Механизмы действия ребамипида: систематизация литературных данных
Механизмы действия ребамипида: систематизация литературных данных
Андреев Д.Н., Кулиева А.К. Механизмы действия ребамипида: систематизация литературных данных. Consilium Medicum. 2020; 22 (8): 41–45.
DOI: 10.26442/20751753.2020.8.200373
________________________________________________
Andreev D.N., Kulieva A.K. Mechanisms of action of rebamipide: systematic review. Consilium Medicum. 2020; 22 (8): 41–45. DOI: 10.26442/20751753.2020.8.200373
Механизмы действия ребамипида: систематизация литературных данных
Андреев Д.Н., Кулиева А.К. Механизмы действия ребамипида: систематизация литературных данных. Consilium Medicum. 2020; 22 (8): 41–45.
DOI: 10.26442/20751753.2020.8.200373
________________________________________________
Andreev D.N., Kulieva A.K. Mechanisms of action of rebamipide: systematic review. Consilium Medicum. 2020; 22 (8): 41–45. DOI: 10.26442/20751753.2020.8.200373
Ребамипид используется в клинической практике для лечения и профилактики разных заболеваний желудочно-кишечного тракта на протяжении 30 лет. Принципиальным механизмом действия препарата являются индукция эндогенного синтеза простагландинов и опосредованное увеличение скорости рубцевания язвенных дефектов. Вместе с тем фундаментальные экспериментальные исследования, проведенные за последние несколько лет, значительно расширили наши знания о протективных механизмах этой молекулы. В настоящей статье систематизированы основные данные о механизмах действия ребамипида при заболеваниях гастроэнтерологического профиля. Представлены литературные данные, свидетельствующие, что препарат обеспечивает нейтрализацию перекисного окисления липидов, способствует улучшению кровоснабжения слизистой оболочки, поддерживает эпителиальный барьер путем репарации плотных контактов клеток, реализует антагонистическое влияние по отношению к колонизационной активности Helicobacter pylori.
Rebamipide has been used in clinical practice for the treatment and prevention of various gastrointestinal diseases for 30 years. The principal mechanism of action of the drug is the induction of endogenous synthesis of prostaglandins and an indirect acceleration of ulcer healing. With that, fundamental experimental studies conducted over the past few years have significantly expanded our knowledge of the protective mechanisms of this molecule. This article summarizes the basic data on the mechanisms of action of rebamipide in gastroenterological diseases. The article provides literature data showing that the drug neutralizes lipid peroxidation, improves blood supply to the mucosa, maintains the epithelial barrier by repairing tight cell junctions, and has an antagonistic effect against the colonization activity of Helicobacter pylori.
1. Naito Y, Yoshikawa T. Rebamipide: a gastrointestinal protective drug with pleiotropic activities. Expert Rev Gastroenterol Hepatol 2010; 4 (3): 261–70.
2. Звяглова М.Ю., Князев О.В., Парфенов А.И. Фармакологический и клинический профиль ребамипида: новые терапевтические мишени. Терапевтический архив. 2020; 92 (2): 104–11. DOI: 10.26442/00403660.2020.02.000569
[Zvyaglova M.Yu., Knyazev O.V., Parfenov A.I. Pharmacological and clinical feature of rebamipide: new therapeutic targets. Therapeutic Archive. 2020; 92 (2): 104–11. DOI: 10.26442/00403660.2020.02.000569 (in Russian).]
3. Arakawa T, Higuchi K, Fujiwara Y et al. 15th anniversary of rebamipide: looking ahead to the new mechanisms and new applications. Dig Dis Sci 2005; 50 (Suppl. 1): S3–S11. DOI: 10.1007/s10620-005-2800-9
4. Genta RM. Review article: the role of rebamipide in the management of inflammatory disease of the gastrointestinal tract. Aliment Pharmacol Ther 2003; 18 (Suppl. 1): 8–13. DOI: 10.1046/j.1365-2036.18.s1.5.x
5. Arakawa T, Kobayashi K, Yoshikawa T, Tarnawski A. Rebamipide: overview of its mechanisms of action and efficacy in mucosal protection and ulcer healing. Dig Dis Sci 1998; 43 (9 Suppl.): 5S–13S.
