Ayurvedic Personalized Healthcare

[Full title: Ayurvedic Personalized Healthcare: Integrating Genomics, Epigenomics and Traditional Wisdom]

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[Find the meaning and references behind the names: Nair, Priya, Tamil, Devi, Lakshmi]

REVIEW ARTICLE November 2024 Journal of Ayurveda and Integrated Medical Sciences | November 2024 | Vol. 9 | Issue 11 192 Ayurvedic Personalized Healthcare: Integrating Genomics, Epigenomics and Traditional Wisdom Lakshmi Priya R 1 , Devi S. Nair 2 1 Second Professional BAMS, Ayurveda College Coimbatore, Tamil Nadu, India. 2 Associate Professor & HOD, Dept. of Roga Nidana, Ayurveda College Coimbatore, Tamil Nadu, India. I NTRODUCTION The evolution of personalized medicine marks a significant shift in healthcare delivery, emphasizing the need for treatments tailored to individual genetic profiles [1] Ayurveda , an ancient Indian system of medicine, provides a holistic framework for understanding health through the lens of individual constitution or Prakriti . This paper presents a practical approach to integrating Ayurvedic principles with Address for correspondence: Dr. Devi S. Nair Associate Professor & HOD, Dept. of Roga Nidana, Ayurveda College Coimbatore, Tamil Nadu, India. E-mail: drlakshmipriyarajkumar@gmail.com Submission Date: 12/10/2024 Accepted Date: 20/11/2024 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.9.11.27 modern genomic science to enhance personalized healthcare. A Prakriti -based approach to medicine holds significant potential in the evolving landscape of global health wisdom. Ayurveda contributes through its modalities of Ahara (diet), Vihara ( lifestyle), and Aushadhi (medication), which serve as foundational pillars in creating a holistic healthcare system rooted in Prakriti , thereby establishing it as a comprehensive science [2] The concept of Prakriti encompasses physical, mental, and emotional attributes that define an individual. By correlating these attributes with genomic data, we can develop personalized treatment strategies that address not only genetic predispositions but also lifestyle and environmental factors. This integration has the potential to revolutionize healthcare by offering more effective prevention and treatment options. A IM AND O BJECTIVES The primary objective of this paper is to propose a framework for merging Ayurvedic principles with A B S T R A C T In the evolving landscape of personalized medicine, integrating Ayurvedic principles with modern genomic science presents a transformative opportunity for healthcare. This paper explores the concept of Prakriti , the unique constitution of individuals as defined in Ayurveda , and its potential correlation with genetic profiles. By merging Ayurvedic insights with genomic and epigenomic research, we propose a framework for personalized healthcare that considers both genetic predispositions and lifestyle factors. The study outlines practical approaches, including the use of Single Nucleotide Polymorphism (SNP) analysis to identify genetic variations linked to specific Prakriti types, and the role of epigenetics in understanding how lifestyle choices influence gene expression. Additionally, we discuss the implementation of Genome-Wide Association Studies (GWAS) to identify biomarkers that can enhance disease prevention and treatment strategies tailored to individual needs. By fostering collaboration between Ayurvedic practitioners and genomic researchers, we aim to promote a holistic understanding of health that bridges ancient wisdom with contemporary science. Ultimately, this integration not only enriches personalized healthcare but also paves the way for innovative treatment solutions that honor both genetic diversity and traditional knowledge. Key words: Ayurveda, Personalized healthcare, Genomics, Epigenomics, SNP Analysis, GWAS

