|Year : 2018 | Volume
| Issue : 2 | Page : 139-144
Serum galectin-9 level in patients with atopic dermatitis
Tarek E Amin1, Abeer A Hodeib1, Jehan A Elsharnouby2, Shaimaa E Elgedawy3
1 Department of Dermatology and Venereology, Tanta University Hospital, Tanta, Egypt
2 Department of Clinical Pathology, Tanta University Hospital, Tanta, Egypt
3 Department of Dermatology and Venerology, Kafr Elsheikh Dermatology Hospital, Tanta, Egypt
|Date of Submission||26-Jul-2017|
|Date of Acceptance||02-Jan-2018|
|Date of Web Publication||31-Oct-2018|
Shaimaa E Elgedawy
Mahallet Ziad, Samannoud, Gharbia Governorate, 31816
Background Atopic dermatitis (AD) is a common chronic inflammatory skin disease of unknown etiology. It is characterized by peripheral eosinophilia, mast cell activation, and predominance of T-helper-2 cells. Galectin-9 is a potent eosinophilic chemoattractant. It also alters T-cell balance by negatively regulating T-helper cells, resulting in T-helper-2 polarization. Inhibition of endogenous galectin-9 may improve the course of the disease.
Aim The aim of this study was to evaluate serum level of galectin-9 in patients with AD to assess its possible role in pathogenesis of the disease.
Patients and methods The current study included 20 patients with AD and 10 age-matched and sex-matched healthy individuals who served as a control group. Patients were divided into three groups, mild, moderate, and severe, according to their Six-Area, Six-Sign Atopic Dermatitis score. Peripheral venous blood sample was taken from each participant, and serum was examined by enzyme-linked immunosorbent assay for quantitative evaluation of galectin-9.
Results Galectin-9 was significantly increased in patients with AD compared with the control group. The difference between the three studied groups was statistically significant regarding serum galectin-9 level. There was significant positive correlation between serum galectin-9 level and severity of the disease. In contrast, no significant correlations were found between serum galectin-9 level and age, sex of the patients, and duration of the disease.
Conclusion Serum galectin-9 level was significantly elevated in patients with AD. This increase was positively correlated with disease severity. This suggests a possible role of galectin-9 in the pathogenesis of AD. New treatment strategies that are directed toward lowering galectin-9 level may be a hope for future perspectives of the treatment of AD.
Keywords: atopic dermatitis, galectins, Six-Area Six-Sign Atopic Dermatitis, T-cell immunoglobulin mucin-3
|How to cite this article:|
Amin TE, Hodeib AA, Elsharnouby JA, Elgedawy SE. Serum galectin-9 level in patients with atopic dermatitis. Tanta Med J 2018;46:139-44
|How to cite this URL:|
Amin TE, Hodeib AA, Elsharnouby JA, Elgedawy SE. Serum galectin-9 level in patients with atopic dermatitis. Tanta Med J [serial online] 2018 [cited 2019 May 24];46:139-44. Available from: http://www.tdj.eg.net/text.asp?2018/46/2/139/244691
| Introduction|| |
Atopic dermatitis (AD) is a pruritic disease of unknown origin that usually starts in early infancy, though an adult-onset variant has been recognized. This is the first disease to present in a series of allergic diseases, that include food allergy, asthma, and allergic rhinitis, in order of presentation, which has given rise to the ‘atopic march’ theory. It has been suggested that AD is part of a progression that may lead to subsequent allergic disease at other epithelial-barrier surfaces ,.
Two main hypotheses have been proposed regarding the development of inflammation that leads to AD. The first hypothesis suggests a primary immune dysfunction resulting in immunoglobulin E sensitization and secondary epithelial-barrier disturbance. The second hypothesis proposes a primary defect in the epithelial barrier leading to secondary immunologic dysregulation and resulting in inflammation .
Galectins are a large family proteins with relatively broad specificity. They have a broad variety of functions including mediation of cell–cell interactions, cell–matrix adhesion, and transmembrane signaling. Their expression and secretion are well regulated, suggesting that they may be expressed at different times during development . Galectins can regulate cell death both intracellularly and extracellularly. Extracellularly, they cross-link glycans on the outside of cells and transduce signals across the membrane to directly cause cell death or activate downstream signaling that triggers apoptosis. Intracellularly, they can directly regulate proteins that control cell fate. So, galectins have a vital role in apoptosis. One essential way by which galectins regulate apoptosis is by controlling positive and negative selection of T cells in the thymus. This process prevents the circulation of T cells that are self-reactive and recognize self-antigen .
