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Involvement of Epigenetics in the Pathogenesis, Testing and Management of Coronavirus Disease 2019 (COVID-19) Pandemic: A Narrative Review

Background: There is an intense search for the Coronavirus Disease 19 (COVID-19) cure, to stem the spread and burden of the disease worldwide. Studies revealed that epigenetic modifications impact the pathogenesis of some COVID-19 cases, which can be used as therapeutic targets.  
Objectives: This review articulated the role of epigenetics in the pathogenesis and management of COVID-19. 
Methods: Relevant articles published between January 2000 and November 2020 were retrieved from reputable academic databases, including PubMed, SpringerLink, Scopus, and Google Scholar. 
Results: Epigenetic modifications in the COVID-19’s pathogen, called the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and host’s cells may influence susceptibility or resistance to the disease. Notably, abnormal Deoxyribonucleic Acid (DNA) methylation and histone modification involving immune regulatory genes and molecules, such as cytokines and interferon-regulated genes may compromise immune function and enhance the host’s susceptibility and disease severity. The hypomethylation of SARS-CoV-2’s receptor, called the Angiotensin-Converting Enzyme 2 (ACE2), causing its overexpression, can also enhance SARS-CoV-2’s infectivity. Moreover, SARS-CoV-2 can hijack the host’s MicroRNA (miRNA) using its miRNA and compromise the immune function, increasing its infectivity. Fortunately, epigenetic changes are reversible; thus, a therapy that targets the epigenetic changes in the affected case may reverse COVID-19.  
Conclusion: Modifications in the SARS-CoV-2 or host epigenome promote the pathogenesis and severity of COVID-19. Epigenetic changes are reversible, so healthcare providers are advised to formulate therapeutic procedures that target the causal mechanisms in the affected individual.