Epigenetic silencing can mimic genetic mutation by abolishing expression of a gene. We hypothesized that an epimutation could occur in any gene as a germline event that predisposes to disease and looked for examples in tumor suppressor genes in individuals with cancer. Here we report two individuals with soma-wide, allele-specific and mosaic hypermethylation of the DNA mismatch repair gene MLH1. Both individuals lack evidence of genetic mutation in any mismatch repair gene but have had multiple primary tumors that show mismatch repair deficiency, and both meet clinical criteria for hereditary nonpolyposis colorectal cancer. The epimutation was also present in spermatozoa of one of the individuals, indicating a germline defect and the potential for transmission to offspring. Germline epimutation provides a mechanism for phenocopying of genetic disease. The mosaicism and nonmendelian inheritance that are characteristic of epigenetic states could produce patterns of disease risk that resemble those of polygenic or complex traits.Epigenetic silencing is a stable but reversible alteration of gene function mediated by histone modification, cytosine methylation, the binding of nuclear proteins to chromatin and interactions among these 1,2 . It does not require, or generally involve, changes in DNA sequence. Errors in the elaborate apparatus of epigenetic silencing possessed by higher eukaryotes can lead to 'epimutation' 3-5 , which we define as epigenetic silencing of a gene that is not normally silenced, or epigenetic activation of a gene that is normally silent. Germline epimutations are known in plants, examples being methylation and transcriptional silencing of the gene Lcyc in toadflax (Linaria vulgaris) 6 , paramutation in maize 5,7 and the clark kent alleles of SUPERMAN in Arabidopsis thaliana 8 . Similar phenomena in mammals could be an unrecognized source of phenotypic effects, which might manifest as disease. The increasingly detailed understanding of the genetics of human disease suggests a strategy to identify epimutations: screen for methylation of known disease-associated genes in affected individuals who do not carry a mutation in the relevant gene. Tumor suppressors are good candidates for this strategy because there is a clear relationship between their inactivation and the development of cancer. Germline mutations in tumor suppressor genes can predispose to cancer 9 . Tumor suppressors are also commonly methylated (and inactivated) in the course of neoplastic progression 10 , but the causal relationship between hypermethylation and tumorigenesis has not been established.We hypothesized that some individuals are predisposed to develop cancer because they carry germline epimutations of tumor suppressor genes. We selected 94 individuals for this study: 18 with hyperplastic polyposis 11 , 11 with personal histories of colorectal cancer and 65 with a family history of colorectal cancer but without deleterious germline changes in MSH2, MLH1 or APC 12 . We screened a subset of 44 individuals for promoter met...