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Lakshmi Priya R. et al. Integrating Genomics, Epigenomics and Traditional Wisdom ISSN: 2456-3110 REVIEW ARTICLE November 2024 Journal of Ayurveda and Integrated Medical Sciences | November 2024 | Vol. 9 | Issue 11 193 genomic and epigenomic research to advance the personalized healthcare. The specific aims include: 1. To explore the relationship between genetic constitution and Prakriti : Understanding how genetic variations correspond to different Ayurvedic constitutions. 2. To examine the role of lifestyle factors in gene expression: Investigating how diet, stress management, and other lifestyle choices influence health outcomes through epigenetic modifications. 3. To identify genetic markers associated with Prakriti types: Utilizing Genome-Wide Association Studies (GWAS) to discover biomarkers that can inform disease prevention and treatment strategies. L ITERATURE R EVIEW A thorough review of existing literature was conducted to identify key findings on the intersection of Ayurveda and genomics. This review encompassed studies on Single Nucleotide Polymorphism (SNP) analysis and its relevance in understanding individual differences in health. Practical Framework Development 1. SNP Analysis We propose utilizing SNP analysis as a tool for identifying genetic variations linked to specific Ayurvedic constitutions. By examining SNPs associated with various health conditions prevalent in different Prakriti types, healthcare practitioners can tailor interventions accordingly. 2. Epigenetic Considerations The role of epigenetics in modifying gene expression based on lifestyle factors is crucial. We suggest developing educational programs focused on diet, exercise, and stress management that align with individual Prakriti types to optimize health outcomes. GWAS Implementation Implementing GWAS can provide insights into genetic variations across different populations. By identifying specific biomarkers associated with each Prakriti type, we can enhance our understanding of disease susceptibility and treatment efficacy. Integration Strategies 1. Collaborative Research Initiatives Establishing partnerships between Ayurvedic practitioners and genomic researchers will facilitate the exchange of knowledge and resources necessary for integrating these fields effectively. 2. Public Awareness Campaigns Raising awareness about the benefits of personalized healthcare through Ayurveda and genomics can encourage individuals to seek personalized treatment approaches based on their unique constitutions. 3. Technology Utilization Leveraging technology such as mobile applications for dietary recommendations based on genetic profiles can enhance patient engagement and adherence to personalized health plans. R ESULT Expected Outcomes By implementing the proposed framework for integrating Ayurveda with genomics, we anticipate several positive outcomes: 1. Enhanced Personalization Individuals will receive more tailored healthcare solutions that consider their unique genetic makeup and lifestyle factors. 2. Improved Health Literacy Educational programs will empower individuals to make informed decisions about their health based on their Prakriti type. 3. Innovative Treatment Strategies The identification of genetic markers linked to specific health conditions will lead to more effective prevention and treatment strategies tailored to individual needs. Practical Applications 1. Dietary Modifications: Based on an individual's Prakriti type identified through SNP analysis,

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[Find the meaning and references behind the names: Aakash]

Lakshmi Priya R. et al. Integrating Genomics, Epigenomics and Traditional Wisdom ISSN: 2456-3110 REVIEW ARTICLE November 2024 Journal of Ayurveda and Integrated Medical Sciences | November 2024 | Vol. 9 | Issue 11 194 dietary recommendations can be customized to optimize metabolic health and prevent chronic diseases. 2. Lifestyle Interventions: Personalized lifestyle interventions focusing on stress reduction techniques suitable for different Prakriti types can improve overall well-being. 3. Preventive Healthcare Models: Developing preventive healthcare models that incorporate both Ayurvedic principles and genomic insights will promote proactive health management among individuals. DISCUSSION Prakriti Each individual is born with a distinct proportion of the Tridoshas , which is influenced not only by genetics but also by the environment during foetal development. The characteristics of a person are shaped by their predominant Dosha Prakriti , and the dominant Dosha plays a crucial role in regulating their physiology. Consequently, taking into account an individual's Dosha Prakriti when developing preventive and treatment strategies can help identify effective lifestyle interventions to be used in conjunction with medication. This approach is reflected in the concept of Dashavidha Pariksha , a fundamental principle of personalized medicine, which emphasizes the importance of considering an individual's Dosha Prakriti (Charaka Samhita). Prakriti refers to the unique combination of the three doshas that each individual is born with. The Tridoshas consist of the five Mahabhutas - Air ( Vayu ), Water ( Jal ), Fire ( Agni ), Earth ( Bhumi ), and Space ( Aakash ) - with one Dosha typically being predominant while the others exert a lesser influence. The Vata Dosha is composed of the Mahabhutas Akasha (space) and Vayu (air). Pitta Dosha is formed by the combination of Tejas or Agni (fire) and Ap (water) Mahabhutas . In contrast, Kapha Dosha consists of Ap (water) and Prithvi (earth) Mahabhutas . When there is an imbalance in the Doshas , an individual is identified as being dominant in Vata , Pitta , or Kapha . Each Dosha confers specific traits to the person, which allows for categorization into a particular Dosha type [3] Among the disorders associated with Vata are neurological, developmental, speech, and motor disorders, as well as dementia and arrhythmias. Pitta elevation is linked to conditions such as ulcers, skin diseases, and bleeding disorders, while Kapha elevation is associated with diabetes, obesity, and atherosclerotic conditions. The assessment of disturbances in specific Doshas is conducted through various indications, and the primary objective of Ayurvedic practitioners is to quantify the extent of these disturbances. This is followed by efforts to restore balance to the Doshas through appropriate dietary and therapeutic interventions [4] While Prakriti and the Tridoshas form the foundational principles of personalized Ayurvedic practices for prognostic treatments, it is essential to establish their molecular basis [5] Genomics A genome is a comprehensive set of DNA that comprises all of an organism's genes, as well as its hierarchical, three-dimensional structural configuration. The human genome consists of 23 pairs of chromosomes (diploid), each containing approximately 3 billion base pairs of DNA inherited from both parents. Variations in the human genome sequence, known as single nucleotide polymorphisms (SNPs), can occur. While some of these variations are common and found in a significant proportion of individuals, others are rare. Variations that occur in less than 1% of the population are typically classified as mutations. Many rare disorders are monogenic, resulting from mutations in a single gene, such as hemophilia and beta-thalassemia. In contrast, complex disorders like diabetes, asthma, and cardiovascular disease are multigenic, involving multiple genes [6] Genomics provides a predictive, personalized understanding of an individual's genetic information, while Ayurveda , as an ancient system of personalized medicine, determines the appropriate treatments and dietary plans based on a detailed clinical assessment of the patient's disease characteristics, innate

