Source: https://russianpatents.com/patent/255/2557977.html
Timestamp: 2019-04-20 13:11:00+00:00

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The invention relates to the field of medical diagnostics, namely to gynecology, and can be used to predict the risk of development of endometrial hyperplasia (GGE).
-atypical hyperplasia - a perverted, abnormal growth of endometrial tissue (adenomatosis, adenomatous hyperplasia) [Sun N. In. The importance of molecular genetic and immune factors in the pathogenesis and treatment tactics of patients with hyperplastic processes of the endometrium. //Author. Diss.to.m.N. - SPb., 2011. - 20 P.].
Endometrial hyperplastic processes possible at any age, are found almost one in four women with infertility and have varying degrees of manifestations, but their frequency increases significantly to perimenopausal. The prevalence of hyperplasia ending�Tria is 10-30%, endometrial polyps - 0.5 to 35.7 percent [Lysenko O. V. endometrial Hyperplastic processes in different age periods the study of cytokine status and SFAS ligand//Obstetrics and gynecology. - 2011. - №4.- S. 12-15].
Endometrial hyperplasia as a possible basis for the formation of malignant tumors for many decades represent an important medico-social problem. The frequency of malignancy of endometrial hyperplastic processes varies within a wide range (0.25 to 50%) and is determined by the morphological features of the disease, duration of recurrence, and patient's age. Simple endometrial hyperplasia without atypia proceeds to cancer in 1% of cases, polypoid form without atypia - 3 times more often.
For clinical endometrial hyperplasia characterized by anovulatory uterine bleeding that occurs typically after a delay of menstruation. Bleeding is usually prolonged, with moderate blood loss, or abundant, profuse. In hyperplastic processes of the endometrium (often with endometrial polyps) sometimes appear intermenstrual spotting [Maksimov S. Y. risk Factors for malignant neoplasms of reproductive system women//Problems of Oncology.-2003. - Vol. 49, No. 3, Pp. 496 - 501].
About�Anchalee confirmation of the diagnosis of the GGE is only possible after hysteroscopy with subsequent histological examination of the endometrium. Unfortunately, we have to admit that ultrasound diagnosis is not always effective. In some cases, the patients with unexplained even after the diagnostic laparoscopy infertility GGE revealed during hysteroscopic examination may be the only likely cause.
Pathological transformation of the endometrium is a complex biological process involving all links neurohumoral regulation of a woman's body. It is known that the reason for the development of the GGE could be defects in ovulation, giperestrogeniya, progesterone deficiency, disturbance of proliferation and suppression of apoptosis, and changes of the receptor phenotype of the endometrium. GGE often occurs with endometriosis, fibroids and chronic inflammatory processes in the endometrium. In recent years revealed a complex system of factors that are involved in cell regulation, and expanded notions of intercellular interaction and intracellular processes in hormone-dependent tissues. So, it is established that in the regulation of proliferative activity of cells of the endometrium along with the estrogen involved a number of biologically active compounds (interleukins, factors tumor necrosis, chemokines). In the regulation of tissue homeostasis and the pathogenesis of proliferative diseases an important role belonging to�IIT not only increased cell proliferation, but the dysregulation of cell death (apoptosis). The resistance of the endometrial cells to programmed cell death (apoptosis) leads to the accumulation of modified and excessively proliferous cells, which is characteristic of neoplastic changes in the endometrium [Lysenko O. V. Hyperplastic processes in the endometrium at different ages, the study of cytokine status and SFAS ligand//Obstetrics and gynecology. - 2011. - №4.- S. 12-15].
The known method according to the patent of Russian Federation №2466390 published on 10.11.2012 the application for invention No. 2011105301/15 from 15.02.2011 G. "a method for predicting the development of cancer in pathological processes of the endometrium in women of reproductive age" (Sidorova I. S. Unanyan A. L. (RU), Vlasov R. S. (RU), etc.), proposed a method for predicting the development of endometrial cancer, including the identification of clinical signs, scraping of the uterus, histological examination, determination of the methylation of genes-suppressors MLH1, RASSF1, GSTP1, P16, RAR-b, CDX1 tumor growth by the method of methyl-sensitive PCR (MCH-PCR), the calculation of the probability of development of cancer of the uterine body. When the value of R greater than 0.6 predict a high likelihood of developing cancer of the uterine body, p, equal to 0.3 and 0.59, - moderate probability of cancer, at p below 0,29 - low probability of cancer.
