Month: February 2018

What will it take for childhood trauma research to change paradigms?

gettingwell4 0-1 star Wasted resources, Brain development, Cortisol, Epigenetics, Hippocampus, Hypothalamus, Limbic system, Memory, Neurochemicals, Serotonin, Stress , , ,

This 2018 German human study found:

“DNA methylation in a biologically relevant region of NR3C1-1F [glucocorticoid receptor gene] moderates the specific direction of HPA-axis dysregulation (hypo- vs. hyperreactivity) in adults exposed to moderate-severe CT [childhood trauma].

In contrast, unexposed and mildly-moderately exposed individuals displayed moderately sized cortisol stress responses irrespective of NR3C1-1F DNA methylation. Contrary to some prior work, however, our data provides no evidence for a direct association of CT and NR3C1-1F DNA methylation status.”

The study was an example of why researchers investigating the lasting impacts of human traumatic experiences won’t find causes, effects, and productive therapies until their paradigms change.

1. Limited subject histories

A. Why weren’t the subjects asked for historical information about their parents, grandparents, and great-grandparents?

The researchers had no problem using animal studies to guide the study design, EXCEPT for animal studies of the etiologic bases of intergenerational and transgenerational transmission of biological and behavioral phenotypes. Just the approximate places and dates of three generations of the German subjects’ ancestors’ births, childhoods, adolescences, and early adulthoods may have provided relevant trauma indicators.

B. Why are studies still using the extremely constrained Childhood Trauma Questionnaire? Only one CTQ aspect was acknowledged as a study design limitation:

“Our findings rely on retrospective self-report measures of CT, which could be subject to bias.”

But bias was among the lesser limiting factors of the CTQ.

The study correlated epigenetic changes with what the subjects selectively remembered, beginning when their brains developed sufficient cognitive functionalities to put together the types of memories that could provide CTQ answers – around age four. The basic problem that kept the CTQ from discovering likely most of the subjects’ traumatic experiences causing epigenetic changes was that these experiences predated the CTQ’s developmental starting point:

  1. A human’s conception through prenatal period is when both the largest and the largest number of epigenetic changes occur, and is when our susceptibility and sensitivity to our environment is greatest;
  2. Birth through infancy is the second-largest; and
  3. Early childhood through the age of three is the third largest.

CTQ self-reports were – at best – evidence of experiences after age three, distinct from the  experience-dependent epigenetic changes since conception. If links existed between the subjects’ early-life DNA methylation and later-life conditions, they weren’t necessarily evidenced by CTQ answers about later life that can’t self-report relevant early-life experiences that may have caused DNA methylation.

2. Limited subject selection

The researchers narrowed down the initial 622 potential subjects to the eventual 200 subjects aged 18 to 30. An exclusion criteria that was justified as eliminating confounders led to this limitation statement:

“Our results might be based on a generally more resilient sample as we had explicitly excluded individuals with current or past psychopathology.”

Was it okay for the researchers to assert:

“Exposure to environmental adversity such as childhood trauma (CT) affects over 10% of the Western population and ranges among the best predictors for psychopathology later in life.”

but not develop evidence for the statement by letting people who may have been already affected by age 30 and received treatment participate in the study?

Was the study design so fragile that it couldn’t adjust to the very people who may be helped by the research findings?

3. Limited consequential measurements

The current study design conformed to previous studies’ protocols. The researchers chose cortisol and specific DNA methylation measurements.

A. Here’s what Sex-specific impacts of childhood trauma had to say about cortisol:

“Findings are dependent upon variance in extenuating factors, including but not limited to, different measurements of:

  • early adversity,
  • age of onset,
  • basal cortisol levels, as well as
  • trauma forms and subtypes, and
  • presence and severity of psychopathology symptomology.”

The researchers knew or should have known all of the above since this quotation came from a review.

B. What other consequential evidence for prenatal, infancy, and early childhood experience-dependent epigenetic changes can be measured? One overlooked area was including human emotions as evidence.

There are many animal studies from which to draw inferences about human emotions. There are many animal models of creating measurable behavioral and biological phenotypes of human emotion correlates, with many methods, including manipulating environmental variables during prenatal, infancy, and early childhood periods.

Studies that take detailed histories may arrive at current emotional evidence for human subjects’ earliest experience-dependent changes. Researchers who correlate specific historical environments and events, stress measurements, and lasting human emotions expressed as “I’m all alone” and “No one can help me” will better understand causes and effects.

