A Novel Biomarker of Acute-on-Chronic Liver Failure: Galectin-9

Abstract

Background Galectin-9 (Gal-9) expression in patients with acute-on-chronic liver failure or its correlation with prognosis remain unclear. This study investigated the relationship between the prognosis of liver failure and the analysis of Gal-9 expression in patients with acute-on-chronic liver failure. Methods Patients with acute-on-chronic liver failure attributable to hepatitis B and those with chronic hepatitis B were included in this single-center prospective cohort study. The expressions of Gal-9 and Tim-3 in T cells were measured; the amounts of Gal-9 and related components in each group were examined using the enzyme-linked immunosorbent assay and flow cytometry. An investigation of the expression and distribution of Gal-9 in liver tissues was conducted using immunohistochemistry and immunofluorescence staining. Results The Gal-9 levels in the acute-on-chronic liver failure group were significantly higher than those in the chronic hepatitis B group. There was an upregulation of Gal-9 and T-cell immunoglobulin domain and mucin domain-3 expressions in peripheral blood T cells. Gal-9 was localized in the regenerative areas of liver tissues in patients with acute-on-chronic liver failure, co-localizing with Kupffer cells. Kaplan–Meier survival curves showed that patients with Gal-9 levels less than 9.6 ng/mL had a worse prognosis, with the area under the receiver operating characteristic curve being superior to that of the Model for End-Stage Liver Disease score. Conclusions Plasma Gal-9 levels can serve as a prognostic marker in patients with hepatitis B virus-acute-on-chronic liver failure. The predominant expression of Gal-9 in liver Kupffer cells suggests a potential immunosuppressive role in this patient population.