadian regular Bmal1. Food Chem Toxicol., 110, 189-199.