CTQ answers weren’t sufficiently detailed histories.

4. Limited effective treatments and therapies

The current study only addressed this area in the final sentence:

“Given their potential reversibility, uncovering epigenetic contributions to differential trajectories following childhood adversity may serve the long-term goal of delivering personalized prevention strategies.”

Researchers – if your paradigms demonstrate these characteristics:

  • Why are you spending your working life in efforts that can’t make a difference?
  • Aren’t your working efforts more valuable than that?
  • What else could you investigate that could make a difference in your field?

I hope that researchers will value their professions enough to make a difference with their expertise. And that sponsors won’t thwart researchers’ desires for difference-making science by putting them into endless funding queues.

http://www.psyneuen-journal.com/article/S0306-4530(17)31355-0/pdf “Glucocorticoid receptor gene methylation moderates the association of childhood trauma and cortisol stress reactivity” (not freely available)

Cell senescence and DNA methylation

gettingwell4 2-3 stars Required further work, Epigenetics, Stress, Telomeres ,

This 2018 Baltimore cell study found:

“Based on similarities in overall methylation patterns in replicative senescence and cancers, it is hypothesized that tumor-promoting DNA methylation in cancers derives from cells escaping senescence.

We show that the tumor-associated methylation changes evolve independently of senescence and are pro-survival events with functional implications contrasting that in senescence.

In our analyses, although overall global gains and losses in DNA methylation are similar, at individual genomic regions the methylation patterns are very different for senescence versus transformation.”

https://www.sciencedirect.com/science/article/pii/S1535610818300084 “DNA Methylation Patterns Separate Senescence from Transformation Potential and Indicate Cancer Risk” (not freely available)

I hesitated to use the study’s main graphic:
because the “Stochastic” labeling of the upper branch didn’t represent the vector’s meaning. The In Brief and the Summary sections contributed to the misrepresentation by stating:

“transformation-associated methylation changes arise stochastically.”

which wasn’t the study’s main finding:

“Our data outlined in the above sections strongly suggest against this senescence bypass hypothesis.”

Although the experimental design and methods evoked randomness:

“Immortalization on the path to malignant transformation involves stochastic epigenetic patterns from which cells contributing to transformation may evolve.”

the graphic’s upper branch vector represented the cells’ evolutionary responses. The Significance section best characterized what the study found:

“Tumor-associated methylation changes evolve independently of senescence and are pro-survival events.”

Would anyone at John Hopkins argue, as the graphic’s upper branch labeling suggested, that cellular aging is a predominantly random process? NO!

1. Epigenetics research and evolution promoted understanding the graphic’s upper branch vector:

“Evolution is an ongoing set of iterative interactions between organisms and the environment. Directionality is introduced by the agency of organisms themselves.”

2. The current study provided another data point about the uselessness of convenient but non-etiologic, inconsequential measurements of global methylation:

“Although overall global gains and losses in DNA methylation are similar, at individual genomic regions the methylation patterns are very different.”

3. The current study was congruent with the below finding of Using an epigenetic clock to distinguish cellular aging from senescence regarding the differentiation of cellular aging from senescence:

“Cellular ageing is distinct from cellular senescence and independent of DNA damage response and telomere length.”

The influence of donor age on induced pluripotent stem cell functionality

gettingwell4 4-5 stars Advanced knowledge, Epigenetics, Telomeres ,

This 2018 German review subject was the influence of donor age on induced pluripotent stem cell functionality:

“Induced pluripotent stem cells (iPSCs) avoid many of the restrictions that hamper the application of human embryonic stem cells. Also, the donor’s clinical phenotype is often known when working with iPSCs.

Typical signs of cellular ageing are reverted in the process of iPSC reprogramming, and iPSCs from older donors do not show diminished differentiation potential nor do iPSC-derived cells from older donors suffer early senescence or show functional impairments when compared with those from younger donors.”

