Promoters & Inhibitors of the Metabolic & Antioxidative Pathway of PGC-1a and Its Role in Environmental Illness

When you are talking about biological pathways there is never a linear path where one protein action only leads to another. It would make understanding these pathways alot simpler but it just does not work that way. Of course, if this were so, it would be so easy for everything to just stop working if something went wrong. When there are multiple pathways that intersect, run parallel or make feedback loops on proteins that ultimately activate other proteins, it results in a kind of "checks and balance system" inside a cell. This provides a safety mechanism so processes keep working or at least "keep chugging along" even if one protein or even a few proteins that make up a pathway are damaged, are lost or their signals get misdirected. It is easy to get confused when thinking about all those protein interactions at the same time. For me.... it is easier to break the activities down and focus on the processes individually. It makes it easier to understand how these pathways work and easier to remember just what they do! (If you would like to see a graphical depiction of the tangled mess these pathways make - click here!) Today's focus is on mostly on the PGC1a pathway and its relevance to the molecular biology of environmental illnesses.

In a recent blog, I wrote about my interest in nutrition as well as, a variety of other topics I have studied that impact health and wellness. In that blog, I discussed how a number of dietary excesses or deficiencies may influence environmental disease. Specifically dietary deficiencies include vitamin D, vitamin B and folate and also may include methionine(either too little or too much). I added changes in human dietary patterns and lifestyles over the last several decades or more may have contributed to this. There is debate on whether we get too much or too little methionine from our diet. The most recent articles provide evidence that methionine actually increases mitochondrial stress and lack of DNA repair even though others recommend supplementation of methionine. Generally, our bodies use methionine to make something called s-adenosyl methionine (SAM) which is used for biosynthesis of hormones like dopamine and serotonin. (Deth, Cully) It breaks down into homocysteine which can be toxic at excess amounts but with the help of B6, B12 and folate it recycles back into methionine or glutathione. (This means we have to have substantial amounts of these nutrients too!) Methionine can also be used to make cysteine, cartinine, taurine and lecithin. Excess levels of homocysteine (homocysteinemia) has been demonstrated to have negative effects on the cardiovascular system, impair the urea cycle and may produce problematic cognitive effects. It has recently been demonstrated that PGC-1a effects homocysteine metabolism and overexpression of the antioxidant may elevate levels of homocysteine and lower PGC-1a expression is associated with lower plasma homocysteine levels. Low levels of homocysteine can alter the normal metabolism of glutathione, taurine and sulfate and therefore can be a health concern. Because homocysteine is the intermediate in the production of methionine to cysteine, it may make one more susceptible to oxidative stress and certain toxic exposures. In these cases, NAC, methionine and taurine are often recommended.

Now that we have reviewed how PGC-1a interacts with the methionine synthase pathway, let us now discuss more about this protein and its importance for maintaining overall cellular metabolism and homestasis. Homeostasis inside cells can be severely impaired without proper expression of PGC-1a because its expression influences the regulation of a number of other proteins including the PPARS, estrogen, thyroid hormone, glucocorticoids and the pregnane X receptor, just to name a few. (Finck) To demonstrate this take for example how the pregnane X receptor interacts with PGC-1a in the synthesis of CYPA26 and CYPA34. These are two enzymes necessary for the metabolism and/or detoxification of certain anesthetics, antidepressants, nicotine and other contaminants like certain molds. Additional key targets for PGC-1a include NRF1 and NRF2 which regulate mitochondrial function. The former, NRF1, is regulated by Nrf2 and taken together, Nrf2 and PGC-1a are responsible for most of the activities that promote oxidative stress resistance and cellular survival in toxic environments. PGC-1a also interacts with vitamin D and "because the expression of PGC-1α is regulated by environmental stimuli, such as diet and lower temperatures, it follows that the function of VDR could be influenced in response to these external stimuli in the tissues that exhibit an overlap in the expression of PGC-1α." (Savkur)

