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The development of a tilting disc heart valve in full compliance with ISO standards and affordable for low-income patients in India was undertaken in the early 1980s at the Sree Chitra Institute, Trivandrum. The constraint on resources and emphasis on self-reliance made frugal innovation obligatory for valve development. After the failure of three initial models, the fourth model succeeded and was used clinically in December 1990. Equally successful in a multi-centric trial in India, it has been implanted in over 100,000 patients to date. In overcoming problems in relation to the choice of materials and tests for performance during valve development, several innovations were employed in the low-resource setting of Chitra Institute, which anticipated the advent of “Frugal Innovation” by three decades.

The practice of Ayurveda , the traditional medicine of India, is based on the concept of three major constitutional types (Vata, Pitta and Kapha) defined as “ Prakriti ”. To the best of our knowledge, no study has convincingly correlated genomic variations with the classification of Prakriti. In the present study, we performed genome-wide SNP (single nucleotide polymorphism) analysis (Affymetrix, 6.0) of 262 well-classified male individuals (after screening 3416 subjects) belonging to three Prakritis. We found 52 SNPs ( p  ≤ 1 × 10 −5 ) were significantly different between Prakritis , without any confounding effect of stratification, after 10 6 permutations. Principal component analysis (PCA) of these SNPs classified 262 individuals into their respective groups (Vata, Pitta and Kapha) irrespective of their ancestry, which represent its power in categorization. We further validated our finding with 297 Indian population samples with known ancestry. Subsequently, we found that PGM1 correlates with phenotype of Pitta as described in the ancient text of Caraka Samhita, suggesting that the phenotypic classification of India’s traditional medicine has a genetic basis; and its Prakriti -based practice in vogue for many centuries resonates with personalized medicine.

Background DNA methylation and its perturbations are an established attribute to a wide spectrum of phenotypic variations and disease conditions. Indian traditional system practices personalized medicine through indigenous concept of distinctly descriptive physiological, psychological and anatomical features known as prakriti . Here we attempted to establish DNA methylation differences in these three prakriti phenotypes. Methods Following structured and objective measurement of 3416 subjects, whole blood DNA of 147 healthy male individuals belonging to defined prakriti ( Vata , Pitta and Kapha ) between the age group of 20-30years were subjected to methylated DNA immunoprecipitation (MeDIP) and microarray analysis. After data analysis, prakriti specific signatures were validated through bisulfite DNA sequencing. Results Differentially methylated regions in CpG islands and shores were significantly enriched in promoters/UTRs and gene body regions. Phenotypes characterized by higher metabolism ( Pitta prakriti ) in individuals showed distinct promoter (34) and gene body methylation (204), followed by Vata prakriti which correlates to motion showed DNA methylation in 52 promoters and 139 CpG islands and finally individuals with structural attributes ( Kapha prakriti ) with 23 and 19 promoters and CpG islands respectively. Bisulfite DNA sequencing of prakriti specific multiple CpG sites in promoters and 5′-UTR such as; LHX1 ( Vata prakriti ), SOX11 ( Pitta prakriti ) and CDH22 ( Kapha prakriti ) were validated. Kapha prakriti specific CDH22 5′-UTR CpG methylation was also found to be associated with higher body mass index (BMI). Conclusion Differential DNA methylation signatures in three distinct prakriti phenotypes demonstrate the epigenetic basis of Indian traditional human classification which may have relevance to personalized medicine.