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[Find the meaning and references behind the names: Long, Main, Ayush]

Lakshmi Priya R. et al. Integrating Genomics, Epigenomics and Traditional Wisdom ISSN: 2456-3110 REVIEW ARTICLE November 2024 Journal of Ayurveda and Integrated Medical Sciences | November 2024 | Vol. 9 | Issue 11 195 constitution, and current health status [7] For the first time, the integration of Prakriti classification methods with modern genomics led to the identification of the molecular and genomic foundations of Dosha Prakriti theory. Healthy individuals with different Prakriti types, as defined by Ayurveda , exhibit notable variations in their biochemical and hematological parameters. Genomic research further revealed significant differences in gene expression among the main Prakriti types, particularly in genes related to immunity, cell division, blood coagulation, and other vital processes [8] Ayurveda and genomics can complement each other, particularly in developing preventive healthcare strategies. Access to timetested, personalized prevention and lifestyle recommendations would make it easier for individuals to practice self-care. For the first time, integrating Prakriti differentiation methods with modern genomics has revealed the molecular genetics foundation of the Dosha Prakriti concept [9] Epigenetics Epigenetics examines heritable and stable changes in gene expression that arise from modifications to the chromosome, rather than changes to the DNA sequence itself. Although epigenetic mechanisms do not alter the DNA sequence directly, they regulate gene expression through chemical modifications of DNA bases and alterations to the chromosomal structure in which the DNA is organized [10] This process leads to phenotypic changes without altering the genotype. The genotype refers to the genetic makeup that determines specific traits (coding genes) and remains unchanged unless there is toxic damage. On the other hand, an individual's phenotype - such as appearance, behaviour, and development - is influenced by the genotype. However, environmental factors like lifestyle or psychological influences can impact the phenotype, potentially affecting the expression of the genotype. Epigenetics is thought to play a crucial role in Ayurveda, as it integrates both genotypic and phenotypic variations. Ayurveda explains how various factors such as behaviour, lifestyle, stress, diet, digestion, and the environment influence Deha Prakriti (the psychological and physiological constitution), which corresponds to the phenotype, while Janma Prakriti relates to the genotype. By understanding this connection, the interaction between Ayurveda and the modern healthcare system can be enhanced, fostering a stronger integration of both fields in promoting overall health and well-being [11] Four key factors influence the phenotype, or Deha Prakriti , either positively or negatively based on an individual’s lifestyle: 1) behaviour and lifestyle, 2) digestion and diet, 3) stress, and 4) environmental conditions. Ayurveda identifies these aspects as essential for positively affecting both genotype and phenotype through epigenetic mechanisms. Consequently, epigenetics is considered a fundamental element in Ayurveda . Epigenetic changes can also have long-term effects, impacting future generations. Factors such as nutritional deficiencies, environmental toxins, and stress may trigger epigenetic modifications that are inherited, potentially leading to illness in descendants. Epigenomics explores how proteins, metabolic processes, and both genetic and non-genetic factors influence human physiology, highlighting key mechanisms that contribute to individual health risks. Ayurgenomics can offer insights into how current medications could be more effectively tailored when targeted at individuals with specific Prakriti types [12] Research Insights on Genomics and Epigenomics: Transforming Drug Development for Personalized Care Numerous scientific articles highlight the effectiveness and potential of Ayurvedic medicines. For instance, during the ongoing COVID-19 pandemic, an in-silico evaluation of AYUSH-64 - a patented Ayurvedic formulation developed by India’s Central Council of Research in Ayurvedic Sciences, which has been used clinically for several decades as an anti-malarial, antiinflammatory, and anti-pyretic agent - indicated that this medicine could be a promising candidate for repurposing in the treatment of COVID-19 [13] A 2015 study discovered specific DNA methylation markers that differentiate among the various types of Prakriti . The findings indicate that DNA methylation may play a