6. Miller SB. Prostaglandins in health and disease: an overview. Semin Arthritis Rheum 2006; 36 (1): 37–49. DOI: 10.1016/j.semarthrit.2006.03.005
7. Cryer B. Mucosal defense and repair. Role of prostaglandins in the stomach and duodenum. Gastroenterol Clin North Am 2001; 30 (4): 877–vi. DOI: 10.1016/s0889-8553(05)70218-1
8. Wallace JL. Prostaglandins, NSAIDs, and gastric mucosal protection: why doesn't the stomach digest itself? Physiol Rev 2008; 88 (4): 1547–65. DOI: 10.1152/physrev.00004.2008
9. Маев И.В., Самсонов А.А., Андреев Д.Н. Гастропатии, индуцированные нестероидными противовоспалительными средствами: патогенетически обоснованные подходы к профилактике и терапии. Фарматека. 2016; 2: 49–54.
[Maev I.V., Samsonov A.A., Andreev D.N. Gastropatii, indutsirovannye nesteroidnymi protivovospalitel'nymi sredstvami: patogeneticheski obosnovannye podkhody k profilaktike i terapii. Farmateka. 2016; 2: 49–54 (in Russian).]
10. Tarnawski AS, Chai J, Pai R, Chiou SK. Rebamipide activates genes encoding angiogenic growth factors and Cox2 and stimulates angiogenesis: a key to its ulcer healing action? Dig Dis Sci 2004; 49 (2): 202–9. DOI: 10.1023/b:ddas.0000017439.60943.5c
11. Sun WH, Tsuji S, Tsujii M et al. Induction of cyclooxygenase-2 in rat gastric mucosa by rebamipide, a mucoprotective agent. J Pharmacol Exp Ther 2000; 295 (2): 447–52.
12. Murata H, Yabe Y, Tsuji S et al. Gastro-protective agent rebamipide induces cyclooxygenease-2 (COX-2)
in gastric epithelial cells. Dig Dis Sci 2005; 50 (Suppl. 1): S70–5. DOI: 10.1007/s10620-005-2809-0
13. Suetsugu H, Ishihara S, Moriyama N et al. Effect of rebamipide on prostaglandin EP4 receptor gene expression in rat gastric mucosa. J Lab Clin Med 2000; 136 (1): 50–7. DOI: 10.1067/mlc.2000.107303
14. Tanigawa T, Watanabe T, Ohkawa F et al. Rebamipide, a mucoprotective drug, inhibits NSAIDs-induced gastric mucosal injury: possible involvement of the downregulation of 15-hydroxyprostaglandin dehydrogenase. J Clin Biochem Nutr 2011; 48 (2): 149–53. DOI: 10.3164/jcbn.10-75
15. Iijima K, Ichikawa T, Okada S et al. Rebamipide, a cytoprotective drug, increases gastric mucus secretion in human: evaluations with endoscopic gastrin test. Dig Dis Sci 2009; 54 (7): 1500–7. DOI: 10.1007/s10620-008-0507-4
16. Gaschler MM, Stockwell BR. Lipid peroxidation in cell death. Biochem Biophys Res Commun 2017; 482 (3): 419–25. DOI: 10.1016/j.bbrc.2016.10.086
17. Manda-Handzlik A, Demkow U. Neutrophils: The Role of Oxidative and Nitrosative Stress in Health and Disease. Adv Exp Med Biol 2015; 857: 51–60. DOI: 10.1007/5584_2015_117
18. Iinuma S, Naito Y, Yoshikawa T et al. In vitro studies indicating antioxidative properties of rebamipide. Dig Dis Sci 1998; 43 (9 Suppl.): 35S–39S.
19. Yoshikawa T, Naito Y, Tanigawa T, Kondo M. Free radical scavenging activity of the novel anti-ulcer agent rebamipide studied by electron spin resonance. Arzneimittelforschung 1993; 43 (3): 363–6.