The reviewers discussed limitations in the current research:

  • “Mutations in nuclear and mitochondrial DNA acquired over the donor’s lifespan and during the reprogramming process might persist.
  • It is not yet known how strongly the variable genetic background of individual donors affects the reprogramming process and the quality of resulting iPSCs.
  • A low number of donors and cell lines is a general problem in almost all research articles on the topic of iPSCs. This combined with the lack of a standardised protocol for optimal iPSC derivation, culture and quality control makes any comparison between different publications very difficult if not impossible. Especially, since it has been shown that many factors influence the quality of iPSCs and iPSC-derived cells, such as time and cell type used for reprogramming, time in culture, or reprogramming modality.
  • A problem lies in the retention of tissue-specific epigenetic alterations which in part could be caused by incomplete reprogramming and might be improved by vigorous quality testing and careful selection of iPSC colonies during reprogramming and passaging.
  • The question regarding tumourigenicity will most likely only be answered satisfactorily once 1) the differentiation methods are further improved, 2) iPSC-derived cell-based therapies have made their way further into clinical practice, and 3) patients receiving treatments have been observed for multiple years.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5790033/pdf/fcvm-05-00004.pdf “Age Is Relative-Impact of Donor Age on Induced Pluripotent Stem Cell-Derived Cell Functionality”

Sex-specific impacts of childhood trauma

gettingwell4 4-5 stars Advanced knowledge, Amygdala, Anterior cingulate cortex, Cerebrum, Cortisol, Dopamine, Epigenetics, Hippocampus, Hypothalamus, Limbic system, Memory, Neurochemicals, Serotonin, Stress, Telomeres, Testosterone , , , , ,

This 2018 Canadian paper reviewed evidence for potential sex-specific differences in the lasting impacts of childhood trauma:

“This paper will provide a contextualized summary of neuroendocrine, neuroimaging, and behavioral epigenetic studies on biological sex differences contributing to internalizing psychopathology, specifically posttraumatic stress disorder and depression, among adults with a history of childhood abuse.

Given the breadth of this review, we limit our definition [of] trauma to intentional and interpersonal experiences (i.e., childhood abuse and neglect) in childhood. Psychopathological outcomes within this review will be limited to commonly explored internalizing disorders, specifically PTSD and depression.

Despite the inconsistent and limited findings in this review, a critical future consideration will be whether the biological effects of early life stress can be reversed in the face of evidence-based behavioral interventions, and furthermore, whether these changes may relate to potentially concurrent reductions in susceptibility to negative mental health outcomes.”

It was refreshing to read a paper where the reviewers often interrupted the reader’s train of thought to interject contradictory evidence, and display the scientific method. For example, immediately after citing a trio of well-respected studies that found:

“Psychobiological research on relationships linking impaired HPA axis functioning and adult internalizing disorders are suggestive of lower basal and afternoon levels of plasma cortisol in PTSD phenotype.”

the reviewers stated:

“However, a recent meta-analysis suggests no association between basal cortisol with PTSD.”

and effectively ended the cortisol discussion with:

“Findings are dependent upon variance in extenuating factors, including but not limited to, different measurements of:

  • early adversity,
  • age of onset,
  • basal cortisol levels, as well as
  • trauma forms and subtypes, and
  • presence and severity of psychopathology symptomology.”

The reviewers also provided good summaries of aspects of the reviewed subject. For example, the “Serotonergic system genetic research, childhood trauma and risk of psychopathology” subsection ended with:

“Going forward, studies must explore the longitudinal effects of early trauma on methylation as well as comparisons of multiple loci methylation patterns and interactions to determine the greatest factors contributing to health outcomes. Only then, can we start to consider the role of sex in moderating risk.”

I didn’t agree with the cause-ignoring approach of the behavior therapy mentioned in the review. Does it make sense to approach one category of symptoms:

“the biological effects of early life stress”

by treating another category of symptoms?

“can be reversed in the face of evidence-based behavioral interventions.”

But addressing symptoms instead of the sometimes-common causes that generate both biological and behavioral effects continues to be the direction.

After receiving short-term symptom relief, wouldn’t people prefer treatments of originating causes so that their various symptoms don’t keep bubbling up? Why wouldn’t research paradigms be aligned accordingly?

I was encouraged by the intergenerational and transgenerational focus of one of the reviewer’s research:

“Dr. Gonzalez’s current research focus is to understand the mechanisms by which early experiences are transmitted across generations and how preventive interventions may affect this transmission.”

This line of hypotheses requires detailed histories, and should uncover causes for many effects that researchers may otherwise shrug off as unexplainable individual differences. Its aims include the preconception through prenatal periods when both the largest and the largest number of epigenetic changes occur, and is when our susceptibility and sensitivity to our environment is greatest. There are fewer opportunities for effective “preventive interventions” in later life compared with these early periods.