Galectin-9 (Gal-9) is secreted by epithelial cells in the thymus and mediates T-cell apoptosis. T-cell death is also necessary to kill activated and infected T cells after an immune response. Gal-9 has been well characterized as an eosinophilic chemoattractant. Inhibition of endogenous Gal-9 function may improve the disease course of AD .
| Aim|| |
The aim of this study was to evaluate serum level of Gal-9 in patients with AD to assess its possible role in pathogenesis of the disease.
| Patients and methods|| |
This study was carried out on 20 patients with AD who were recruited from the outpatient clinic of Dermatology and Venereology Department, Tanta University Hospitals. In addition, 10 age-matched and sex-matched healthy individuals were recruited who served as a control group.
The patient group included 11 males and nine females. Their ages ranged between 3 months and 25 years. The diagnosis of AD was based on Hanifin and Rajka criteria for AD . The control group included five males and five females with no past or family history of atopic disorders. Their ages ranged between 5 months and 26 years.
The following were the inclusion criteria:
- Patients with different stages and severity of the disease.
- Patients who accepted to be enrolled in the study and signed informed consents.
The following were the exclusion criteria:
- Patients who received any topical or systemic treatment for AD during the past 6 weeks before the study.
- Patients with history of drug or alcohol dependency or cigarette smokers.
- Patients with other dermatological diseases that may affect serum Gal-9 such as systemic lupus erythematosus and viral infection such as herpes simplex virus and HIV.
- Patients with any systemic diseases that may affect serum Gal-9 level such as autoimmune diseases, coronary artery disease, and various cancers (hepatocellular carcinoma, cholangiocarcinoma, or hematologic malignancies).
- Patients under NSAIDs or antioxidants, as they may affect the serum level of Gal-9.
All participants were subjected to the following:
- Complete history taking:
- Personal history included name, age, sex, occupation, and special habits.
- Present history included onset, course, and duration of the disease.
- Family history of AD or other allergic diseases.
- Past history of similar condition.
- Thorough general and dermatological examination was done to exclude any systemic or dermatological diseases:
- Patients were examined for the site, morphology, and distribution of the lesions.
- The severity of the disease was assessed using Six-Areas Six-Signs Atopic Dermatitis (SASSAD) severity score . The patients were classified into mild (SASSAD score<20), moderate (SASSAD score=20–40), and severe (SASSAD score>40).
- Laboratory investigations: routine laboratory investigations included complete blood count, random blood glucose level, lipid profile, liver and renal function tests, along with determination of the serum level of Gal-9 by enzyme-linked immunosorbent assay for quantitative detection of human Gal-9 were done .
- Statistical presentation and analysis of the study were conducted using the mean value, SD, χ2-test and linear correlation coefficient (r) by SPSS, Newtest company Egypt, V.16.
| Results|| |
The present study included 20 patients with AD and 10 age-matched and sex-matched healthy persons serving as controls.
This group included five (50%) males and five (50%) females. Their ages ranged from 5 months to 26 years, with a mean of 10.48±10.97 years. They included three (30%) infants, three (30%) children, and four (40%) adults ([Table 1]).
This group included 20 patients with AD, with 11 (55%) males and nine (45%) females. Their ages ranged from 3 months to 25 years, with mean of 9.77±9.28 years. They included six (30%) infants, seven (35%) children, and seven (35%) adults. Comparison between patients and control groups regarding the age and sex revealed no significant difference ([Table 1]).
Duration of the disease ranged from 2 months to 20 years, with a mean of 5.87±5.86 years. There was a positive personal history of other atopic disorders in nine (45%) patients, in the form of allergic rhinitis in seven (35%) patients and asthma in two (10%) patients. Family history of atopic diseases was positive in 11 (55%) patients only ([Table 2]).
Patients were classified according to SASSAD score into mild, moderate, and severe. The score ranged from 10 to 42, with mean of 29.05±10.87. Mild AD group included five (25%) patients. Of them, one (20%) was infant, two (40%) were children, and two (40%) were adults. Moderate AD group included nine (45%) patients. Of them, there were three (33.3%) infants, three (33.3%) children, and three (33.3%) adults. Severe AD group included six (30%) patients. Of them, there were two (33.3%) infants, two (33.3%) children, and two (33.3%) adults ([Table 3] and [Table 4]).
|Table 3 Data of the studied patients according to Six-Area, Six-Sign Atopic Dermatitis score|
Click here to view
Routine laboratory investigations including complete blood count, random blood glucose level, lipid profile, liver and renal function tests were within normal limits.