20. Naito Y, Yoshikawa T, Tanigawa T et al. Hydroxyl radical scavenging by rebamipide and related compounds: electron paramagnetic resonance study. Free Radic Biol Med 1995; 18 (1): 117–23. DOI: 10.1016/0891-5849(94)00110-6
21. Sakurai K, Sasabe H, Koga T, Konishi T. Mechanism of hydroxyl radical scavenging by rebamipide: identification of mono-hydroxylated rebamipide as a major reaction product. Free Radic Res 2004; 38 (5): 487–94. DOI: 10.1080/1071576042000209808
22. Kim CD, Kim YK, Lee SH, Hong KW. Rebamipide inhibits neutrophil adhesion to hypoxia/reoxygenation-stimulated endothelial cells via nuclear factor-kappaB-dependent pathway. J Pharmacol Exp Ther 2000; 294 (3): 864–9.
23. Farhadi A, Keshavarzian A, Fitzpatrick LR et al. Modulatory effects of plasma and colonic milieu of patients with ulcerative colitis on neutrophil reactive oxygen species production in presence of a novel antioxidant, rebamipide. Dig Dis Sci 2002; 47 (6): 1342–8. DOI: 10.1023/a:1015382800434
24. Hahm KB, Park IS, Kim YS et al. Role of rebamipide on induction of heat-shock proteins and protection against reactive oxygen metabolite-mediated cell damage in cultured gastric mucosal cells. Free Radic Biol Med 1997; 22 (4): 711–6. DOI: 10.1016/s0891-5849(96)00406-6
25. Kim HK, Kim JI, Kim JK et al. Preventive effects of rebamipide on NSAID-induced gastric mucosal injury and reduction of gastric mucosal blood flow in healthy volunteers. Dig Dis Sci 2007; 52 (8): 1776–82. DOI: 10.1007/s10620-006-9367-y
26. Farré R, Vicario M. Abnormal Barrier Function in Gastrointestinal Disorders. Handb Exp Pharmacol 2017; 239: 193–217.
27. Zihni C, Mills C, Matter K, Balda MS. Tight junctions: from simple barriers to multifunctional molecular gates. Nat Rev Mol Cell Biol 2016; 17 (9): 564–80.
28. Piche T. Tight junctions and IBS – the link between epithelial permeability, low-grade inflammation, and symptom generation? Neurogastroenterol Motil 2014; 26 (3): 296–302.
29. Björkman EV, Edebo A, Oltean M, Casselbrant A. Esophageal barrier function and tight junction expression in healthy subjects and patients with gastroesophageal reflux disease: functionality of esophageal mucosa exposed to bile salt and trypsin in vitro. Scand J Gastroenterol 2013; 48 (10): 1118–26. DOI: 10.3109/00365521.2013.828772
30. Thakre-Nighot M, Blikslager AT. Indomethacin induces increase in gastric epithelial tight junction permeability via redistribution of occludin and activation of p38 MAPK in MKN-28 Cells. Tissue Barriers 2016; 4 (3): e1187325. DOI: 10.1080/21688370.2016.1187325
31. Андреев Д.Н. Роль нарушения проницаемости слизистой оболочки кишечника в генезе функциональных заболеваний желудочно-кишечного тракта. Consilium Medicum. 2019; 21 (8): 29–34. DOI: 10.26442/20751753.2019.8.190539
[Andreev D.N. The role of alterations in permeability of the intestinal mucosa in the genesis of functional gastrointestinal disorders. Consilium Medicum. 2019; 21 (8): 29–34. DOI: 10.26442/20751753.2019.8.190539 (in Russian).]
32. Gweon TG, Park JH, Kim BW et al; Incheon and Western Kyonggi Gastrointestinal Study. Additive Effects of Rebamipide Plus Proton Pump Inhibitors on the Expression of Tight Junction Proteins in a Rat Model of Gastro-Esophageal Reflux Disease. Gut Liver 2018; 12 (1): 46–50. DOI: 10.5009/gnl17078
33. Suzuki T, Yoshida N, Nakabe N et al. Prophylactic effect of rebamipide on aspirin-induced gastric lesions and disruption of tight junctional protein zonula occludens-1 distribution. J Pharmacol Sci 2008; 106 (3): 469–77. DOI: 10.1254/jphs.fp0071422
34. Shim S, Jang HS, Myung HW et al. Rebamipide ameliorates radiation-induced intestinal injury in a mouse model. Toxicol Appl Pharmacol 2017; 329: 40–7. DOI: 10.1016/j.taap.2017.05.012
35. Jang H, Park S, Lee J et al. Rebamipide alleviates radiation-induced colitis through improvement of goblet cell differentiation in mice. J Gastroenterol Hepatol 2018; 33 (4): 878–86. DOI: 10.1111/jgh.14021
36. Маев И.В., Андреев Д.Н. Инфекция Helicobacter pylori и ассоциированные заболевания. М.: Ремедиум, 2018.
