Email this article The value of azoximer bromide for optimization of therapy for HPV-associated cervical precancerous diseases
- Authors: Kononova I.N.1, Dobrokhotova Y.E.1, Shmakova N.A.2, Kareva E.N.1,3, Chistyakova G.N.2
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Affiliations:
- Pirogov Russian National Research Medical University
- Urals Scientific Research Institute for Maternal and Child Care
- Sechenov First Moscow State Medical University (Sechenov University)
- Issue: Vol 22, No 6 (2020)
- Pages: 80-83
- Section: ORIGINAL ARTICLE
- URL: https://journal-vniispk.ru/2079-5831/article/view/58734
- DOI: https://doi.org/10.26442/20795696.2020.6.200463
- ID: 58734
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Abstract
A significant increase in human papillomavirus-associated cervical oncological diseases, a high rate of recurrence of the process (48–62.4%) after surgical treatment, changes in the local immune microenvironment in cervical biopsy specimens with (HSIL) created the prerequisites for studying the clinical efficacy of local immunocorrection in complex HSIL therapy.
Aim. To study the clinical efficacy of local immunocorrection of azoximer with bromide in the complex therapy of cervical intraepithelial neoplasias.
Materials and methods. Examination and treatment of 40 patients with HSIL was carried out. The study of the effectiveness of azoximer bromide in complex therapy in patients with cervical intraepithelial neoplasias of a high degree of oncogenic risk was carried out on the basis of an immunohistochemical study of cervicobioptates to markers CD3, CD56, CD20, CD138, M-CSF.
Results and discussion. It was revealed that cervical intraepithelial neoplasias of a high degree of oncogenic risk are accompanied by changes in the local immune microenvironment in the epithelium and stroma of neoplastic altered tissues, which may contribute to the development of neoplasia progression. The inclusion of a local immunomodulator azoximer bromide in the complex therapy helped to reduce the recurrence of the process by 2 times, the elimination of the human papillomavirus by 3.5 times relative to the comparison group.
Conclusion. 1. In cervico-biopsy specimens of patients with HSIL, there is an increase in the proportion of cells with expression of receptors CD20, CD3, CD138 (in stromal cells) and a decrease in epithelial infiltration with M-CSF, which indicates significant changes in immune homeostasis in cells of the affected epithelium. Based on the results obtained, at the stage of preparation for surgical treatment of patients with HSIL, it is advisable to include local immunocorrection to improve the outcome of therapy. 2. The inclusion of a local immunomodulator azoximer bromide in the complex therapy helped to reduce the recurrence of the process by 2 times, the elimination of the human papillomavirus by 3.5 times, which dictates the need for complex immunomodulation in the treatment of HSIL at the stage of preparation for surgery.
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##article.viewOnOriginalSite##About the authors
Irina N. Kononova
Pirogov Russian National Research Medical University
Author for correspondence.
Email: irkonmed@mail.ru
ORCID iD: 0000-0003-3483-9464
D. Sci (Med.)
Russian Federation, 1, Ostrovityanova street, Moscow, 117997Yuliya E. Dobrokhotova
Pirogov Russian National Research Medical University
Email: pr.dobrohotova@mail.ru
ORCID iD: 0000-0003-2786-6181
D. Sci (Med.), Prof.
Russian Federation, 1, Ostrovityanova street, Moscow, 117997Nadezhda A. Shmakova
Urals Scientific Research Institute for Maternal and Child Care
Email: naschmakova@yandex.ru
ORCID iD: 0000-0002-4797-3876
Graduate Student
Russian Federation, 1, Repina street, Ekaterinburg, 620028Elena N. Kareva
Pirogov Russian National Research Medical University; Sechenov First Moscow State Medical University (Sechenov University)