The PGC-1a gene responds to a number of different environmental cues including diet like fasting, caffeine, exercise and cold exposure and is preferentially expressed in tissues with high oxidative capacity. (Finck) On the other hand, it is inhibited by obesity, lack of exercise and the exposure to endotoxin. These factors lead one to consider important policy and regulatory concerns for the elderly and vulnerable populations, those with access issues to proper nutrition or individuals living with unhospitable conditions like contaminated water supplies. In general, the inhibition of PGC-1a expression has a variety of physiological effects including lower cardiac function, lower mitochondrial function, endothelial and epithelial dysfunction, poor thermoregulation, lower protection against environmental toxins, reduced energy metabolism, alterations of muscle fiber type and numerous others. One will note, all of these contribute to a variety of complications indentified in patients with environmental illnesses. As Patti describes, one complication from reduced PGC-1a expression leading to oxidative stress and altered cellular metabolism is insulin resistance and diabetes. As we noted earlier, PGC-1a interacts with NRF-1 a nuclear respiratory factor. This author demonstrates that although NRF-1 is reduced in diabetics, a number of other proteins that interact with and including PGC-1a such as PGC-1b, PPAR-gamma and NRF1 are also reduced in members of their families. From this it is assumed that decreased expression of PGC-1a is responsible for a decrease in NRF genes and the associated disturbances of insulin resistance and diabetes.

At this point, it would be worth suggesting here that metabolic disturbances may not only be the result of a reduction in expression in PGC-1a but may also be due to a reduction in the expression or regulation of NRF1 by Nrf2 at least in some cell types. One protein that has been implicated in a number of mental and physical health disorders, GSK-3b, is like an off and on switch for the Nrf2 antioxidant system that allows for cellular stress resistance. Also, other proteins may participate and PGC-1a inhibition. Tnf-a from cigarette smoke inhibites PGC-1a and may be a "key step" to vascular and myocyte dysfunction. (Tang) Both NRF1 and NRF2 are involved in the generation of the respiratory chain and it seems NRF1's role includes inducing gene expression and maintaining cytochrome C levels. An interesting article explains that several pathways exist that inhibit PGC-1a which may be different in different tissues. In addition to possible inhibition of PGC-1a in hepatocytes by Akt/PKB, there is evidence expression of PGC-1a can be dependant on reduction of a ligase called Cdc4 or through the activation of GSK-3b which also contributes to neuroinflammation. GSK-3b increases in response to oxidative stress and can regulate the TH1/Th2 balance (Ohtani) and its inhibition according to one author may lead to "stabilization of PGC-1a". Cdc4 is elevated in Parkinson's disease and as one author mentions, "it will be interesting to see if Cdc4 is responsible for the reduction of PGC-1a in the brains of PD patients." (Olson) For GSK-3b, metallothionein which can be upregulated by Nrf2 is an effective inhibitor of GSK-3b and prevents a number of diabetic-induced changes in inflammation, nitrosative stress and energy metabolism. (Wang) In cardiac cells the presense of metallothionein "abrogates mitochondrial damage, loss of mitochondrial DNA and downregulation of PGC-1a and its downstream targets. In this article the author proposes eNOS uncoupling induces the down-regulation of PGC-1a, NRF1, NRF2 and other proteins which contributes to the loss of mitochondrial biogenesis while saying further the precise mechanism for loss of mitochondrial biogenesis under eNOS uncoupling is not known. It might be important to stress here that it is now understood that Nrf2 is an important protective component against eNOS uncoupling. (Heiss) Recent evidence provides evidence of an alternative mechanism involving elevations in CO and H2O2 activates mitochondrial biogenesis through PGC-1a independantly of eNOS. In any event, PGC-1a expression is vital for normal heart function, because reductions in expression of PGC-1a results in compromised function. Other important inducers of PGC-1a include cAMP, CAMKII, AMPK and NO.

Numerous studies demonstrate and as we mentioned earlier, exercise elevates both PGC-1a gene and protein expression. As Wright explains, "with this discovery it was initially believed that exercise-induced biogenesis was mediated by increases in PGC-1a but suggests that activation of PGC-1a mediates mitochondrial biogenesis rather than the increases in protein expression." His study provides support for this because a) PGC-1a regulates binding of NRF1 and NRF2 and he demonstrates that their binding increased after exercise but before there was an increase in PGC-1a protein expression and b) a number of mitochondrial constituents were increased beforeelevations in protein levels. Other studies have demostrated that P38 activation is linked to an adaptive increase in mitochondrial biogenesis. Wright agrees and believes that generally PGC-1a production occurs in this order 1) exercise activates P38 which in turn activates PGC-1a 2) PGC-1a activates transciption factors and nuclear receptors that regulate mitochondrial expression which is part of the first phase of an adaptive response, 3) activation of the PGC-1a by the promoter and transcription factors coactivated by PGC-1a results in an increase in PGC-1a expression and 4) this mediates the second phase of an adaptive response and includes sustaining and enhancing mitochondrial biogenesis by PGC-1a. With all this in mind, one must consider that mitochondrial biogenesis and homostastic metabolism is dependant at least in part on participation of Nrf2 antioxidant system because it also regulates NRF1 and therefore, impairments of this system may contribute to conditions in metabolism where PGC-1a plays a central role.