[Maev I.V., Andreev D.N. Helicobacter pylori infection and associated diseases. Moscow: Remedium, 2018 (in Russian).]
37. Malfertheiner P, Venerito M, Schulz C. Helicobacter pylori Infection: New Facts in Clinical Management. Curr Treat Options Gastroenterol 2018; 16 (4): 605–15. DOI: 10.1007/s11938-018-0209-8
38. Hooi JKY, Lai WY, Ng WK et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology 2017; 153 (2): 420–9. DOI: 10.1053/j.gastro.2017.04.022
39. Zamani M, Ebrahimtabar F, Zamani V et al. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. Aliment Pharmacol Ther 2018; 47 (7): 868–76. DOI: 10.1111/apt.14561
40. Coelho E, Magalhães A, Dinis-Ribeiro M, Reis CA. Mecanismos Moleculares de Adesão e Colonização da Mucosa Gástrica pela Helicobacter pylori e suas Implicações Clínicas [Molecular Mechanisms for Adhesion and Colonization of Human Gastric Mucosa by Helicobacter pylori and its Clinical Implications]. Acta Med Port 2016; 29 (7–8): 476–83. DOI: 10.20344/amp.6651
41. Bonsor DA, Sundberg EJ. Roles of Adhesion to Epithelial Cells in Gastric Colonization by Helicobacter pylori. Adv Exp Med Biol 2019; 1149: 57–75. DOI: 10.1007/5584_2019_359
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________________________________________________
1. Naito Y, Yoshikawa T. Rebamipide: a gastrointestinal protective drug with pleiotropic activities. Expert Rev Gastroenterol Hepatol 2010; 4 (3): 261–70.
2. Zvyaglova M.Yu., Knyazev O.V., Parfenov A.I. Pharmacological and clinical feature of rebamipide: new therapeutic targets. Therapeutic Archive. 2020; 92 (2): 104–11. DOI: 10.26442/00403660.2020.02.000569 (in Russian).
3. Arakawa T, Higuchi K, Fujiwara Y et al. 15th anniversary of rebamipide: looking ahead to the new mechanisms and new applications. Dig Dis Sci 2005; 50 (Suppl. 1): S3–S11. DOI: 10.1007/s10620-005-2800-9
4. Genta RM. Review article: the role of rebamipide in the management of inflammatory disease of the gastrointestinal tract. Aliment Pharmacol Ther 2003; 18 (Suppl. 1): 8–13. DOI: 10.1046/j.1365-2036.18.s1.5.x
5. Arakawa T, Kobayashi K, Yoshikawa T, Tarnawski A. Rebamipide: overview of its mechanisms of action and efficacy in mucosal protection and ulcer healing. Dig Dis Sci 1998; 43 (9 Suppl.): 5S–13S.
6. Miller SB. Prostaglandins in health and disease: an overview. Semin Arthritis Rheum 2006; 36 (1): 37–49. DOI: 10.1016/j.semarthrit.2006.03.005
7. Cryer B. Mucosal defense and repair. Role of prostaglandins in the stomach and duodenum. Gastroenterol Clin North Am 2001; 30 (4): 877–vi. DOI: 10.1016/s0889-8553(05)70218-1
8. Wallace JL. Prostaglandins, NSAIDs, and gastric mucosal protection: why doesn't the stomach digest itself? Physiol Rev 2008; 88 (4): 1547–65. DOI: 10.1152/physrev.00004.2008
9. Maev I.V., Samsonov A.A., Andreev D.N. Gastropatii, indutsirovannye nesteroidnymi protivovospalitel'nymi sredstvami: patogeneticheski obosnovannye podkhody k profilaktike i terapii. Farmateka. 2016; 2: 49–54 (in Russian).
10. Tarnawski AS, Chai J, Pai R, Chiou SK. Rebamipide activates genes encoding angiogenic growth factors and Cox2 and stimulates angiogenesis: a key to its ulcer healing action? Dig Dis Sci 2004; 49 (2): 202–9.