Untill�the horizon is he improves the accuracy of forecasting of development of cancer of the uterine body while existing pathological processes of the endometrium in women of reproductive age, and gives the opportunity to predict the propensity of patients to the formation of isolated endometrial hyperplastic processes.
The known method of quantitative morphological assessment of the severity of chronic endometritis on the patent of Russian Federation №2475742, published on 20.02.2013. The inventive method consists in the fact that examine the scrapings of the endometrium. On the histological specimen score the presence of morphological signs of chronic inflammation in most areas, and at selected sites, depending on their availability and homogeneity. The total score, which ranges from 1 to 10 points, is the quantitative assessment of the severity of chronic endometritis. The sum from 1 up to 4 points allows you to install a light degree of severity of chronic endometritis. From 5 to 7 points - medium, 8 to 10 - heavy. The disadvantage is that the method can be used only by the research histomorphological examination of scrapings from the uterus.
A method of predicting the development of endometriosis, leading to disruption of reproductive function in girls with oligomenorrhea RF patent №2161311, �published 27.12. 2000. The method is based on the study of a number of indicators of the immune system and includes determining the number of T-lymphocytes by flow cytometry (using a cytometric system FACS Calibur company Beckton Dickinson), determining the concentration of immunoglobulin M (IgM) using the test radial immunodiffusion according to Mancini, the determination of the level of circulating immune complexes (CIC) in serum - method of separation in polyethylene glycol with an assessment on the spectrograph Multiscan company Labsystems (wavelength 450 nm). Determination of the diagnostic factor F by the formula F=- K1 0,00793+K2 0,013 - K3 0,043+3,09, where K1- indicator IgM, K2- the value of the CEC, K3- figure T-cells (-CD3). If F>0, then predict a patient's risk of developing endometriosis. If F<0, then the occurrence of endometriosis is unlikely. The proposed method gives the probability of correct prediction in 76% of cases.
The method allows taking into account the main links of the pathogenesis of endometriosis to predict the development of this disease in adolescent girls with oligomenorrhea and chronic pelvic pain, in a timely manner to diagnose the disease and recommend pathogenetically based treatment that may affect the frequency of heavy running FD�m of endometriosis and associated infertility.
The disadvantage is that it can only be used to predict the development of endometriosis in adolescent girls with oligomenorrhea and chronic pelvic pain, but does not allow to predict the formation of isolated endometrial hyperplastic processes.
The objective of this study is to expand the Arsenal of methods of diagnosis, namely the creation of a prediction method of forming isolated hyperplastic processes of the endometrium in women of Russian nationality, urozhenko of the Central Chernozem region of Russia, on combinations of genetic polymorphisms: -308 TNFα G, +36 A TNFR1, A I-TAC, -889 T IL-1A and/or +36 A TNFR1, A I-TAC, -889 T IL-1A and/or -308 TNFα G, +250 G Ltα, -889 T IL-1A.
The technical result of the invention - to provide criteria for the assessment of the risk of isolated endometrial hyperplastic processes.
1A(-889 T IL-1A), lymphotoxin α (+250 G Ltα), prediction of an increased risk of isolated forms of hyperplastic processes of endometrium in patients in case of detection of a combination of alleles -308 TNFα G 36 A TNFR1, A I-TAC, -889 T IL-1A and/or combinations of alleles+36 A TNFR1, A I-TAC, -889 T IL-1A and/or combinations of alleles -308 TNFα G,+250 G Ltα, -889 T IL-1A.
