Yevdokimova V. Molecular-genetic and epigenetic mechanisms of endometriosis course. Prognosis. Diagnosis, Treatment.

An important scientific problem of the improvement of prognosis, diagnosis, and treatment of patients suffering from adenomyosis and external genital endometriosis using modern molecular genetic technologies was solved in the thesis. A comparative analysis of the clinical manifestations of external genital endometriosis and adenomyosis demonstrates the dependence of the severity of the lesions on the disease term, presence of concomitant gynecological pathology, chronic viral infections, and family history. There was found that the presence of homozygous allelic variants of single-nucleotide polymorphisms of genes VEGF, TNFA, IL6, IL8, GSTM1, GSTT1 increases the risk of endometriosis occurrence. It is shown that the cytokine balance in women with adenomyosis and external genital endometriosis is characterized by proinflammatory cytokines TNF- , IL-6 overproduction. During the administration of natural low-molecular immunomodulating therapy there were observed more significant decrease of pain syndrome intensity and improvement of psychoemotional state of patients. Algorithm for prognosis, diagnosis, and treatment of endometriosis should consider the genetic determination of the expression of pro-angiogenic and pro-inflammatory factors and their actual levels in the peritoneal liquid. Clinical research has proved the efficacy of drugs which have pronounced anticytokin activity in the treatment of endometriosis.