DOI: 10.1023/b:ddas.0000017439.60943.5c
11. Sun WH, Tsuji S, Tsujii M et al. Induction of cyclooxygenase-2 in rat gastric mucosa by rebamipide, a mucoprotective agent. J Pharmacol Exp Ther 2000; 295 (2): 447–52.
12. Murata H, Yabe Y, Tsuji S et al. Gastro-protective agent rebamipide induces cyclooxygenease-2 (COX-2)
in gastric epithelial cells. Dig Dis Sci 2005; 50 (Suppl. 1): S70–5. DOI: 10.1007/s10620-005-2809-0
13. Suetsugu H, Ishihara S, Moriyama N et al. Effect of rebamipide on prostaglandin EP4 receptor gene expression in rat gastric mucosa. J Lab Clin Med 2000; 136 (1): 50–7. DOI: 10.1067/mlc.2000.107303
14. Tanigawa T, Watanabe T, Ohkawa F et al. Rebamipide, a mucoprotective drug, inhibits NSAIDs-induced gastric mucosal injury: possible involvement of the downregulation of 15-hydroxyprostaglandin dehydrogenase. J Clin Biochem Nutr 2011; 48 (2): 149–53. DOI: 10.3164/jcbn.10-75
15. Iijima K, Ichikawa T, Okada S et al. Rebamipide, a cytoprotective drug, increases gastric mucus secretion in human: evaluations with endoscopic gastrin test. Dig Dis Sci 2009; 54 (7): 1500–7. DOI: 10.1007/s10620-008-0507-4
16. Gaschler MM, Stockwell BR. Lipid peroxidation in cell death. Biochem Biophys Res Commun 2017; 482 (3): 419–25. DOI: 10.1016/j.bbrc.2016.10.086
17. Manda-Handzlik A, Demkow U. Neutrophils: The Role of Oxidative and Nitrosative Stress in Health and Disease. Adv Exp Med Biol 2015; 857: 51–60. DOI: 10.1007/5584_2015_117
18. Iinuma S, Naito Y, Yoshikawa T et al. In vitro studies indicating antioxidative properties of rebamipide. Dig Dis Sci 1998; 43 (9 Suppl.): 35S–39S.
19. Yoshikawa T, Naito Y, Tanigawa T, Kondo M. Free radical scavenging activity of the novel anti-ulcer agent rebamipide studied by electron spin resonance. Arzneimittelforschung 1993; 43 (3): 363–6.
20. Naito Y, Yoshikawa T, Tanigawa T et al. Hydroxyl radical scavenging by rebamipide and related compounds: electron paramagnetic resonance study. Free Radic Biol Med 1995; 18 (1): 117–23. DOI: 10.1016/0891-5849(94)00110-6
21. Sakurai K, Sasabe H, Koga T, Konishi T. Mechanism of hydroxyl radical scavenging by rebamipide: identification of mono-hydroxylated rebamipide as a major reaction product. Free Radic Res 2004; 38 (5): 487–94. DOI: 10.1080/1071576042000209808
22. Kim CD, Kim YK, Lee SH, Hong KW. Rebamipide inhibits neutrophil adhesion to hypoxia/reoxygenation-stimulated endothelial cells via nuclear factor-kappaB-dependent pathway. J Pharmacol Exp Ther 2000; 294 (3): 864–9.
23. Farhadi A, Keshavarzian A, Fitzpatrick LR et al. Modulatory effects of plasma and colonic milieu of patients with ulcerative colitis on neutrophil reactive oxygen species production in presence of a novel antioxidant, rebamipide. Dig Dis Sci 2002; 47 (6): 1342–8. DOI: 10.1023/a:1015382800434
24. Hahm KB, Park IS, Kim YS et al. Role of rebamipide on induction of heat-shock proteins and protection against reactive oxygen metabolite-mediated cell damage in cultured gastric mucosal cells. Free Radic Biol Med 1997; 22 (4): 711–6. DOI: 10.1016/s0891-5849(96)00406-6
25. Kim HK, Kim JI, Kim JK et al. Preventive effects of rebamipide on NSAID-induced gastric mucosal injury and reduction of gastric mucosal blood flow in healthy volunteers. Dig Dis Sci 2007; 52 (8): 1776–82. DOI: 10.1007/s10620-006-9367-y
26. Farré R, Vicario M. Abnormal Barrier Function in Gastrointestinal Disorders. Handb Exp Pharmacol 2017; 239: 193–217.
27. Zihni C, Mills C, Matter K, Balda MS. Tight junctions: from simple barriers to multifunctional molecular gates. Nat Rev Mol Cell Biol 2016; 17 (9): 564–80.
