Chronobiology

Neuroscience

Disease

Circadian clock

Biology

Circadian rhythm

Internal medicine

Chronotherapy (sleep phase)

Medicine

Nature Reviews Drug Discovery

The circadian clock evolved in diverse organisms to integrate external environmental changes and internal physiology. The clock endows the host with temporal precision and robust adaptation to the surrounding environment. When circadian rhythms are perturbed or misaligned, as a result of jet lag, shiftwork or other lifestyle factors, adverse health consequences arise, and the risks of diseases such as cancer, cardiovascular diseases or metabolic disorders increase. Although the negative impact of circadian rhythm disruption is now well established, it remains underappreciated how to take advantage of biological timing, or correct it, for health benefits. In this Review, we provide an updated account of the circadian system and highlight several key disease areas with altered circadian signalling. We discuss environmental and lifestyle modifications of circadian rhythm and clock-based therapeutic strategies, including chronotherapy, in which dosing time is deliberately optimized for maximum therapeutic index, and pharmacological agents that target core clock components and proximal regulators. Promising progress in research, disease models and clinical applications should encourage a concerted effort towards a new era of circadian medicine. Disregulation of circadian rhythms, as a result of jet lag or other lifestyle factors, can increase the risks of certain diseases. This Review analyses the different pathways involved in the regulation of the circadian clock and strategies that target the circadian systems.

Circadian rhythm as a therapeutic target