Genital endometriosis belongs to the top three diseases of female genital organs. Originally described more than 150 years ago (1860), endometriosis is an estrogen-dependent, chronic, inflammatory disease that is prevalent all over the world in 10-30% of women of reproductive and older age. This disease is of significant social importance, meaning that about 40% of women with endometriosis suffer from infertility. Endometriosis is characterized by an increase in endometrial-like tissue in aberrant areas outside the uterus, which is responsible for symptoms, including chronic pelvic pain, inflammation, dysmenorrhea, dyspareunia and subfertility, which significantly impair the quality of life of women. In Germany, direct and indirect economic costs for endometriosis annually reach up to $ 1.5 billion, and up to $ 20 billion in the United States [1]. The volume of data in the field of endometriosis is constantly updated. The purpose of this review is to analyze sientific data devoted to research, in particular, molecular aspects, of the development of endometriosis in order to find the possibilities of early non-invasive diagnosis of this disease. In March 2018, President of the World Endometriosis Research Foundation (WERF), Professor Adamson and President of the International Society for Endometriosis (WES), Professor Johnson, in their official joint statement, noted that one of the leading priorities of modern endometriosis research is the search for reliable biomarkers of endometriosis and development of non-invasive and low-invasive methods for their determination that will significantly speed up and facilitate the diagnosis of endometriosis, improve the quality of treatment, monitor its effectiveness and to track the relapse of the disease [2].
According to the definition of the FDA-NIH biomarker working group, (USA, 2018): "The diagnostic biomarker is used to detect or confirm the presence of an interesting disease or condition or identify individuals with a subtype of the disease. This is an indicator that can be objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes or pharmacological response to therapeutic intervention. Before recognizing the biomarker test as diagnostic, in addition to clinical, stable analytical functioning is necessary "[3].
Such routine diagnostic tests for endometriosis are not currently accepted in routine clinical practice, and the only standard for the final diagnosis of endometriosis remains a biopsy of the foci in surgical intervention, which is the main factor determining the high cost of management of endometriosis. Multifactority and insufficient knowledge of the etiology of endometriosis make it difficult to find diagnostic markers and requires an unusual approach to the search for potential diagnostic targets. Published data of Yu.G.Payanidi and co-authors on the close connection of primary-multiple malignant diseases of the endometrium and ovaries in women at the perimenopausal age with the presence of endometriosis are confirmed by the results of earlier studies on the similarity of the pathogenesis of endometriosis and malignant neoplasms, which allows extrapolating the approach to minimally invasive and Noninvasive diagnosis of endometriosis from cancer diagnosis studies. This concerns, first of all, the study of extracellular vesicles circulating in the peripheral blood and micro-RNA contained in them.
Thanks to the decoding of the human genome, a completely new direction emerged: molecular medicine. Complex analysis of diseases, from the identification of the causative gene, its expression, the characteristics of protein products, and the identification of the role of each gene in the metabolic (signal) pathways of the cell, the whole organism in norm and in pathology, formed the basis for a new, rapidly developing direction - systemic genetics, which considers the development of any quantitative trait at the level of transcription of genes, their expression, protein synthesis, metabolic pathways, intercellular interactions, of the organ and systems. One of the most progressive areas of molecular medicine today has become epigenetics, the beginning of which was laid by Conrad Waddington back in 1942.