Background. The most frequent female reproductive system tumors are uterine leiomyoma (UL). They are benign monoclonal tumors of uterine smooth muscle. They affect reproductive-age women with a lifetime prevalence of 30–70%. UL is a disease with complex etiology determined by many genetic and environmental factors. Despite the frequency of UL, there is no long-term, cost-effective or fertility-preserving therapy option for it. Aim. To summarize the available literature data on the etiopathogenesis of uterine fibroids as well as the risk factors for the development of this disease. Materials and methods. The PubMed, Scopus, and Web of science literature databases were searched for relevant articles using such keywords as uterine fibroids, UL, association, genetic and hormonal factors, gene, etiology in various combinations. Results. Genetic disorders and hormonal and growth factors all have a part in the etiology of UL, and studies have resulted to the use of hormone therapy for fibroids, with varying results. Recent findings on the etiopathogenesis of UL, as well as the introduction of relevant genetically modified mouse models of UL, have rekindled interest in the disease. In this review, the basic features of fibroids are discussed, as well as the primary contributors to UL etiopathogenesis, including as genetic, hormonal, and growth causes. Besides the risk factors that contribute to the development of UL. Conclusion. Many questions about the causes and mechanisms of development factors that predispose remain unanswered, necessitating the continuation of these studies in order to obtain new information. Prospective studies are needed to better understand the biology and epidemiological associations, both to better understand modifiable risk factors and to shed light on the etiopathogenesis of this disease.
Обоснование. Наиболее частой опухолью женской репродуктивной системы является лейомиома матки (UL). Это доброкачественная моноклональная опухоль гладкой мышечной ткани матки. Она поражает женщин репродуктивного возраста и встречается в течение всей жизни у 30-70%. UL это заболевание со сложной этиологией, в которую вовлечены многие генетические и средовые факторы. Несмотря на значительную распространенность UL, для нее в полной мере не разработаны долгосрочные, экономически эффективные варианты терапии и сохранения фертильности. Цель. Обобщить имеющиеся в литературе данные об этиопатогенезе миомы матки, а также о факторах риска развития этого заболевания. Материалы и методы. В базах данных литературы PubMed, Scopus и Web of Science был проведен поиск соответствующих статей с использованием таких ключевых слов, как «миома матки», «UL», «ассоциация», «генетические и гормональные факторы», «ген», «этиология» в различных комбинациях. Результаты. Генетические нарушения, гормональные факторы и факторы роста играют определенную роль в этиологии UL, при этом результаты исследований использования гормональной терапии при миоме различаются. Исследования этиопатогенеза UL, связанные с использованием генетически модифицированных мышиных моделей заболевания, являются достаточно интересными. В этом обзоре обсуждаются основные факторы этиопатогенеза миомы матки, и в том числе генетические, гормональные и факторы роста. Рассматриваются факторы риска, которые способствуют развитию UL. Заключение. Многие вопросы о причинах и механизмах развития миомы матки, ее факторах риска остаются без ответа, что обуславливает необходимость продолжения этих исследований с целью получения новой информации. Проведение дальнейших работ в этой области позволит лучше понять причины и факторы риска развития заболевания.
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1. Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016;22(6):665-86. DOI:10.1093/humupd/dmw023
2. Drayer SM, Catherino WH. Prevalence, morbidity, and current medical management of uterine leiomyomas. Int J Gynaecol Obstet. 2015;131(2):117-22. DOI:10.1016/j.ijgo.2015.04.051
3. Bulun SE. Uterine fibroids. New Engl J Med. 2013;369(14):1344-55. DOI:10.1056/NEJMra1209993
4. Ponomarenko I, Reshetnikov E, Polonikov A, et al. Candidate genes for age at menarche are associated with uterine leiomyoma. Front Genet. 2021;11:512940. DOI:10.3389/fgene.2020.512940
5. Doherty L, Mutlu L, Sinclair D, Taylor H. Uterine fibroids: clinical manifestations and contemporary management. Reprod Sci. 2014;21(9):1067-92. DOI:10.1177/1933719114533728
6. Адамян Л.В. Миома матки: диагностика, лечение и реабилитация. Клинические рекомендации по ведению больных. М.: Изд-во Научного центра акушерства, гинекологии и перинатологии им. В.И. Кулакова, 2015 [Adamyan LV. Mioma matki: diagnostika, lechenie i reabilitatsiya. Klinicheskie rekomendatsii po vedeniyu bol’nykh. Moscow: Izdatel’stvo Nauchnogo tsentra akusherstva, ginekologii i perinatologii imeni V.I. Kulakova, 2015 (in Russian)].
