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Histone acetylation is the most widespread and pleiotropic of all histone modifications. Initially it was believed to alter gene expression simply by altering the physical compaction of chromatin but it is now recognised that the effects are far more subtle and varied than this. This chapter will focus on the successes but also the roadblocks in generating safe and clinically efficacious modulators of histone acetylation and position current development of HDAC inhibitors in the context of new findings in the related epigenetic field.

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