Serum Gal-9 in patients group ranged from 414.8 to 1296.3 pg/ml, with a mean of 872.44±252.49 pg/ml. In contrast, serum Gal-9 in control group ranged from 121.9 to 351.6 pg/ml, with a mean of 269.94±81.71 pg/ml. There was statistically significant increase in serum Gal-9 in patients compared with control (P<0.001) ([Table 5]).
|Table 5 Comparison between the studied groups according to serum galectin-9 level|
Click here to view
In the 11 studied male patients, serum Gal-9 level ranged from 547.2 to 1121.5 pg/ml, with a mean of 833.75±179.1 pg/ml, whereas in the nine studied female patients, it ranged from 414.8 to 1296.3 pg/ml, with a mean of 919.72±326.71 pg/ml. There was no significant difference between serum Gal-9 in male and female patients (P=0.464) ([Table 6]).
|Table 6 Relation between serum galectin-9 level and sex in patients group|
Click here to view
In the 11 studied patients with negative personal history of other atopic diseases, serum Gal-9 level ranged from 414.8 to 1296.3 pg/ml, with a mean of 840.35±284.55 pg/ml. In the seven studied patients with allergic rhinitis, serum Gal-9 level ranged from 1508 to 2160.3 pg/ml, with a mean of 1759.52±317.8 pg/ml. In the two studied patients with asthma, serum Gal-9 level ranged from 760 to 1121.5 pg/ml, with a mean of 940.75±255.62 pg/ml. There was no significant difference between serum Gal-9 levels in different groups of present history of other atopic diseases ([Table 7]).
|Table 7 Relation between serum galectin-9 level and family history of atopy, personal history of atopy, and disease severity in patients group|
Click here to view
Serum Gal-9 level in the 11 studied patients with positive family history of atopic diseases ranged from 547.2 to 1296.3 pg/ml, with a mean of 916.92±193.95 pg/ml, whereas in the nine studied patients with negative family history of atopic diseases, it ranged from 414.8 to 1255.8 pg/ml, with a mean of 818±313.59 pg/ml. There was no significant difference of serum Gal-9 level in patients with positive family history of atopy than in patients with negative family history ([Table 7]).
Regarding relation between serum Gal-9 and severity of the disease in patients group, serum Gal-9 level in the mild AD group ranged from 414.8 to 682.9 pg/ml, with a mean of 533.18±102.44 pg/ml. In the moderate AD group, it ranged from 760 to 951 pg/ml, with a mean of 875.83±64.24 pg/ml, whereas in the severe AD group, it ranged from 977.1 to 1296.3 pg/ml, with a mean of 1150.05±140.19 pg/ml. There was significant difference in serum Gal-9 level between mild and moderate, between mild and severe, and between moderate and severe ([Table 7]).
Regarding correlations between serum Gal-9 level and different parameters in patients group, there was no significant correlation between serum Gal-9 level and age (r=0.008 and P=0.975) and duration of the disease (r=0.154 and P=0.518). There was significant positive correlation between serum Gal-9 level and severity of the disease (rs=0.932 and P<0.001) ([Table 8]).
|Table 8 Correlation between serum galectin-9 and different parameters in patients group|
Click here to view
| Discussion|| |
AD is a chronic, highly pruritic, inflammatory skin disease. It is characterized by periods of remission and relapse. The clinical phenotype that characterizes AD is the product of complex interactions among susceptibility genes, the host’s environment, defects in skin barrier function, as well as systemic and local immunologic responses .
AD is often the first step in the atopic march that results in asthma and allergic rhinitis in many of affected patients. It has been recognized as Th-2 disease for the abundant secreation of Th-2 cytokines; interleukin (IL)-4, IL-5, and IL-13 associated with eosinophilia; and elevated serum immunoglobulin E level .
Gal-9 is a member of the tandem-repeat galectin family . Gal can regulate multiple physiological and pathological processes including allergy . Gal-9 has been well characterized as an eosinophilic chemoattractant . It alters T-cell balance by negatively regulating Th-1 and Th-17 cells, resulting in Th-2 polarization .
The aim of this work was to evaluate serum level of Gal-9 in patients with AD to assess its possible role in the pathogenesis of the disease.