Unlike lab rats, women and men can reach some degree of honesty about our early lives’ experiential causes of ongoing adverse effects. Experiential therapies that allow humans to potentially change their responses to these causes deserve more investigation than do therapies that apply external “interventions.”

https://www.sciencedirect.com/science/article/pii/S0272735817302647 “Biological alterations affecting risk of adult psychopathology following childhood trauma: A review of sex differences” (not freely available) Thanks to lead author Dr. Ashwini Tiwari for providing a copy.

Viruses target epigenetic processes

gettingwell4 2-3 stars Required further work, Brain development, Epigenetics, Immune system , ,

This 2018 Colorado review subject was general and specific ways viruses target epigenetic processes:

“We describe viral mechanisms and virus-host interactions by which DNA tumor viruses regulate host DNA methylation to evade antiviral immunity.

It is well known that most endogenous retroviruses and retrotransposons in the human genome are inactivated by DNA hypermethylation. In addition to endogenous retroviruses, the genomes of DNA viruses, such as human papillomavirus (HPV), herpes simplex virus 1 (HSV-1), adenovirus, and hepatitis B virus (HBV), are also frequently methylated and silenced in infected cells.

A recently described mechanism for viruses to epigenetically subvert host immunity is repression of immune-related gene expression by induction of DNA hypermethylation. Some host genes are not silenced simply through promoter hypermethylation or histone deacetylation alone, and therefore, viruses may have evolved mechanisms to ensure host gene downregulation through multiple epigenetic modifications.”

http://www.mdpi.com/1999-4915/10/2/82/htm “DNA Tumor Virus Regulation of Host DNA Methylation and Its Implications for Immune Evasion and Oncogenesis”

A second 2018 New York study focused on the Zika virus and DNA methylation:

“We studied the impact of ZIKV infection on the DNA methylation pattern across the entire genome in selected neural cell types. The virus unexpectedly alters the DNA methylome of neural progenitors, astrocytes, and differentiated neurons at genes that have been implicated in the pathogenesis of a number of brain disorders.

It remains open, however, whether the methylation changes come first or whether the viral infection dysregulates epigenetic regulatory genes prior to any epigenetic shift.”

http://msystems.asm.org/content/3/1/e00219-17 “Zika Virus Alters DNA Methylation of Neural Genes in an Organoid Model of the Developing Human Brain”

What are the chances?

gettingwell4 2-3 stars Required further work, Beliefs, Cerebrum ,

This 2018 UC Davis anthropology study was on dice changes over two centuries:

“In Roman times, many dice were visibly lopsided..It did not matter what the objects were made of (metal, clay, bone, antler and ivory), or whether they were precisely symmetrical or consistent in size or shape, because, like the weather, rolls were predetermined by gods or other supernatural elements.

Dice, like many material objects, reflect a lot about people’s changing worldviews, Eerkens said. In this case, we believe it follows changing ideas about chance and fate.”

Think of a significant event in your life. Was it brought about by:

  1. Fate?
  2. Karma, divine intervention?
  3. A prayer, belief, placebo-effect process?
  4. Randomness?
  5. A coin-flip, card-draw, dice-roll decision process?
  6. A weighted-probability decision process?
  7. Chosen behavior, thoughts, and feelings?
  8. Unconscious behavior, thoughts, and feelings?
  9. Culturally-guided motivations?
  10. Non-arbitrary influences of other parties?

Which one or more of these factors would you now prefer to have been involved?

https://www.ucdavis.edu/news/it-not-how-you-play-game-how-dice-were-made “It’s Not How You Play the Game, but How the Dice Were Made”

Your need to feel important will run your life, and you’ll never feel satisfied

gettingwell4 5+ stars Premium, Memory, Primal Therapy , , , ,

Yesterday’s team meeting at work provided one display after another of a person’s need to feel important. These eye-openers were the reason the scheduled 30-minute meeting lasted 45 minutes.

Although half of the forty or so attendees are under the age of 40, curiously, only two of them spoke during the meeting. I wasn’t among the older people who had something to say.

Not that I wasn’t tempted by the team-building exercise with its Skittles prompts:

  • Red – Tell us something you do well
  • Orange – Tell us something about your childhood
  • Purple – What could you live without?
  • Yellow – What couldn’t you live without?

Participation in the exercise was voluntary. Yes, I drew an orange Skittle.