Notes:

• Lipoic acid increases mitochondrial biogenesis and improves muscular energy through a AMPK-PGC-1a pathway which increases GLUT4 expression in aged mice. (Wang)

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ImmunoGenetics in Autism, MCS and Cancer -- What Has Food Got To Do With It!

ImmunoGenetics in Autism, MCS and Cancer --
What Has Food Got To Do With It

Research scientists are gaining more understanding why certain physical changes occur and are passed on to successive generations without changes to DNA. The field of research that studies involving these kinds of changes is called epigenetics and ultimately examines how behaviors and their influence on biological systems, whether beneficial or detrimental, can be passed on to their descendants. This process is called methylation and simply put, is a where a methyl group attaches to an amino acid which permanently or temporarily silences gene expression. Interestingly, as understanding of methylation advances, its role as a cause of environmental illnesses becomes more and more ignored, at least in the media. Why this is true I can tell you but need to stress here that methylation may be the one or one of the most important factors that contributes to environmental illness including chemical sensitivity, autism, cancer and as you will read probably more....Methylation and its impact on genetic expression provides a mechanism that explains why environmental illnesses run in families and why environmental illnesses and exposures effect children, the elderly and males and females differently. It also provides an explanation for the wide range of reactions and "immunological footprints" present in EI patients.

B12 is considered an important part of most therapy protocals for chemical sensitivity. In addition, it has also been shown that it is beneficial as a cancer treatment because of its ability to cycle homocysteine to methionine which provides a "methyl" group for methylation. Research shows that a B12 deficiency can lead to hypomethylation of DNA which increases the risk for cancer. On the other hand, methylation is important for any number of processes in metabolism that occur billions of times in the body each second and therefore, it is an indespensable process for life. One physician, Dr. Schneider explains that silencing viral genes, methylating the dopamine receptor, changing brainwaves and increasing attention and focus are just a few biological processes that utilize methylation. In addition, she describes that "low methylators" will suffer from a variety of health conditions including eczema, asthma, arthritis, colitis and a host of other illnesses because methylation is necessary to make glutathione; the primary antioxidant used in the body to battle inflammation. S-adenosylmethionine (SAMe) is a "product of methionine metabolism" which modulates Il-10 and Il-6. Both Il-6 and Il-10 are involved in pathogies of environmental diseases including sickness syndrome, PTSD and inflammatory and autoimmune diseases. Il-10 provides a number of effects including protection against cytokine-induced insulin resistance, Il-6, fatigue and motor deficits after pathogenic exposure. It also plays a role in adaptive immunity and differentiation of T cells.

Chronic inflammation can lead to autoimmune diseases. Alterations in Nrf2 function are also implicated in driving TH2 that may present very much like autoimmune disease. If one looks a little closer at autism, one may see some similarities to symptoms common in multiple chemical sensitivity. Autistic children also suffer from a variety of maladies including chemical sensitivity. All in all, it leads one to suspect they may have common "roots" so to speak and the "root" of malfunction lies in the methylation pathway. Remember, autism spectrum disorders include by its definition a spectrum of disorders. It is noteworthy to mention several "methy donors" mentioned for treatments of autism and are also considered to be effective for the treatment of MCS. These include methylcobalamin which is a form of B12, the active form of folate which is a precursor to tetrahydrobiopterin (BH4) and Q10 which improves mitochondrial function.

