Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC118110.15690/vramn1181ENDOCRINOLOGY: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ЭНДОКРИНОЛОГИИResearch ArticlePredictive biomarkers in the treatment of acromegaly: a review of the literatureПредиктивные биомаркеры в лечении акромегалии: обзор литературыhttps://orcid.org/0000-0001-9119-24479309-3256PrzhiyalkovskayaE. G.ПржиялковскаяЕлена Георгиевна
Russian Federation

MD, PhD

к.м.н.

przhiyalkovskaya.elena@gmail.comhttps://orcid.org/0000-0003-0473-81448179-7602OsmanovaPatimat O.ОсмановаПатимат Османовна
Russian Federation
osmanova.ne@yandex.ruhttps://orcid.org/0000-0002-9783-35993904-6017MamedovaElizaveta O.МамедоваЕлизавета Октаевна
Russian Federation

MD, PhD

к.м.н.

lilybet@mail.ruhttps://orcid.org/0000-0002-9314-78314037-1030LutsenkoAlexander S.ЛуценкоАлександр Сергеевич
Russian Federation
some91@mail.ruhttps://orcid.org/0000-0002-6674-64414746-7173BelayaZhanna E.БелаяЖанна Евгеньевна
Russian Federation

MD, PhD

д.м.н.

jannabelaya@gmail.comhttps://orcid.org/0000-0002-5634-78778615-0038MelnichenkoGalina A.МельниченкоГалина Афанасьевна
Russian Federation

MD, PhD, Professor

д.м.н., профессор

Teofrast2000@mail.ruEndocrinology Research CentreНациональный медицинский центр эндокринологии13122019211220197464304402509201909122019Copyright ©; 2019, "Paediatrician" Publishers LLCCopyright ©; 2019, Издательство "Педиатръ"2019"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/about/submissionshttps://vestnikramn.spr-journal.ru/jour/article/view/1181

In the era of personalized medicine treatment of acromegaly requires the individual selection of optimal treatment based on the measured parameters. Following the standard algorithm for the management of patients with acromegaly with the choice of neurosurgical treatment as the main and somatostatin analogues as the first line of drug therapy with ineffective surgery prevents the achievement of remission in patients resistant to these types of therapy. The introduction of predictive biomarkers in clinical practice will allow to achieve remission of the disease faster and reduce the financial costs of ineffective treatments. We collected information of possible predictive biomarkers in acromegaly from literature. This review presents data from studies of potential predictive biomarkers in different treatments of acromegaly. According to the analysis of publications, the greatest number of results is devoted to the prediction resistance to somatostatin analogues. Reliable biomarkers predicting the inefficiency of somatostatin analogues include low immunoexpression of somatostatin receptors type 2 and AIP protein, rarely granular type of pituitary adenoma and hyperintensive signal on T2-weighted images in magnetic resonance imaging of the pituitary gland. At the same time, the search for predictors of the effectiveness of pegvisomant is focused on the study of the receptor of growth hormone and opens up new opportunities for pharmacogenomic research. Thus, it is necessary to expand the search of predictive biomarkers for different methods of acromegaly’s treatment. It is especially important to identify biomarkers that do not require mandatory removal of the tumor. Of great interest is the study of epigenetic biomarkers, in particular miRNAs, which carry out post-transcriptional regulation of gene expression. The study of circulating blood microRNAs in acromegaly opens up prospects for the introduction of a personalized approach in the treatment of this disease.

В эпоху персонализированной медицины лечение акромегалии требует изменения подхода от метода «проб и ошибок» до индивидуального подбора оптимального лечения на основании измеряемых параметров. Соблюдение стандартного алгоритма ведения пациентов с акромегалией с выбором нейрохирургического лечения в качестве основного и аналогов соматостатина в качестве первой линии медикаментозной терапии при неэффективном оперативном вмешательстве препятствует достижению ремиссии у пациентов, резистентных к данным видам терапии. Внедрение предиктивных биомаркеров в клиническую практику позволит быстрее достичь ремиссии заболевания и снизить финансовые затраты на неэффективные методы лечения. Этот обзор представляет данные исследований потенциальных предиктивных биомаркеров при различных методах лечения акромегалии. Согласно анализу публикаций, наибольшее количество результатов посвящено предсказанию резистентности к аналогам соматостатина. К надежным биомаркерам, предсказывающим неэффективность аналогов соматостатина, относят низкую иммуноэкспрессию соматостатиновых рецепторов 2-го типа и белка AIP, редкогранулированный тип аденомы гипофиза и гиперинтенсивный сигнал на Т2-взвешенных изображениях при магнитно-резонансной томографии гипофиза. В то же время поиск предикторов эффективности терапии пэгвисомантом сфокусирован на изучении рецептора к соматотропному гормону и открывает новые возможности для фармакогеномных исследований. Таким образом, необходимо расширение области поиска предиктивных биомаркеров при разных методах лечения акромегалии. Особенно важно выявление биомаркеров, не требующих обязательного удаления опухоли. Большой интерес вызывает исследование эпигенетических биомаркеров, в частности микроРНК, которые осуществляют посттранскрипционную регуляцию экспрессии генов. Изучение циркулирующих в крови микроРНК при акромегалии открывает перспективы для внедрения персонализированного подхода в лечении данного заболевания.

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