The present study included 20 patients of AD and 10 healthy participants of matched age and sex who served as controls. The age of the patients ranged from 3 months to 25 years, as they were selected according to their ages to include all types of AD. AD occurs primarily in childhood affecting 15–30% of children and 2–10% of adults and most frequently begin in early childhood, with 45% of cases occurring within the first 6 months of life whereas 85% of cases diagnosed within the first 5 years . The study included 11 (55%) male and nine (45%) female patients. This result was similar to Thomas and Myalil  who reported that male to female ratio in AD is 1.5 : 1. Selcuk et al.  and Shultz et al.  reported a male predominance. In contrast, Kim et al. , Edan et al. , and Williams et al.  reported higher AD prevalence in girls than in boys. In contrast, Johnston et al. , Saito , and Larsen and Hanifin  reported that both sexes are equally affected with AD. This wide range of results may be attributed to different race, education, and environmental factors of different studies.
The present study showed statistically significant increase of mean serum Gal-9 in patients with AD in comparison with controls. Significant positive correlation has been reported between serum Gal-9 level and the severity of the AD as evaluated by SASSAD score. This result agreed with Nakajima et al.  who reported that mean serum Gal-9 level was significantly increased in patients with AD than in controls. They suggested that Gal-9 is a potent chemoattractant for eosinophils in AD. In addition, it alters T-cell balance by negatively regulating T-helper Th-1 and Th-17 cells, resulting in Th-2 polarization. They also reported that serum Gal-9 levels were decreased after treatment, accompanied by improvement of skin lesions. This strongly indicates that serum Gal-9 levels correlate with disease activity.
Few articles discussed the evaluation of serum Gal-9 level in AD. In contrast, there are only few publications on Gal-9 in other atopic diseases with conflicting results reported ,,. Yamamoto et al.  showed that Gal-9 is not involved in airway hypersensitivity of guinea pig but is partly involved in prolonged eosinophil accumulation in the lung. In contrast, Chen et al.  documented that normal intestinal epithelial cells (IEC) show mild expression of Gal-9 that is markedly enhanced in patients with food allergy as mast cells induce IEC to produce Gal-9 via releasing tryptase that activated the proteinase-activated receptor 2 on IEC. Gal-9 activated dendritic cell to produce TIM-4 by ligating TIM3 on dendritic cell by activating the cyclic GMP pathway. In a mouse food allergy model, blocking Gal-9 inhibits the allergic hypersensitivity status and the antigen-specific Th-2 response in the intestine. Sziksz et al.  stated that Gal-9 plays a role as a mediator contributing to the development of allergic airway inflammation and may serve as a recruiter of eosinophil granulocytes and promoter of Th-2 dominance.
The previous data and results showed the possible role of Gal-9 in the pathogenesis of AD and its relation with disease activity.
| Conclusion|| |
From this study, it can be concluded that serum Gal-9 level was significantly elevated in patients with AD. This increase was positively correlated with disease severity as evaluated by SASSAD score. This suggests a possible role of Gal-9 in the pathogenesis of AD. New treatment strategies directed to lower Gal-9 level may be a hope for future perspectives in the treatment of AD.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Spergel JM. From atopic dermatitis to asthma: the atopic march. Ann Allergy Asthma Immunol 2010; 105:99–106.
Carlsten C, Dimich-Ward H, Ferguson A, Watson W, Rousseau R, Dybuncio A et al.
Atopic dermatitis in a high-risk cohort: natural history, associated allergic outcomes, and risk factors. Ann Allergy Asthma Immunol 2013; 110:24–28.
Koga C, Kabashima K, Shiraishi N, Kobayashi M, Tokura Y. Possible pathogenic role of Th17 cells for atopic dermatitis. J Invest Dermatol 2008; 128:2625–2630.
Figer CB, Sassetti CM, Rosen SD. Carbohydrate recognition in cell adhesion and signalling. In: Drickamer K, Taylor M, editors. Introduction to glycobiology. 3rd ed. Oxford, UK: Oxford University Press 2011. pp. 139–169.
Hernandez JD, Baum LG. Ah, sweet mystery of death! Galectins and control of cell fate. Glycobiology 2002; 12:127R–136R.
Matsumoto R, Matsumoto H, Seki M, Hata M, Asano Y, Kanegasaki S et al.