Novelty and inventive step lies in the fact that the prior art not known to the ability to forecast the evolution of isolated endometrial hyperplasia by the presence of allele combinations -308 G gene of tumor necrosis factor α (-308 polymorphism TNFα G), allele+36 A receptor of the tumor necrosis factor (polymorphism+36 A TNFR1), allele And interferon inducible of chemoattractant T cells (polymorphism And I-TAC), -889 allele T of interleukin-1A (-889 polymorphism T IL-1A, allele+250 G lymphotoxin α (polymorphism+250 G Ltα).
Fig.1. Discrimination of alleles at locus G/A I-TAC (rs4512021) (where homozygotes GG, homozygotes AA, heterozygotes AG - negative control).
Fig.2. Electrophoretic separation of the products of restriction gene -889 C/T IL-1A, 2,3,4 where homozygotes -889 CT; 5,6,10 homozygotes -889 MOP; 1,7-9,11-14 -heterozygote -889 CT.
DNA extracted from samples of peripheral venous blood of patients with isolated hyperplastic processes of the endometrium by the method of phenol-chloroform extraction in 2 stages. In the first stage to 4 ml of blood add 25 ml of lyse buffer containing 320 mm sucrose, 1% Triton X-100, 5 mm MgCl2, 10 mm Tris-HCl (pH=7,6). The resulting mixture was stirred and centrifuged at 4 º C, 4000 rpm for 20 minutes. After centrifugation the supernatant decanted, to the residue add 4 ml of a solution containing 25 mm EDTA (pH=8.0) and 75 mm NaCl, resuspension. Then add 0.4 ml 10% SDS, 35 ál proteinase K (10 mg/ml) and incubated the sample at 37º for 16 hours.
In the second phase from the resulting lysate sequentially perform the extraction of DNA equal volumes of phenol, phenol-chloroform (1:1) and chloroform by centrifugation at 4000 rpm for 10 minutes. After each centrifugation produce a selection of the aqueous phase. DNA is precipitated from the solution with two volumes of chilled 96% ethanol. Formed DNA is dissolved in twice-distilled, deionized water and stored at -200°C.
The selected DNA is then subjected�Ute polymerase chain reaction using standard oligonucleotide primers (table 1).
Molecular genetic analysis is carried out by polymerase chain reaction of DNA synthesis. PCR is performed on the amplifiers IQ5 (BioRad) and TP-PCR-01-TERZIC".
On the amplifier IQ5 (Bio-Rad) analyze nucleotide polymorphism (-308 G/A TNFα,+36 A/G TNFR1 AND/G I-TAC,+250 A/G Ltα by polymerase chain reaction of DNA synthesis using standard oligonucleotide primers and specific probes with subsequent analysis of the polymorphism method for the discrimination of alleles. The reaction mixture volume of 25 μl includes: 6.7 mm Tris-HCl (pH 8,8), 2.5 mm MgCl2, 0.1 μg of genomic DNA, 10 PM of each primer, 5 pcmall each probe, 200 μm dATP, dGTP, dCTP, dTTP, and 1 unit of active Taq polymerase. After denaturation perform 40 cycles of amplification under the scheme: a primer annealing and denaturation.
On the amplifier TP-PCR-01-TERZIC" analyze polyester�of hizma gene -889 C/T IL-1A by polymerase chain reaction of DNA synthesis using standard oligonucleotide primers according to the method specified in [Hulkkonen, J. Inflammotory cytokines and cytokine gene polymorphisms in chronic lymphocytic leukaemia, in primary Sjögren''s Syndrome and Haelthy Subjects: [acad. diss.] /J. Hulkkonen; University of Tampere, Medical School Tampere University Hospital. - Tampere, 2002. - R. 81].
The reaction is carried out in a 12.5 µl total volume of the mixture containing 33.5 mm Tris-HCl (pH 8,8), 1.25 mm MgCl2, 0.5 μg of genomic DNA, 5 PM of each primer, 100 µm dATP, dGTP, dCTP, dTTP, and 1 unit of active Taq polymerase. After denaturation perform a 32 cycle amplification scheme: denaturation, primer annealing and elongation. Then, the samples incubated for 5 min at 72°C and cooled. The amplification products analyzed in 2% agarose gel, stained with ethidium bromide for 30 minutes at 160V. As the electrophoretic buffer used htae (Tris-acetate buffer). Then, the samples identified in transmitted UV light.
