Epigenetic variations can play remarkable roles in different normal and abnormal situations. Such variations have been shown to have a direct role in the pathogenesis of various diseases either through inhibition of tumor suppressor genes or increasing the expression of oncogenes. Enzymes involving in epigenetic machinery are the main actors in tuning the epigenetic-based controls on gene expressions. Aberrant expression of these enzymes can trigger big chaos in the cellular gene expression networks and finally lead to cancer progression. This situation has been shown in different types of leukemia, where high or low levels of an epigenetic enzyme are partly or highly responsible for the involvement or progression of a disease. DNA hypermethylation, different histone modifications, and aberrant miRNA expressions are three main epigenetic variations, which have been shown to play a role in leukemia progression. Epigenetic based treatments now are considered as novel and effective therapies in order to decrease the abnormal epigenetic modifications in patient cells. Different epigenetic-based approaches have been developed and tested to inhibit or reverse the unusual expression of epigenetic agents in leukemia. Acute myeloid leukemia (AML), the most prevalent acute leukemia in adults, is anaggressive hematological malignancy arising in hematopoietic stem and progenitor cells. With the exception of a few specific AML subtypes, the mainstays of treatment have not significantly changed over the last 20 years, and are still based on standard cytotoxic chemotherapy. In this review, we will discuss the recent development of therapeutics specifically targeting these key epigenetic programs in AML, describe their mechanism of action and present their current clinical development. Finally, we will discuss the opportunities presented by epigenetically targeted therapy in AML and will highlight future challenges ahead for the AML community, to ensure that this novel therapeutics are optimally translated into clinical practice and result in clinical improvement for AML patients.

中文翻译：

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表观遗传学在白血病中的作用：从机制到治疗。

表观遗传变异可以在不同的正常和异常情况下发挥重要作用。通过抑制肿瘤抑制基因或增加癌基因的表达，已表明这种变异在各种疾病的发病机理中具有直接作用。涉及表观遗传机制的酶是调节基于表观遗传的基因表达控制的主要角色。这些酶的异常表达会在细胞基因表达网络中引发巨大混乱，并最终导致癌症进展。在不同类型的白血病中已经显示出这种情况，其中高或低水平的表观遗传酶部分或高度负责疾病的参与或发展。DNA超甲基化，不同的组蛋白修饰，miRNA异常表达是三种主要的表观遗传变异，已显示在白血病进展中起作用。为了减少患者细胞中异常的表观遗传修饰，基于表观遗传的治疗方法现在被认为是新颖有效的疗法。已经开发并测试了不同的基于表观遗传学的方法来抑制或逆转白血病中表观遗传学试剂的异常表达。急性髓细胞性白血病（AML）是成人中最普遍的急性白血病，是造血干细胞和祖细胞产生的侵袭性血液系统恶性肿瘤。除少数特定的AML亚型外，过去20年来治疗的主要方法没有显着改变，仍然基于标准的细胞毒性化学疗法。在这篇评论中 我们将讨论专门针对AML中这些关键表观遗传程序的疗法的最新发展，描述其作用机理并介绍其当前的临床发展。最后，我们将讨论表观遗传学靶向治疗在AML中提供的机会，并将突出AML社区未来的挑战，以确保将这种新型疗法最佳地转化为临床实践并为AML患者带来临床改善。