28. Piche T. Tight junctions and IBS – the link between epithelial permeability, low-grade inflammation, and symptom generation? Neurogastroenterol Motil 2014; 26 (3): 296–302.
29. Björkman EV, Edebo A, Oltean M, Casselbrant A. Esophageal barrier function and tight junction expression in healthy subjects and patients with gastroesophageal reflux disease: functionality of esophageal mucosa exposed to bile salt and trypsin in vitro. Scand J Gastroenterol 2013; 48 (10): 1118–26. DOI: 10.3109/00365521.2013.828772
30. Thakre-Nighot M, Blikslager AT. Indomethacin induces increase in gastric epithelial tight junction permeability via redistribution of occludin and activation of p38 MAPK in MKN-28 Cells. Tissue Barriers 2016; 4 (3): e1187325. DOI: 10.1080/21688370.2016.1187325
31. Andreev D.N. The role of alterations in permeability of the intestinal mucosa in the genesis of functional gastrointestinal disorders. Consilium Medicum. 2019; 21 (8): 29–34. DOI: 10.26442/20751753.2019.8.190539 (in Russian).
32. Gweon TG, Park JH, Kim BW et al; Incheon and Western Kyonggi Gastrointestinal Study. Additive Effects of Rebamipide Plus Proton Pump Inhibitors on the Expression of Tight Junction Proteins in a Rat Model of Gastro-Esophageal Reflux Disease. Gut Liver 2018; 12 (1): 46–50. DOI: 10.5009/gnl17078
33. Suzuki T, Yoshida N, Nakabe N et al. Prophylactic effect of rebamipide on aspirin-induced gastric lesions and disruption of tight junctional protein zonula occludens-1 distribution. J Pharmacol Sci 2008; 106 (3): 469–77. DOI: 10.1254/jphs.fp0071422
34. Shim S, Jang HS, Myung HW et al. Rebamipide ameliorates radiation-induced intestinal injury in a mouse model. Toxicol Appl Pharmacol 2017; 329: 40–7. DOI: 10.1016/j.taap.2017.05.012
35. Jang H, Park S, Lee J et al. Rebamipide alleviates radiation-induced colitis through improvement of goblet cell differentiation in mice. J Gastroenterol Hepatol 2018; 33 (4): 878–86. DOI: 10.1111/jgh.14021
36. Maev I.V., Andreev D.N. Helicobacter pylori infection and associated diseases. Moscow: Remedium, 2018 (in Russian).
37. Malfertheiner P, Venerito M, Schulz C. Helicobacter pylori Infection: New Facts in Clinical Management. Curr Treat Options Gastroenterol 2018; 16 (4): 605–15. DOI: 10.1007/s11938-018-0209-8
38. Hooi JKY, Lai WY, Ng WK et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology 2017; 153 (2): 420–9. DOI: 10.1053/j.gastro.2017.04.022
39. Zamani M, Ebrahimtabar F, Zamani V et al. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. Aliment Pharmacol Ther 2018; 47 (7): 868–76. DOI: 10.1111/apt.14561
40. Coelho E, Magalhães A, Dinis-Ribeiro M, Reis CA. Mecanismos Moleculares de Adesão e Colonização da Mucosa Gástrica pela Helicobacter pylori e suas Implicações Clínicas [Molecular Mechanisms for Adhesion and Colonization of Human Gastric Mucosa by Helicobacter pylori and its Clinical Implications]. Acta Med Port 2016; 29 (7–8): 476–83. DOI: 10.20344/amp.6651
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DOI: 10.1016/j.bcp.2016.06.003
Авторы
Д.Н. Андреев*, А.К. Кулиева
ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*dna-mit8@mail.ru
________________________________________________
Dmitrii N. Andreev*, Alla K. Kulieva
Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*dna-mit8@mail.ru