Genotyping is carried out by the method of discrimination of alleles using the Tag Man probes. When conducting PCR amplifier with fluorescence detection (amplifier IQ5) genotyping is performed by method Man Tag probes according to the values of OEF (relative fluorescence unit) of each probe.
Two lanes, vertical and horizontal, divide the graph into four sections: one for each homozygous state, one for the heterozygous state and the section without reaction. The assignment of genotypes of unknown samples is determined by tracing OEP for about�tion of the fluorophore on the x-axis relative to OEF for another fluorophore on the y-axis on the chart discrimination of alleles.
• If the values of OEF of the unknown sample are above the horizontal stripes and the right vertical stripes, genotype heterozygote (GA).
• If the values of OEF of the unknown sample are above the horizontal stripes and vertical bars to the left, genotype homozygote for an allele 2 (OEF allele 2 pending on the y-axis).
• If the values of OEF an unknown sample are below the horizontal bars and to the right of vertical, genotype homozygote for an allele of 1 (RFU allele 1 pending on the x-axis).
• If the values of OEF an unknown sample are below the horizontal bars and to the left of vertical, the definition of the genotype is not possible, in this case an undefined sample - negative control.
Genotyping of DNA markers (locus -889 C/T IL-1A) produced by the method of analysis of the polymorphism of the lengths of restriction fragments (RFLP) of PCR products amplification of specific genomic regions using appropriate enzymes produced by "Simanim" (Novosibirsk).
After incubation, the restriction mixture for 16 hours at 37°C is carried out the separation of DNA fragments by horizontal electrophoresis in an electrophoretic cell production company "Helikon" (Russia). Depending on the size of the partial DNA fragments using agarose gel 2-3% concentration, PR�prepared on the basis of TVE-buffer stained with ethidium bromide solution (0,01%). Visualization of trigram performed in a dark box with a transilluminator company UVP (Sweden).
Creation of database and statistical calculations carried out using the program "STATISTICA 6.0" [Borovikov, V. Statistica: the art of computer data analysis /V. Borovikov. - 2nd ed. - SPb.: Peter, 2003. - 688 p.: ill. - (For professionals)].
Study of the role of combinations of genetic variants of polymorphic markers of genes of interleukins in the formation of isolated uterine fibroids was performed using the software APSampler [http:sources.redhat.com/cygwin/] using Monte-Carlo Markov chains and Bayesian nonparametric statistics [A. V. Favorov A Gibbs sampler for identification of symmetrically structured, spaced DNA motifs with improved estimation of the signal length /A. V. Favorov, M. S. Gelfand, A. V. Gerasimova [et al.] //ioinformatics. - 2005. - Vol.21, No. 10. - R. 2240-2245].
Assessment of the level of statistical significance of the obtained results is carried out using the Bonferroni (pcor), i.e., amendments that minimizes the probability of false positive results [Rebrova O. Yu., Statistical analysis of medical data. https://sites.google.com/site/oyurebrova/book" t "_blank /O. Y. Rebrova//M media. - 2006 - 312 p.].
The possibility of using the proposed method to assess the risk of development of isolated endometrial hyperplasia confirmation�em analysis of the results of observations of 713 patients with different proliferative processes of the reproductive system, including uterine fibroids, endometriosis, endometrial hyperplastic processes and population control group of 500 people. Among 713 surveyed in 150 women were observed hyperplastic processes in the endometrium. Patients were included in the relevant group of patients only after diagnosis of the disease, confirmed by clinical, laboratory and instrumental methods of examination and confirmed by histology data.
In the studied group included individuals of Russian nationality who are nationals of the Central Chernozem region of Russia and have no relationship among themselves.
