mvjrМедицинский вестник Юга РоссииMedical Herald of the South of Russia2219-80752618-7876The Rostov State Medical University10.21886/2219-8075-2022-13-2-18-25mvjr-1561Research ArticleАКУШЕРСТВО И ГИНЕКОЛОГИЯOBSTETRICS AND GYNECOLOGYМиома матки: взгляд на проблемуUterine fibroids: a look at the problemhttps://orcid.org/0000-0002-4368-2203КарамянР. А.KaramyanR. A.

Карамян Ромелла Артуровна, аспирант кафедры акушерства и гинекологии с курсом перинатологии, Медицинский институт

Москва

Romella A. Karamyan, postgaruate of Obstetrics and Gynecology with the Course of Perinatal Medicine department

Moscow

romikaramyan@mail.ruhttps://orcid.org/0000-0001-5882-9995ОрдиянцИ. М.OrdiyatsI. M.

Ордиянц Ирина Михайловна, д. м. н., профессор кафедры акушерства и гинекологии с курсом перинатологии, Медицинский институт 

Москва

Irina M. Ordiyats, Dr. Sci. (Med.), Professor of the Department of Obstetrics and Gynecology with the Course of Perinatal Medicine 

Moscow

ordiyantc@mail.ruhttps://orcid.org/0000-0003-0790-0928ХорольскийВ. А.KhorolskiyV. A.

Хорольский Вадим Александрович, к. м. н., доцент кафедры акушерства, гинекологии и перинатологии 

Краснодар

Vadim A. Khorolsky, candidate of medical sciences

Krasnodar

vadim23_67@mail.ruhttps://orcid.org/0000-0002-9997-378XАсатрянД. Р.AsatryanD. R.

Асатрян Дарья Рубеновна, студентка 6 курса Медицинский институт 

Москва

Daria R. Asatryan, student

Moscow

asterdasha@mail.ruРоссийский университет дружбы народовРоссияPeoples’ Friendship UniversityRussian FederationКубанский государственный медицинский университетРоссияKuban State Medical University of Public Health Care of RussiaRussian Federation2022060720221321825Copyright © Карамян Р.А., Ордиянц И.М., Хорольский В.А., Асатрян Д.Р., 20222022Карамян Р.А., Ордиянц И.М., Хорольский В.А., Асатрян Д.Р.Karamyan R.A., Ordiyats I.M., Khorolskiy V.A., Asatryan D.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medicalherald.ru/jour/article/view/1561

В настоящее время отсутствует однозначное мнение о причинах возникновения и рецидивирования миомы матки, но благодаря высокому уровню молекулярной медицины достигнут значительный прогресс в изучении гормональных и молекулярно-генетических механизмов инициации, формирования и роста миоматозного узла. Актуальным остается вопрос патогенетического лечения и профилактики рецидива миомы матки в репродуктивном возрасте. Целью данного обзора является обобщение текущих данных о роли генетических и эпигенетических детерминант, сигнальных путей, микро-РНК в патофизиологии лейомиомы матки (ММ). эти сведения могут улучшить понимание широкого молекулярного взаимодействия передачи сигнальных путей в формировании ММ и в дальнейшем поддерживании эпигенетической регуляции. Были найдены и проанализированы оригинальные и обзорные статьи, главы книг в базе данных PubMed, связанные с изучением патогенеза миомы матки в период с 2004 по 2022 гг. Аналитический обзор показал, что аномальные стволовые клетки миометрия и миомы демонстрируют повышенный ответ на воздействие эстрогенов и прогестерона. Ряд генов-супрессоров опухолей аномально гиперметилированы в лейомиоме при сравнении с нормальным миометрием, генами, формирующими и регулирующими коллаген, и подмножество генов эстрогеновых рецепторов. Множественные исследования с использованием микроматричного анализа или секвенирования продемонстрировали существование нарушения регуляции ряда генов, кодирующих белок, вовлеченных в клеточную пролиферацию и апоптоз. Не имеют надёжной доказательной базы и не дают возможности для практического применения клинически значимые факторы риска, возможность математического прогнозирования роста миомы матки у женщин репродуктивного возраста. Весьма противоречивы данные о влиянии экспресии ряда микро-РНК на рост миомы матки in vivo. Не до конца изучены и обоснованы эпигенетические процессы регуляции и патогенез роста лейофибромиом в репродуктивном возрасте. Практически отсутствуют данные о прогнозировании роста миомы матки в репродуктивном возрасте. Дальнейшая работа над индентификацией специфических генов, микроРНК, которые участвуют в патогенезе ММ, может вдохновить на создание новых патогенетических методов лечения. Целенаправленное лечение также может предотвратить рецидив миомы матки, следовательно, необходимость повторного хирургического вмешательства.

Despite scientific progress, there is currently no sigle opinion about the cause of the occurrence and recurrence of uterine fibroids, but due to the high level of molecular medicine, progress is being made in the hormonal and molecular genetic mechanisms of initiation, formation and growth of the fibroisds. The issue of pathogenetic treatment and prevention of recurrence of uterine fibroids in reproductive age remains relevant. The aims of the review. The aim of this review is to summarize current data about microRNA in biology of uterine leiomyoma (LM). This information can improve our understanding of the broad molecular interaction of signaling pathways in the formation of LM, and further maintaining epigenetic regulation as an important mechanism in the pathogenesis of uterine leiomyoma. In leiomyomas, the expression of a number of non-proteincoding genes is altered, such as microRNAs (miRNAs), which target genes that code protein. Material and research methods. Original and review articles, book chapters in the PubMed database related to the study of the pathogenesis of uterine fibroids in the period from 2004 to 2022 were found and analyzed. Results and discussions. Based on an analytical review of the literature, it becomes obvious that as evidence should be considered: 1. Abnormal myometrial and fibroid stem cells show an increased response to estrogen and progesterone exposure, stimulating processes such as cell proliferation, inhibition of apoptosis, and extracellular matrix (ECM) formation. 2. A number of tumor suppressor genes are abnormally hypermethylated in the LM when compared to normal myometrium, genes that form and regulate collagen, and a subset of estrogen receptor genes. 3. Multiple studies using microarray analysis or sequencing have demonstrated the existence of dysregulation of a number of protein-coding genes involved in cell proliferation and apoptosis, which are critical for the growth and progression of uterine fibroids. There are no reliable evidence base and do not provide an opportunity for practical application of clinically significant risk factors, the possibility of mathematical prediction of the growth of uterine fibroids in women of reproductive age. Data on the effect of the expression of a number of microRNAs on the growth of uterine fibroids in vivo are rather contradictory. The epigenetic processes of regulation and pathogenesis of the growth of leiofibromyomas in reproductive age have not been fully studied and substantiated. There are practically no data on predicting the growth of uterine fibroids in reproductive age, which will allow us to assess the risk of growth and determine further treatment tactics. Conclusion. Further work on the identification of specific genes, miRNAs, that are involved in the pathogenesis of LM may inspire the creation of new pathogenetic treatments. Such treatment is especially relevant for those groups of patients of reproductive age for whom surgical treatment may be ineffective. Targeted treatment can also prevent the recurrence of uterine fibroids, hence the need for repeat surgery.

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The authors declare that there are no conflicts of interest present.