Human ecalectin, a variant of human galectin-9, is a novel eosinophil chemoattractant produced by T lymphocytes. J Biol Chem 1998; 273:16976–16984.
Brenninkmeijer EE, Schram ME, Leeflang MM, Bos JD, Spuls PI. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol 2008; 23:117–125.
Ikezawa Z, Ikebe T, Ogura H, Odajima H, Kurosaka F, Komatu H et al.
Mass trial of hypoallergenic rice (HRS-1) produced by enzymatic digestion in atopic dermatitis with suspected rice allergy. HRS-1 Research Group. Acta Derm Venereol suppl (Stockh) 1992; 176:108–112.
Hirashima M, Kashio Y, Nishi N, Yamauchi A, Imaizumi TA, Kageshita T et al.
Galectin-9 in physiological and pathological conditions. Glycoconj J 2004; 19:593–600.
Bieber T. Atopic dermatitis. N Engl J Med 2008; 358:1483–1494.
Leung DY. Atopic dermatitis: new insights and opportunities for therapeutic intervention. J Allergy Clin Immunol 2000; 105:861–864.
Tsutsui S, Yoshinaga T, Komiya K, Yamashita H, Nakamura O. Differential expression of skin mucus c-type lectin in two freshwater eel species, Anguilla marmorata and Anguilla japonica
. Dev Comp Immunol 2016; 61:154–160.
Novak N, Bieber T. Allergic and nonallergic forms of atopic diseases. J Allergy Clin Immunol 2003; 112:252–262.
Fuiano N, Incorvaia C. Dissecting the cases of atopic dermatitis in children: less food, more mites. Aller inter 2012; 61: 231–43.
Thomas IN, Myalil JM. How significant is family history in atopic dermatitis? a study on the role of family history in atopic dermatitis in children in Ajman, United Arab Emirates. Egypt Dermatol Online J 2010; 6:1–6.
Selcuk ZT, Caglar T, Enunlu T, Topal T. The prevalence of allergic diseases in primary school children in Edrine, Turkey. Clin Exp Allergy 1997; 27:262–269.
Shultz LF, Diepge T, Svensson A. The occurrence of atopic dermatitis in North Europe: an international questionnaire study. J Am Acad Dermatol 1996; 34(Pt 1):760–764.
Kim DS, Lee JH, Lee KH, Lee MG. Prevalence of atopic dermatitis among Korean adults visiting Health Service Center of the Catholic Medical Center in Seoul Metropolitan Area, Korea. Acta Dermatol Venereol 2012; 92:472–474.
Edan AI, Al-Hamdi K, Bakr S. The prevalence of atopic eczema/dermatitis syndrome (AEDS) in Basrah providence, Iraq. Int J Dermatol 2005; 3:49–53.
Williams HC, Pembroke AC, Forsdyke H, Boodoo G, Hay RJ, Burney PG. London-born black Caribbean children are at increased risk of atopic dermatitis. J Am Acad Dermatol 1995; 32(Pt 1):212–217.
Johnston GA, Bilbao RM, Graham-Brown RA. The use of complementary medicine in children with atopic dermatitis in secondary care in Leicester. Br J Dermatol 2003; 149:566–571.
Saito H. Much atopy about the skin: genome-wide molecular analysis of atopic eczema. Int Arch Allergy Immunol 2005; 137:319–325.
Larsen FS, Hanifin JM. Epidemiology of atopic dermatitis. Clin Immunol Allergy North Am 2002; 22:1–25.
Nakajima R, Miyagaki T, Oka T, Nakao M, Kawaguchi M, Suga H et al.
Elevated serum galectin-9 levels in patients with atopic dermatitis. J Dermatol 2015; 42:723–726.
Sziksz E, Kozma GT, Pállinger E, Komlósi ZI, Adori C, Kovács L et al.
Galectin-9 in allergic airway inflammation and hyper-responsiveness in mice. Int Arch Allergy Immunol 2010; 151:308–317.
Chen X, Song CH, Liu ZQ, Feng BS, Zheng PY, Li P et al.
Intestinal epithelial cells express galectin-9 in patients with food allergy that plays a critical role in sustaining allergic status in mouse intestine. Allergy 2011; 66:1038–1046.
Yamamoto H, Kashio Y, Shoji H, Shinonaga R, Yoshimura T, Nishi N et al.
Involvement of galectin-9 in guinea pig allergic airway inflammation. Int Arch Allergy Immunol 2007; 143(Suppl 1):95–105.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]