Found that the combination of molecular genetic markers -308 TNFα G,+36 A TNFR1, A I-TAC, -889 T IL-1A occurs in 41,86% of patients in 2 times more often than in the control group (20,92%, p=0,000005, pcor=0,01, OR=2,72 95%CI 1,76 - 4,18). Also in patients with isolated endometrial hyperplasia common in the combination of genetic variants +36 A TNFR1, A I-TAC, -889 T IL-1A (42,64%) 1.9 times more often in comparison with the control (22,25%, p=0,0000008, pcor=0,02, OR=TO 2.59, 95%CI 1,70 - 3,95). The combination of the three genetic markers -308 TNFα G,+250 G Ltα, -889 T IL-1A (14,81%) in this group significantly more often (in 4.5 times) occurs than in the control group (or 3.28%, p=0,000001, pcor=0,02, OR=5,12, 95%CI 2,47 - 10,61).
The patient H. the Russian national�spine, a native of the Central Chernozem region of Russia, was held the fence peripheral venous blood, extraction of DNA from peripheral venous blood; polymerase chain reaction typing of genetic polymorphisms of the tumor necrosis factor α (-308 G/A TNFα), receptor of tumor necrosis factor 1 (+36 A/G TNFR1), interferon inducible of chemoattractant T cells (A/G I-TAC), interleukin-1A (-889 C/T IL-1A), lymphotoxin α (+250 A/G Ltα) and analysis of combinations of gene polymorphisms of tumor necrosis factor α (-308 TNFα G), the receptor of tumor necrosis factor 1 (+36 A TNFR1), interferon inducible of chemoattractant T cells (I-TAC), interleukin-1A (-889 T IL-1A), lymphotoxin α (+250 G Ltα). The results are shown in figures 1 and 2.
It is revealed that due to the presence of a combination of alleles -308 TNFα G, +36 A TNFR1, A I-TAC, -889 T IL-1A and combinations of alleles+36 A TNFR1, A I-TAC, -889 T IL-1A, a woman can be attributed to the risk group of the probability of occurrence of isolated endometrial hyperplastic processes with the aim of preventing the development of clinical manifestations, and with the aim of early diagnosis to reduce the frequency of surgical intervention and improve the quality of life of women.
Thus, the obtained data indicate that combinations of alleles -308 TNFα G,+36 A TNFR1, A I-TAC, -889 T IL-1A, allele+36 A TNFR1, A I-TAC, -889 T IL-1A and allele -308 TNFα G,+250 G Ltα, -889 T IL-1A are risk factors R�Suite endometrial hyperplasia (OR=2,72, OR=2,59 and OR=5,12, respectively) in women of Russian nationality, urozhenko of the Central Chernozem region of Russia.
The use of this method will allow to form among women of Russian nationality, urozhenko of the Central Chernozem region of Russia, a group of patients with increased risk of development of endometrial hyperplastic processes for mandatory dynamic ultrasound to monitor the condition of the endometrium, histomorphological examination of the contents of the uterine cavity, with subsequent selection of measures of prevention, supervision or medical treatment from a specialist doctor. With early diagnosis and proper differentiated approach to the management of patients with endometrial hyperplasia will have the opportunity to prevent slamonline of endometrial hyperplastic processes.
A method of predicting risk of development of endometrial hyperplasia in women of Russian nationality, urozhenko of the Central Chernozem region of Russia, including extraction of DNA from peripheral venous blood typing by polymerase chain reaction genetic polymorphisms of the tumor necrosis factor α (-308 G/A TNFα), receptor of tumor necrosis factor 1 (+36 A/G TNFR1), interferon inducible of chemoattractant T cells (A/G I-TAC), interleukin-1A (-889 CT IL-1A), lymphotoxin α (+250 A/G Ltα), and the prediction of an increased risk of endometrial hyperplastic processes in identifying combinations of alleles -308 TNFα G, +36 A TNFR1, A I-TAC, -889 T IL-1A and/or combinations of alleles+36 A TNFR1, A I-TAC, -889 T IL-1A and/or combinations of alleles -308 TNFα G,+250 G Ltα, -889 T IL-1A.

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