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Lakshmi Priya R. et al. Integrating Genomics, Epigenomics and Traditional Wisdom ISSN: 2456-3110 REVIEW ARTICLE November 2024 Journal of Ayurveda and Integrated Medical Sciences | November 2024 | Vol. 9 | Issue 11 196 role in chromatin regulation, which influences the distinct phenotypes of Prakriti . This research offers valuable insights into the epigenetic mechanisms that support the personalized approach of Ayurvedic medicine [14] Numerous significant efforts have been undertaken to correlate Prakriti classification with genetic data, particularly by examining the association of single nucleotide polymorphisms (SNPs), in an attempt to establish the genetic and molecular basis of Prakriti . One of the most comprehensive studies published in 2015 identified 52 SNPs that were significantly different among the three primary forms of Prakriti . SNPs (single nucleotide polymorphisms) are the most common type of genetic variation found in humans, representing changes at a single nucleotide level in the DNA sequence. The study also revealed that the SNP in the PGM 1 gene (rs 11208257), which is associated with energy generation, is more homogeneous and consistent in Pitta body types compared to Kapha and Vata types [15] Genetic marker studies and genome-wide expression analyses (GWAS) indicate that the majority of genetic variation arises from differences in genetic loci between individuals within a population. The vast diversity in gene expression and sequence variation, combined with interactions within genetic networks and environmental influences, plays a significant role in phenotypic variation, impacting both health and disease. In 2008, a comprehensive study conducted by her team examined the biological and genome-wide expression levels among participants from the three primary Prakriti groups — Vata, Pitta, and Kapha . The study involved healthy individuals representing the extreme variations of these Prakriti types. Researchers focused on the CYP 2 C 19 gene, finding a strong association between this gene and the Prakriti phenotype. The results indicated that individuals with a Pitta dominance exhibited over-expression of genes related to immune response pathways. In contrast, Kapha males showed higher levels of metabolic syndrome and chronic inflammation markers compared to their Vata counterparts, which aligned with the increased expression of inflammatory response genes in these individuals. Additionally, prothrombin time, an indicator of blood coagulation, was found to be lower in Kapha males. The study also revealed increased expression of hemoglobin-related genes in Pitta individuals compared to both Vata and Kapha , which corresponded with higher hemoglobin levels and the characteristic skin redness observed in Pitta types. Furthermore, genes associated with fibrinolysis were down-regulated in Kapha males, while those involved in ATP and cofactor production were up-regulated. The researchers also noted that Kapha individuals had elevated levels of total cholesterol, triglycerides, high-density lipoprotein (HDL), and lowdensity lipoprotein (LDL) compared to both Pitta and Vata types [16] CONCLUSION Integrating Ayurveda with genomics offers a promising pathway toward personalized healthcare that respects both ancient wisdom and modern scientific advancements. By focusing on individual constitutions through Prakriti while considering genetic predispositions and lifestyle factors, we can develop innovative healthcare solutions that enhance patient outcomes. This synthesis not only enriches our understanding of health but also paves the way for individualized treatments based on comprehensive insights into genetics and traditional practices. As we continue to explore these intersections, the future of personalized healthcare looks bright. Challenges and Considerations While the potential benefits are significant, several challenges must be addressed: 1. Cultural Acceptance: Ensuring that both practitioners and patients embrace this integrative approach requires cultural sensitivity and education about the benefits of personalized medicine. 2. Regulatory Frameworks: Developing appropriate regulatory frameworks will be essential for ensuring ethical practices in genomic testing and data usage within Ayurvedic contexts

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[Find the meaning and references behind the names: Raju, Sharath, Sharma, Singh, Ram, Jyothi, Genet, Ayu, Keith, Nizamuddin, Mar, Mandal, Devaraj, Kumari, Ray, Haider, Nil, Aboud, Med, Pasha, Shilpa, Jan]