7. Gallagher CS, Mäkinen N, Harris HR, et al. Genome-wide association and epidemiological analyses reveal common genetic origins between uterine leiomyomata and endometriosis. Nat Commun. 2019;10(1):4857. DOI:10.1038/s41467-019-12536-4
8. Van Heertum K, Barmat L. Uterine fibroids associated with infertility. Womens Health (Lond). 2014;10(6):645-53. DOI:10.2217/whe.14.27
9. Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91(4):1215-23. DOI:10.1016/j.fertnstert.2008.01.051
10. Wise LA, Laughlin-Tommaso SK. Epidemiology of uterine fibroids: from menarche to menopause. Clin Obstet Gynecol. 2016;59(1):2-24. DOI:10.1097/GRF.0000000000000164
11. Pavone D, Clemenza S, Sorbi F, et al. Epidemiology and risk factors of uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2018;46:3-11. DOI:10.1016/j.bpobgyn.2017.09.004
12. Alsudairi HN, Alrasheed AT, Dvornyk V. Estrogens and uterine fibroids: an integrated view. Research Results in Biomedicine. 2021;7(2):156-63. DOI:10.18413/2658-6533-2021-7-2-0-6
13. Al-Hendy A, Myers ER, Stewart E. Uterine fibroids: burden and unmet medical need. Semin Reprod Med. 2017;35(6):473-80. DOI:10.1055/s-0037-1607264
14. Ulin M, Ali M, Chaudhry ZT, et al. Uterine fibroids in menopause and perimenopause. Menopause. 2020;27(2):238-42. DOI:10.1097/GME.0000000000001438
15. Qin H, Lin Z, Vásquez E, Xu L. The association between chronic psychological stress and uterine fibroids risk: A meta-analysis of observational studies. Stress Health. 2019;35(5):585-94. DOI:10.1002/smi.2895
16. Пономаренко И.В., Полоников А.В., Чурносов М.И. Полиморфные локусы гена LHCGR ассоциированы с развитием миомы матки. Акушерство и гинекология. 2018;10:86-91 [Ponomarenko IV, Polonikov AV, Churnosov MI. Polymorphic loci of the LHCGR gene are associated with the development of uterine leiomyma. Obstetrics and Gynecology/Akusherstvo i ginekologiya. 2018;10:86-91 (in Russian)]. DOI:10.18565/ aig.2018.10.86-91
17. Osinovskaya NS, Ivaschenko TE, Dzhemlikhanova LKh, et al. Features of the gene polymorphism of estrogen and progesterone receptors in women with uterine leiomyoma. Journal of Obstetrics and Women’s Diseases/Zhurnal akusherstva i zhenskikh boleznei. 2012;61(3):109-14 (in Russian).
18. Altukhova OB, Radzinsky VE, Polyakova IS, et al. The role of the folate cycle genes in development of uterine fibroids. Obstetrics and Gynecology/Akusherstvo i ginekologiya. 2021;12:96-101 (in Russian).
19. Bushueva OYu, Kudryavtseva OK, Barysheva EМ, et al. GSR (glutathione reductase) gene as a possible candidate gene for predisposition to uterine fibroids. Medical genetics. 2021;20(3):41-6 (in Russian). DOI:10.25557/2073-7998.2021.03.41-46
20. Altuhova OB, Radzinskij VE, Sirotina SS, et al. Polimorfizm genov interlejkinov i risk razvitiya miomy matki. Obstetrics and Gynecology/Akusherstvo i ginekologiya. 2022;7:81-7 (in Russian). DOI:10.18565/aig.2022.7.81-87
21. Baranov VS, Osinovskaya NS, Yarmolinskaya MI. Pathogenomics of uterine fibroids development. Int J Mol Sci. 2019;20(24):6151. DOI:10.3390/ijms20246151
22. Manta L, Suciu N, Toader O, et al. The etiopathogenesis of uterine fibromatosis. J Med Life. 2016;9(1):39-45.
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Авторы
Ola M. Alali*, Mikhail I. Churnosov
Belgorod State National Research University, Belgorod, Russia
*alaliola9@gmail.com
________________________________________________
О.М. Алали*, М.И. Чурносов
ФГАОУ ВО «Белгородский государственный национальный исследовательский университет», Белгород, Россия
*alaliola9@gmail.com