Everyone knew there wasn’t enough time for each of us to speak and have the exercise become team-building, yet a dozen people piped up. Every one of the self-selected responses could have been prefaced with “I’m important because..”


There are many needs a person develops and tries to satisfy as substitutes for real needs that weren’t fulfilled. In this blog I’ve focused on the need to feel important.

I started with How do we assess “importance” in our lives? An example from scientists’ research choices and highlighted it on the Welcome page:

“Do you agree that an individual’s need to feel important is NOT a basic human need on the same level as nourishment, protection, and socialization? How does this need arise in our lives?”

I supported an explanation of the need to feel important with evidence and arguments on the Scientific evidence page and said:

“If the explanation is true yet someone rejected it, they at least wouldn’t have suffered from exposure to it. They’ll just remain in our world’s default mode of existence:

  1. Unaware of their own unconscious act-outs to feel important;
  2. Unaware of what’s driving such personal behavior; and
  3. Uninformed of other people’s behavioral origins as a consequence of 1 and 2.”

Other examples of substitute needs include:

What do you think? Any arguments for or against interrupting our default mode of existence?

Lysine acetylation is gnarly and dynamic

gettingwell4 4-5 stars Advanced knowledge, Epigenetics, Memory, Stress, Telomeres , ,

This 2018 UC San Francisco cell review provided details of lysine acetylation:

“Lysine acetylation has moved from being a specialized mark on histones to a critical modification controlling cell fate, proliferation, and metabolism.

During the lifetime of a protein there are many points at which an acetyl group may be added to influence function. The dynamic interplay between the writers, erasers, and readers of acetylation regulates critical epigenomic and metabolic processes, in addition to other major cellular functions.

Acetylation sites are well conserved, in contrast to methylation, where species-specific differences exist.”

The review included a section on mitochondrial protein acetylation:

“Mitochondria have emerged as organelles in which acetylation is more prominent than phosphorylation and plays a key role in integrating metabolic cues with the bioenergetic equilibrium of the cell.

Increased mitochondrial protein acetylation is associated with physiological conditions that result in higher levels of acetyl-CoA (e.g., fasting, calorie restriction, high-fat diet, and ethanol intoxication).”

https://pubs.acs.org/doi/full/10.1021/acs.chemrev.7b00181 “Lysine Acetylation Goes Global: From Epigenetics to Metabolism and Therapeutics” (not freely available) Thanks to lead author Ibraheem Ali for providing a full copy.

Epigenetic mechanisms of muscle memory

gettingwell4 2-3 stars Required further work, Epigenetics, Memory, Testosterone

This 2018 UK human study detailed epigenetic muscle memory:

“We aimed to investigate an epigenetic memory of earlier hypertrophy in adult human skeletal muscle using a within measures design, by undertaking:

  1. Resistance exercise induced muscle growth (loading) [3 days a week for 7 weeks], followed by;
  2. Cessation of resistance exercise, to return muscle back towards baseline levels (unloading) [7 weeks], and;
  3. A subsequent later period of resistance exercise induced muscle hypertrophy (reloading) [3 days a week for 7 weeks].”

The findings were:

“Frequency of genome-wide hypomethylation is the largest after reloading induced hypertrophy where lean muscle mass is enhanced.

Hypomethylation is maintained from earlier load induced hypertrophy even during unloading where muscle mass returns back towards baseline, and is inversely associated with gene expression.

A single bout of acute resistance exercise evokes hypomethylation of genes that have enhanced gene expression in later reload induced hypertrophy.”

https://www.nature.com/articles/s41598-018-20287-3 “Human Skeletal Muscle Possesses an Epigenetic Memory of Hypertrophy”

The study provided another example of how our bodies remember. It began with only eight male 27.6 ± 2.4 year-old subjects, though, and one of them dropped out.

See the discussion of a 2017 Netherlands human study in Are Underpowered Studies Ever Justified? with comments on studies with few subjects, such as:

“The problem occurs when people do small quantitative studies, but draw conclusions nonetheless, simply adding a disclaimer to the discussion (which they don’t put in the abstract, or the press release).”

“Underpowered studies may only be useful to check if the experiment works out wrt understanding instructions, do the programs run, etc, but not as much for testing and estimating effects.”