To further understand the relationships between MCS, autism and other environmental illnesses, we propose and Dr. Scheider, MD suggests, it might be useful to look at several autism pathways which include catecholamine-o-methyltransferase (COMT), methionine synthase, crystathione beta synthase (CBS) and PON1. (Care) These are also pathways suggested in MCS, CFS and other environmentally-induced conditions. Just today, it was announced mutations in PON1 and the exposure to pesticides make one more susceptible to at least one type of Parkinson's disease. (Manthripragada) Methionine is protective against dopamine induced oxidative stress but may induce cellular damage of its own. A cellular enzyme called methionine sulfoxide reductase protects against methionine oxidation; a deficiency in Msra may increase DNA damage. Thus, Msra dysfunction must be considered as a factor in environmental illness. Several studies show that Nrf2 is protective against liver injury which is of course, what one has to consider after chronic or acute toxic injury and Nrf2 deficiency has been associated with autoimmune-type disease. (Li) Homocysteine has also been shown to contribute to liver disease and whether caused by genetic or diet, elevated homocysteine levels "alter the abundance of liver enzymes in methionine metabolism, the urea cycle and antioxidant defense. Homocysteine may impair the urea cycle.Normally this cycle is responsible for converting ammonia into urea for subsequent excretion by the kidneys. As we noted above, pesticides and other crop treatments may influence the development of environmental diseases including Parkinson's disease, autism and MCS. Studies have determined hydrazine, a chemical in fertilizer, causes a reduction in methionine reductase with no involvement from NO or NOS or reversal by arginine, increases homocysteine and impairs the sulphur amino acid pathway. In addition, several gene variants including cysteine b synthase, the less active MTHFR allele and weaker forms of nitric oxide synthase can predispose an individual to high ammonia levels that may also be produced by gut bacteria. Methytetrahydrofolate is often prescribed for high ammonia levels and its mode of action raises tetrahydrobiopterin (BH4). BH4 is an important component of the NO/ONOO cycle mechanism for causing environmental illness including multiple chemical sensitivity developed by Dr. Martin Pall, PhD. As he states, when "BH4 is limited, nitric oxide synthase produces superoxide instead of NO". To support Nrf2's role in chemical sensitivy, it is now understood that Nrf2 sustains the balance between eNOS and the production of NO. Also, gut dysbiota has been suggested as a factor in a number of environmental illnesses including chemical sensitivity, fibromyalgia and especially autism. (Care)

The methionine synthase pathway is dependant on B12 and as Deth explains this pathway is a link between folate and methionine. Recent discoveries have revealed methionine synthase is required for the normal metabolism of dopamine such as its neurotransmission and cognitive functioning of attention and focus and can be inhibited both by thimerasol and heavy metals. At the same time, dopamine activates Nrf2 to minimize the effects of the oxidative stress it produces. Some scientists believe abnormal levels of B12-dependant methionine synthase may contribute to ADHD which occurs much more often in boys and may be, as some experts believe, a mild form of autism. Other studies suggest the difference in prevalence of ADHD in boy and girls is less significant and more likely a consequence of failure to diagnose it accurately in girls. (Consentino) In any case and in keeping with this train of thought, caffeine, a methyl donor, is given to remedy some of the symptoms of ADHD but is more addictive to boys than girls. (MedPage Today) From this, one must ask is there a metabolic difference in the methylation cycle and dopamine cycling or another gene such as COMT that effects males and females differently which increases a male's risk for ADHD? Or could there be a sexual dimorphism in Nrf2 expression that can account for this difference. There is no reason why this could not be true, considering caffeine mediates some of its effects through the Nrf2 antioxidant system? (Cavin) Health studies of Nrf2's role in autoimmune disease shows sexual dimorphism with an increased risk for females. It may be the methionine synthase pathway and Nrf2 together account for the sexual dimorphism of ADHD, in caffeine addiction and possibly overall fitness. It could be these two systems have different influences both positive and negative in both boys and girls.(One study demonstrates methionine deficiency complicates Nrf2 deficiency and Nrf2 regulates the MAO system which can control the expression of neurotransmitters and as a result, influence behavior.) Also, why are male flies more resistant to Paraquat and live longer than females flies that are heterozygous for Keap1. (Keap 1 is an an important regulating protein of Nrf2 and sensor for oxidative stress environments.) These are interesting questions and future research may provide answers to these and other questions such as why do more females suffer from environmental diseases like CFS and fibromyalgia but males suffer more from ADHD! (Sykiotis) An Adaptive Biologist and Medical Anthropologist might suggest these dimorphisms exist as trade-offs in behavior control and provide a protective and limiting mechanism for fertility and child-bearing in females but increase lifespan and elevate the drive for sexual foraging in males. At this point, I do not think anyone really knows!

