Serum level of galectin-9 as a potential biomarker for high risk of malignancy in dermatomyositis

Abstract

Abstract Objectives Galectin-9, as immune checkpoint protein, plays a role in regulating autoimmunity and tumour immunity. Therefore, we explored the pathophysiological link between galectin-9 and malignancy in cancer-related DM (CRDM). Methods Serum galectin-9 were quantified via enzyme-linked immunosorbent assay, and its association with serological indices was evaluated using Spearman analysis. Receiver operating characteristic (ROC) analysis was utilized to determine the cut-off value of galectin-9. Results Serum levels of galectin-9 were significantly higher in DM patients [23.38 (13.85–32.57) ng/ml] than those in healthy controls (HCs) [6.81 (5.42–7.89) ng/ml, P < 0.0001], and were positively correlated with the cutaneous dermatomyositis disease area severity index activity (CDASI-A) scores (rs=0.3065, P = 0.0172). DM patients with new-onset and untreated cancer (new-CRDM) [31.58 (23.85–38.84) ng/ml] had higher levels of galectin-9 than those with stable and treated cancer (stable-CRDM) [17.49 (10.23–27.91) ng/ml, P = 0.0288], non-cancer-related DM (non-CRDM) [21.05 (11.97–28.02) ng/ml, P = 0.0258], and tumour patients without DM [7.46 (4.90–8.51) ng/ml, P < 0.0001]. Serum galectin-9 levels significantly decreased [27.79 (17.04–41.43) ng/ml vs 13.88 (5.15–20.37) ng/ml, P = 0.002] after anti-cancer treatment in CRDM patients. The combination of serum galectin-9 and anti-transcriptional intermediary factor 1-γ (anti-TIF1-γ) antibody (AUC = 0.889, 95% CI 0.803–0.977) showed the highest predictive value for the presence of cancer in DM. Conclusion Increased galectin-9 levels were related to tumor progression in CRDM, and galectin-9 was downregulated upon cancer treatment. Monitoring serum galectin-9 levels and anti-TIF1-γ antibodies might be an attractive strategy to achieve tumour diagnosis and predict CRDM outcome.