Lakshmi Priya R. et al. Integrating Genomics, Epigenomics and Traditional Wisdom ISSN: 2456-3110 REVIEW ARTICLE November 2024 Journal of Ayurveda and Integrated Medical Sciences | November 2024 | Vol. 9 | Issue 11 197 REFERENCES 1 Personalized Medicine Coalition. "What is Personalized Medicine?" 2020. 2 Chatterjee B, Pancholi J. Prakriti-based medicine: A step towards personalized medicine. Ayu. 2011 Apr;32(2):141-6. doi: 10.41;03/0974-8520.92539. PMID: 22408293; PMCID: PMC 3296331. 3 Understanding personality from Ayurvedic perspective for psychological assessment A case Shilpa, S 1 ; Venkatesha Murthy, C. G 2 AYU (An International Quarterly Journal of Research in Ayurveda) 32(1):p 12- 19, Jan – Mar 2011. 4 PRASHER, B., GIBSON, G. & MUKERJI, M. Genomic insights into ayurvedic and western approaches to personalized medicine. J Genet 95, 209 – 228 (2016). 5 Haider M, Dholakia D, Panwar A, Garg P, Gheware A, Singh D, Singhal K, Burse SA, Kumari S, Sharma A, Ray A, Medigeshi GR, Sharma U, Prasher B, Mukerji M. Transcriptome analysis and connectivity mapping of Cissampelos pareira L. provides molecular links of ESR 1 modulation to viral inhibition. Sci Rep. 2021 Oct 11;11(1):20095. 6 Aggarwal S, Negi S, Jha P, Singh PK, Stobdan T, Pasha MA, Ghosh S, Agrawal A; Indian Genome Variation Consortium; Prasher B, Mukerji M. EGLN 1 involvement in high-altitude adaptation revealed through genetic analysis of extreme constitution types defined in Ayurveda. Proc Natl Acad Sci U S A. 2010 Nov 2;107(44):18961-6. doi: 10.1073/pnas.1006108107. Epub 2010 Oct 18. 7 Sethi T. P., Prasher B., Mukerji M. (2011). Ayurgenomics: A New Way of Threading Molecular Variability for Stratified Medicine. ACS Chem. Biol. 6, 875 – 880. 10.1021/cb 2003016 8 Chatterjee B., Pancholi J. (2011). Prakriti-based Medicine: A Step towards Personalized Medicine. Ayu 32, 141 – 146. 10.4103/0974-8520.92539 9 Hawkins R. D., Hon G. C., Ren B. (2010). Next-generation Genomics: an Integrative Approach. Nat. Rev. Genet. 11, 476 – 486. 10.1038/nrg 2795 10 Al Aboud NM, Tupper C, Jialal I. Genetics, Epigenetic Mechanism. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. 11 Sharma H., Keith Wallace R. (2020). Ayurveda and Epigenetics. Med. 10.3390/medicina 56120687 12 Chatterjee B., Pancholi J. (2011). Prakriti-based Medicine: A Step towards Personalized Medicine. Ayu 32, 141 – 146. 10.4103/0974-8520.92539 13 Ram T. S., Munikumar M., Raju V. N., Devaraj P., Boiroju N. K., Hemalatha R., et al. (2022). In Silico evaluation of the Compounds of the Ayurvedic Drug, AYUSH-64, for the Action against the SARS-CoV-2 Main Protease. J. Ayurveda Integr. Med. 13, 100413. 10.1016/j.jaim.2021.02.004 14 Rotti H., Mallya S., Kabekkodu S. P., Chakrabarty S., Bhale S., Bharadwaj R., et al. (2015). DNA Methylation Analysis of Phenotype Specific Stratified Indian Population. J. Transl Med. 13, 151. 10.1186/s 12967- 015-0506-0 15 Govindaraj P., Nizamuddin S., Sharath A., Jyothi V., Rotti H., Raval R., et al. (2015). Genome-wide Analysis Correlates Ayurveda Prakriti. Sci. Rep. 5, 15786. 10.1038/srep 15786 16 Prasher B., Negi S., Aggarwal S., Mandal A. K., Sethi T. P., Deshmukh S. R., et al. (2008). Whole Genome Expression and Biochemical Correlates of Extreme Constitutional Types Defined in Ayurveda. J. Transl Med. 6, 48. 10.1186/1479-5876-6-48. How to cite this article: Lakshmi Priya R, Devi S. Nair. Ayurvedic Personalized Healthcare: Integrating Genomics, Epigenomics and Traditional Wisdom. J Ayurveda Integr Med Sci 2024;11:192-197. http://dx.doi.org/10.21760/jaims.9.11.27 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2024 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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