Deficiencies in Nrf2 null animals of methionine and choline, both methyl donors, make them more susceptible to inflammation and fatty liver. This demonstrates Nrf2 deficiency adds to medical pathologies of "poor methylation". In addition, reduced expression of other proteins that coordinate activities with Nrf2 such as the AhR may also influence susceptibility to symptoms of environmental disease including autism and chemical sensitivity. For instance, both the AhR and Nrf2 are required for the induction of UGT transferases which aid in the excretion of toxic compounds such as drugs, bilirubin, hormones and steroids. In the literature, the alteration of UGT function has been implicated in multiple chemical sensitivity and different cancers. Also, the increase of IGF and dopamine increases methionine synthase activity which also requires an increase in B12 and other biological resources. Studies have shown that blocking the methionine synthase pathways inhibits nerve growth factor's (NGF) induction of differentiation and another researcher reports elevation in NGF in B12 deficiency increases neurogenic inflammation resulting in chronic cough and chronic airway discomfort which are symptoms attributed to MCS. (Battaglia-Hsu) The result of B12 deficiency includes "a peripheral sensory neuropathy, causing symptoms such as numbness, tingling, burning, and complete lack of sensation". (Jockers) These are also commonly reported symptoms in MCS. Mercury and lead have been demonstrated to block this pathway, in addition to, an agent called wortmannin which blocks the pathway PI3K. PI3K inhibitors are used experimentally against inflammation and eventually may be used in cancer therapy. (Crane, Science) In a type of liver cancer, the loss of methyltransferases results in uncontrolled epigenetic methylation of DNA. By looking at some of these other pathways that influence methionine metabolism, one must consider a relationship to MCS and autism spectrum disorders.

An important study was released last year by a Canadian research team that demonstrated inflammation in peripheral organs may cause neuroinflammation in the brain. Specifically, the study explains that diseases such as inflammatory bowel disease, hepatitis, and others can lead to inflammatory processes in the brain that can change neurotransmission, alter gene regulation, etc. One of these cytokines is Tnf-a which activates MCP-1. Currently, neuroimmune inflammation is considered one of "the best" hypotheses of what causes autism spectrum disorders and as Dr. Bratt explains, autism is a complex medical condition involving dysfunction in the brain and nervous system, as well as gastrointestinal, immune, emdocrine and detoxification systems." Specifically, "dysregulated immune responses either directly or indirectly adversely affect the course of neurodevelopment in the brain, leading to the development of autism. Immune abnormalities include increased inflammatory cytokines in the plasma and CNS, specifically neuroinflammatory cytokine interleukin-6 (IL-6), proinflammatory cytokine tumor necrosis factor alpha (TNF-a) and chemoattractant cytokine macrophage chemotactic protein-1 (MCP-1). (Enstrom)In addition to the inflammatory mediators above, altered levels of Il23 are found in patients with autism.

Interestingly, these inflammatory processes have been implicated in most environmental illnesses including MCS. IL-23 is a cytokine that initiates T cells to differentiate into IL17 cells which are different from Th1 or Th2. The difference, is a very recent distinction which adds to confusion in the literature of whether inflammatory and autoimmune diseases such as rheumatoid athritis, lupus and MS are Th2 or Il17. Nonetheless, IL17 can stimulate the battery of inflammatory cytokines mentioned above which is capable of neuroimmune dysregulation in the brain and body systems. Last week, we suggested that the absence of Tregs may influence a Nrf2 positive or negative phenotype into an autoimmune-type disorder and demonstrated how environmental pollutants can change the "immune footprint" depending on the type of pollutant and accordingly drive a Th2 driven phenotype characteristic of environmental illnesses such as MCS because they have inflammatory and autoimmune-like presentations. In addition, a study set of CFS patients have been identified with a lower freguency of a protective variant against an anti-inflammatory phenotype of Il-17 giving credibility to the idea that IL-17 may also play an important role in CFS. This also gives support to the idea that CFS and other environmental illnesses including autism are closely linked to one another, are autoimmune and inflammation driven and Nrf2 and cytokine profiles may significantly influence disease presentation and inflammation severity. In addition, individual genetics can influence the exact nature of disease development and the level of methylation may be key to more differences in genetic expression.

Nutrition is an important mechanism for controlling environmental illnesses. Recent nutritional studies show Western Diets promote inflammation. One reason for this, is because saturated fat alters TLR signals that can lead to potentially harmful "immunological footprints". Personally, in addition to the impact of the influences of environment and genetics on environmental illness, another research focus I have is animal health and human nutrition and how different aspects of both can be effect environmental illness. Domesticated pets suffer from many of the same diseases people do and many experts believe these disease may be attributed to imbalances from eating extruded kibble. Poor diet adaptation is common in both animals and humans. Numerous studies have shown that as humans culturally adapt to a more modern diet the prevalence of several diseases increases. As we have demonstrated a number of dietary factors influence environmental illnesses such as autism, CFS and MCS and the modern diet may not only be lacking in B12, vitamin D and fatty acids (ie omega 3) but may lack other macro and micronutrients. Specifically for the diseases I mention here, including autism and chemical sensitivity one must consider methionine (too much or too little) and the pathway that regulates it as a contributing factor.