“The problem with underpowered studies is that all estimates can vary erratically between samples. Combined with the desire of many researchers (and universities’ press offices) to find sensational patterns, this means that evidence from underpowered studies is ‘asymmetrically’ likely to be considered more conclusive. As in, something that seems really cool will probably be considered more conclusive than something that’s disappointing. Highly powered studies don’t afford this flexibility.”

Obtaining convictions with epigenetic statistics?

gettingwell4 < 0 Detracted from science, Epigenetics ,

This 2018 Austrian review subject was forensic applications of epigenetic clock methodologies:

“The methylation-sensitive analysis of carefully selected DNA markers (CpG sites) has brought the most promising results by providing prediction accuracies of ±3–4 years, which can be comparable to, or even surpass those from, eyewitness reports. This mini-review puts recent developments in age estimation via (epi)genetic methods in the context of the requirements and goals of forensic genetics and highlights paths to follow in the future of forensic genomics.”

The point of forensic analysis techniques should be to find the truth about an individual. Doesn’t the principle of “All presumptive evidence of felony should be admitted cautiously; for the law holds it better that ten guilty persons escape, than that one innocent party suffer” still hold?

The methods’ limitations weren’t discussed. Here are some concepts not mentioned in the review:

1) Summary statistics that describe a group or population NEVER necessarily describe an individual member.

For an epigenetic clock methodology example, take a look at Figure 2A in Using an epigenetic clock to assess liver disease. 16 of the 18 individual age acceleration estimates of the control group subjects aren’t close to the median value!

2) The reviewer outlined basic DNA methylation analysis:

“The most commonly pursued approach for analysing CpG sites is sequence analysis of bisulfite-converted DNA, during which single-stranded genomic DNA is treated with sodium bisulfite that deaminates unmethylated cytosine to uracil, while methylated cytosine remains unaffected.

With increasing age, not only genome-wide DNA hypomethylation has been observed but also regional DNA hypermethylation of CpG islands.”

The basic limitation of this analysis wasn’t mentioned, but A study of DNA methylation and age said:

“Due to the methods applied in the present study, not all the effects of DNA methylation on gene expression could be detected; this limitation is also true for previously reported results.

The textbook case of DNA methylation regulating gene expression (the methylation of a promoter and silencing of a gene) remains undetected in many cases because in an array analysis, an unexpressed gene shows no signal that can be distinguished from background and is therefore typically omitted from the analysis.”

3) Another omission was that the numbers and types of targets in the discussed DNA methylation technique were severely limited per The primary causes of individual differences in DNA methylation are environmental factors:

“A main limitation with studies using the Illumina 450 K array is that the platform only covers ~1.5 % of overall genomic CpGs, which are biased towards promoters and strongly underrepresented in distal regulatory elements, i.e., enhancers.

The reviewer didn’t provide convincing justifications for using gene expression profiling to obtain convictions. Was it too much to expect a mini-review to offer a balanced view of using epigenetic age estimation in forensic analyses?

https://www.karger.com/Article/FullText/486239 “Age Estimation with DNA: From Forensic DNA Fingerprinting to Forensic (Epi)Genomics: A Mini-Review”

A review of human pluripotent stem cell research

gettingwell4 4-5 stars Advanced knowledge, Epigenetics, Telomeres , , ,

Starting the fourth year of this blog with a 2018 Belgian review subject was human pluripotent stem cells (hPSCs):

“hPSCs are now starting to live up to the great expectations they created after their first derivation nearly twenty years ago. Indeed, the first results of clinical trials to treat macular degeneration are being published, and an increasing number of clinical or preclinical trials are being started for conditions such as spinal cord injury, diabetes and heart disease.

This imminent transition of pluripotent stem cells to the clinic has resulted in researchers and clinicians becoming acutely aware of the problems related to the genetic and epigenetic diversity of these cells, included acquired mutations.”

The review included a section on mitochondrial processes that impact the differentiation capacity of pluripotent stem cells, summarized by:

“From this overview, we also observe a more ample contribution of mtDNA in cell fate determination than is represented in many studies tackling the topic.

The transition from aerobic glycolysis to aerobic phosphorylation plays a vital role in cells’ ability to correctly proceed through differentiation, though the mtDNA is rarely evaluated.”

https://academic.oup.com/humupd/advance-article-abstract/doi/10.1093/humupd/dmx042/4825062?redirectedFrom=fulltext “Genetic and epigenetic factors which modulate differentiation propensity in human pluripotent stem cells” (not freely available) Thanks to lead author Alexander Keller for providing a copy.