Email: elenakareva@mail.ru
D. Sci (Med.)
Russian Federation, 1, Ostrovityanova street, Moscow, 117997; 8-2, Trubetskaya street, Moscow, 119992Guzel N. Chistyakova
Urals Scientific Research Institute for Maternal and Child Care
Email: 7@niiomm.ru
ORCID iD: 0000-0002-0852-6766
D. Sci (Med.), Prof.
Russian Federation, 1, Repina street, Ekaterinburg, 620028References
- Всемирная организация здравоохранения. Вирус папилломы человека (ВПЧ) и рак шейки матки. http://www.who.int/mediacentre /factsheets/fs380/ru/ [Vsemirnaia organizatsiia zdravookhraneniia. Virus papillomy cheloveka (VPCh) i rak sheiki matki. http://www.who.int/mediacentre/factsheets/fs380/ru/ (in Russian).]
- Каприн А.Д., Старинский В.В., Петрова Г.В. Злокачественные новообразования в России в 2018 году (заболеваемость и смертность). М.: МНИОИ им. П.А. Герцена – филиал ФГБУ «НМИРЦ» Минздрава России, 2019. [Kaprin A.D., Starinskiy V.V., Petrova G.V. Malignant neoplasms in Russia in 2018 (morbidity and mortality). Moscow: Moscow Scientific Research Institute named after P.A. Herzen – branch of the FSBI “NMIRTS” of the Ministry of Health of Russia, 2019 (in Russian).]
- Fang J, Zhang H, Jin S. Epigenetics and cervical cancer: from pathogenesis to therapy. Tumour Biol 2014; 35 (6): 5083–93. doi: 10.1007/s13277-014-1737-z
- Обоскалова Т.А., Кононова И.Н., Севостьянова О.Ю., Берзин С.А. Эпидемиологические особенности рака шейки матки у жительниц крупного промышленного города. Уральский мед. журн. 2014; 4 (118): 69–72.
- [Oboskalova T.A., Kononova I.N., Sevost’ianova O.Iu., Berzin S.A. Epidemiologicheskie osobennosti raka sheiki matki u zhitel’nits krupnogo promyshlennogo goroda. Ural’skii med. zhurn. 2014; 4 (118): 69–72 (in Russian).]
- Адамян Л.В., Артымук Н.В., Ашрафян Л.А. и др. Доброкачественные и предраковые заболевания шейки матки с позиции профилактики рака. Клинические рекомендации (протоколы диагностики и ведения больных), утв. Минздравом России 02.11.2017 №15-4/10/2-7675. М., 2017. [Adamyan L.V., Artymuk N.V., Ashrafyan L.A. et al. Benign and precancerous diseases of the cervix from the perspective of cancer prevention. Clinical guidelines (protocols for diagnosis and management of patients), approved the Ministry of Health of Russia 02.11.2017 No. 15-4/10/2-7675. Moscow, 2017 (in Russian).]
- Доброхотова Ю.Э., Венедиктова М.Г., Саранцев А.Н. и др. Комплексный подход к лечению вирусиндуцированного истинного предрака шейки матки. Лечеб. дело. 2016; 4: 52–6. [Dobrokhotova Yu.E., Venediktova M.G., Sarantsev A.N. et al. Kompleksnyi podkhod k lecheniiu virusindutsirovannogo istinnogo predraka sheiki matki. Lecheb. delo. 2016; 4: 52–6 (in Russian).]
- Bruni L, Barrionuevo-Rosas L, Albero G et al. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in Russian Federation. Summary Report 2016.
- Кононова И.Н., Ворошилина Е.С. Особенности местного иммунитета при цервикальных интраэпителиальных неоплазиях, ассоциированных с папилломавирусной инфекцией. Рос. иммунологический журн. 2014; 8 (3): 809–11. [Kononova I.N., Voroshilina E.S. Osobennosti mestnogo immuniteta pri tservikal’nykh intraepitelial’nykh neoplaziiakh, assotsiirovannykh s papillomavirusnoi infektsiei. Ros. immunologicheskii zhurn. 2014; 8 (3): 809–11 (in Russian).]