New studies suggest that dietary restriction and subsequent restrictions of methionine reduces the amount of oxidative stress on mitochondrial DNA and there are studies have shown that patients with environmental illness have higher levels of oxidative stress. (Caro) From these results, the subject of limiting dietary sources of methionine and supplementation of methionine could be an important conversation to have with a physician. Anthropolically, it is true different people can tolerate different foods and the nutritional resources they provide better than others and this is all due to genetics. It becomes a problem when an individual's genetics do not "mesh" well - so to speak or as I have often said "do not get along" or specific influences (like a lack of biological resources, ie. B12) are altering genetic expression at "that point in time". This, unfortunately, adds to the complexity for diagnosis and treatment of environmental diseases and may contribute to the "fluctuating presentation" of these conditions. Interestingly, elk and fish contain higher levels of methionine and are eaten more by indigenous people. Compare that to a higher consumption of beef (also high in fat) which is part of a more "Western and Modern Diet" and contains less methionine. (eHow) Unfortunately, the prevalence of environmental diseases like cardiovascular disease and diabetes in indigenous people is increasing at an astounding rate and experts believe that eating more foods from "modern" diets in contrast to foods from a traditional diet may be partly to blame. Ethnically-derived genetic mutations in Nrf2 may increase liver injury (and increase environmental disease) exaggerating the effects of inhibiting factors on the methionine synthase pathway. Conditions like these may increase the prevalence of autoimmune and inflammatory disease in some more than others (like indigenous people and their descendants).

In other blogs we discuss how other dietary factors influence environmental illness. Several studies show polyphenols can effect methylation. As we noted above, DNA methylation has been associated with the silencing of genes and the most current research shows there is a relationship of methylation to different kinds of cancer such as bladder and prostate cancer. Fang points out both hypermethylation and hypomethylation are associated with carcinogenesis. Currently, prostate cancer is the second leading cause of cancer in men and a common cause is the silencing of GSTP1. This is a process that occurs through the methylation of "CG islands" by DNA methyltransferase (DMNT) early on in the cancer process. Polyphenols inhibit DMNT and in theory, can reverse hypermethylation of suppressed genes. (Fang) Other studies show abherrant methylation and suppression of Nrf2 expression in prostate tumorigenesis and as Arisawa demonstrates the polymorphisms in Nrf2 greatly effect abherrant methylation and for cancer, Nrf2 becomes a "very" significant factor. Over the years, studies with sulphoraphane (a chemical in broccoli) have shown health benefits at slowing prostate cancer growth and inhibiting colon cancer. Another study demonstrates isothiocyanate prevents glutathione depletion in Parkinson's disease. Also, EGCG, a compound in green tea, has demonstrated promising therapeutic benefits for prostate, breast, pancreatic cancer and most recently, lung cancer. Both sulphoraphane and EGCG activate the Nrf2 antioxidant system, in addition to other mode of therapeutic modes of action.

It has been reported that autism now effects 1 out of 150 children. Although some believe this figure is closer to 1 in 100. Yet there are no "specifics" on the major cause of the spectrum of these disorders. In 2006, over 11 million cases of cancer were reported and the combined cases of prostate, skin, breast and colon cancer cases made up almost 50% of them. While the study of epigenetics is in its infancy, there is substantial support, as we have discussed here, that methylation influences can and do lead to the development of environmental illness. In addition, new research seems to support that all of these conditions are very similar to one another but present with different "genetic footprints" and Nrf2 expression only adds to their complexity. Because of the complexity of environmental illnesses, the severity of their consequences including high morbidity and mortality and the tremendous toll they take on public health resources, there is a critical need for an increase in credible and verifiable environmental illness research which will undoubtedly reveal more about how to diagnose, treat and cure them. In addition, it is important for medical practioners to be trained in both allopathic and complementary and holistic care that emphasizes understanding the genetic, cultural and environmental influences that impact wellness and disease. Lastly, more informed communications should be disseminated to the media and the public at large about new insights and discoveries in environmental medicine and new, innovative and alternative therapies used to treat these diseases that work and to objectively clarify why there are some therapies out there that do not work.




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