胶质瘤是最常见的恶性原发性脑肿瘤，传统上通过WHO分类I-IV（现在1-4）进行分类，低级别胶质瘤属于1或2级别实体。虽然WHO中枢神经系统（CNS）肿瘤分类的焦点历来是组织病理学属性，但最近发布的第五版分类（WHO CNS5）通过综合组织学和分子特征（包括它们的表观遗传学变化，如组蛋白甲基化，DNA甲基化和组蛋白乙酰化）对脑肿瘤（包括胶质瘤）进行了表征，这些特征越来越多地被用于低级别胶质瘤的分类。本篇综述描述了DNA甲基化，去甲基化和组蛋白修饰在脑肿瘤发病机制，临床行为和结果（特别是低级别胶质瘤）方面的作用的现有理解。该综述还强调了相关细胞生物分子，结构和过程中的潜在诊断和/或治疗靶点。定向MGMT启动子甲基化，TET-hTDG-BER途径，G-CIMP与关键基因突变的关联，PARP抑制剂，IDH和2-HG关联过程，TERT突变和ARL9相关途径，DNA甲基转移酶（DNMT）抑制剂，组蛋白去乙酰化酶（HDAC）抑制剂，BET抑制剂，CpG位点DNA甲基化标记等等， 提供了翻译研究的令人兴奋的途径。本篇综述还总结了与低级别胶质瘤表观遗传学在治疗方面的实用价值相关的当前临床试验格局。目前大部分证据仍然局限于临床前研究，需要进一步研究以证明真正的临床实用性。

Gliomas, the most common type of malignant primary brain tumor, were conventionally classified through WHO Grades I-IV (now 1-4), with low-grade gliomas being entities belonging to Grades 1 or 2. While the focus of the WHO Classification for Central Nervous System (CNS) tumors had historically been on histopathological attributes, the recently released fifth edition of the classification (WHO CNS5) characterizes brain tumors, including gliomas, using an integration of histological and molecular features, including their epigenetic changes such as histone methylation, DNA methylation, and histone acetylation, which are increasingly being used for the classification of low-grade gliomas. This review describes the current understanding of the role of DNA methylation, demethylation, and histone modification in pathogenesis, clinical behavior, and outcomes of brain tumors, in particular of low-grade gliomas. The review also highlights potential diagnostic and/or therapeutic targets in associated cellular biomolecules, structures, and processes. Targeting of MGMT promoter methylation, TET-hTDG-BER pathway, association of G-CIMP with key gene mutations, PARP inhibition, IDH and 2-HG-associated processes, TERT mutation and ARL9-associated pathways, DNA Methyltransferase (DNMT) inhibition, Histone Deacetylase (HDAC) inhibition, BET inhibition, CpG site DNA methylation signatures, along with others, present exciting avenues for translational research. This review also summarizes the current clinical trial landscape associated with the therapeutic utility of epigenetics in low-grade gliomas. Much of the evidence currently remains restricted to preclinical studies, warranting further investigation to demonstrate true clinical utility.