- Handisurya A, Lázár S, Papay P et al. Anogenital Human Papillomavirus Prevalence is Unaffected by Therapeutic Tumour Necrosis Factor-alpha Inhibition. Acta Derm Venereol 2016; 96 (4): 494–8. doi: 10.2340/00015555-2298
- Тихомиров А.Л., Сарсания С.И., Филатова Г.А. Вирус папилломы человека: от понимания иммунопатогенеза к рациональной тактике ведения. Гинекология. 2018; 20 (3): 5–11. [Tikhomirov A.L., Sarsania S.I., Filatova G.A. Human papillomavirus: from understanding immunopathogenesis to rational management tactics. Gynecology. 2018; 20 (3): 5–11 (in Russian).]
- Доброхотова Ю.Э., Венедиктова М.Г., Гришин И.И. и др. Эффективность комплексного подхода к лечению дисплазии эпителия шейки матки умеренной и тяжелой степени на фоне инфицирования вирусом папилломы человека. Фарматека. 2015; 3: 44–7. [Dobrokhotova Yu.E., Venediktova M.G., Grishin I.I. et al. Effektivnost’ kompleksnogo podkhoda k lecheniiu displazii epiteliia sheiki matki umerennoi i tiazheloi stepeni na fone infitsirovaniia virusom papillomy cheloveka. Farmateka. 2015; 3: 44–7 (in Russian).]
- Серов В.Н., Сухих Г.Т., Прилепская В.Н., Радзинский В.Е. Руководство по амбулаторно-поликлинической помощи в акушерстве и гинекологии. 2-е изд. М.: ГЭОТАР-Медиа, 2016; с. 1136. [Serov V.N., Sukhikh G.T., Prilepskaya V.N., Radzinsky V.E. A guide to outpatient care in obstetrics and gynecology. 2nd ed. Moscow: GEOTAR-Media, 2016; p. 1136 (in Russian).]
- Кононова И.Н. Цервикальные интраэпителиальные неоплазии: прогнозирование, лечение, реабилитация. Автореф. дис. … д-ра мед. наук. Челябинск, 2017; с. 27. [Kononova I.N. Tservikal’nye intraepitelial’nye neoplazii: prognozirovanie, lechenie, reabilitatsiia. Avtoref. dis. … d-ra med. nauk. Cheliabinsk, 2017; p. 27 (in Russian).]
- Einstein MH, Schiller JT, Viscidi RP et al. Clinician’s guide to human papillomavirus immunology: knowns and unknowns. Lancet Infec Dis 2009; 9 (6): 347–56. doi: 10.1016/s1473-3099(09)70108-2
- Кононова И.Н., Карева Е.Н. Локальная антибактериальная терапия при комплексном лечении пациенток с заболеваниями шейки матки, ассоциированными с вирусом папилломы человека. Акушерство и гинекология. 2018; 7: 103–97. [Kononova I.N., Kareva E.N. Lokal’naia antibakterial’naia terapiia pri kompleksnom lechenii patsientok s zabolevaniiami sheiki matki, assotsiirovannymi s virusom papillomy cheloveka. Akusherstvo i ginekologiia. 2018; 7: 103–97 (in Russian).]
- Kocjan G, Priollet B, Desair M et al. BSCC, Bethesda or other? Terminology in cervical cytology European panel discussion. Cytopathology 2005; 6: 113–9. doi: 10.1111/j.1365-2303.2005.00256.х
- Motamedi M, Böhmer G, Neumann HH, Wasielewski R. CIN III lesions and regression: retrospective analysis of 635 cases. BMC Infect Dis 2015; 21 (15): 541. doi: 10.1186/s12879-015-1277-1
- Mitra A, Yun L, Macintyre D et al. Assessment of the vaginal microbiome with bacterial DNA pyrosequencing assording to CIN grade and severity. In: Abstracts 15th Wold congress for cervical pathology and colposcopy. London, 2014; p. 123–4.
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