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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 146-152

Serum galectin-9 level in patients with atopic dermatitis before and after phototherapy


1 Department of Dermatology and Venereology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
2 Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt

Date of Submission02-Feb-2020
Date of Decision14-Feb-2020
Date of Acceptance16-Feb-2020
Date of Web Publication29-Jun-2020

Correspondence Address:
Marwa Said
Lecturer of Dermatology and Veneareology, Alzahraa University Hospital, Zip Code 02, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjamf.sjamf_14_20

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  Abstract 


Background Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease. Galectin-9 (Gal-9) is a member of galectin family, which is widely distributed in epithelial tissues and binds to various receptors expressed on the cell surface, such as T-cell Ig and Tim −3, CD4, and IgE. Phototherapy is the use of ultraviolet light to treat skin conditions, including AD. It plays important roles in immune suppression.
Aim The aim of the present study was to evaluate the serum level of Gal-9 in patients with AD before and after treatment with phototherapy.
Patients and methods The present study included 20 patients with AD and 20 healthy controls. Blood sample collection was done, and Gal-9 level in sera of patients and controls was measured using ELISA. Patients were subjected to complete history taking, clinical examination, and six area, six sign atopic dermatitis score calculation and received treatment by phototherapy ultravilot B (UVB) sessions for 6–8 weeks. After the end of phototherapy sessions, the authors measured the serum Gal-9 again.
Results Serum level of Gal-9 in patients with AD was significantly higher than control group, with significant increase with severity of the disease. There was a decrease in serum Gal-9 level after treatment with phototherapy.
Conclusion Serum Gal-9 level was significantly elevated in patients with AD, correlated with disease severity, and decreased after treatment with phototherapy. 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.

Keywords: atopic dermatitis, galectin-9, phototherapy


How to cite this article:
Nebar NM, Ahmed NA, Hamdy NM, Said M. Serum galectin-9 level in patients with atopic dermatitis before and after phototherapy. Sci J Al-Azhar Med Fac Girls 2020;4:146-52

How to cite this URL:
Nebar NM, Ahmed NA, Hamdy NM, Said M. Serum galectin-9 level in patients with atopic dermatitis before and after phototherapy. Sci J Al-Azhar Med Fac Girls [serial online] 2020 [cited 2020 Oct 23];4:146-52. Available from: http://www.sjamf.eg.net/text.asp?2020/4/2/146/288263




  Introduction Top


Atopic dermatitis (AD) is a pruritic skin disease [1] that adversely affects quality of life. It is characterized by peripheral eosinophilia, mast cell activation, and predominance of Th2 cells [2].

There are two types of AD. The allergic or extrinsic form affects ∼80% of the patients with AD and occurs in the context of an IgE sensitization toward environmental allergens. The intrinsic AD is independent of atopy and allergy, and it is associated with normal IgE level [3].

Galectin-9 (Gal-9) is a member of the tandem-repeat galectin family that is considered as a potent chemoattractant for eosinophils. It alters the T-cell balance by negatively regulating T-helper (Th)1 and Th17 cells, resulting in Th2 polarization [4].

Phototherapy may reduce the number of Langerhans cells, cause alteration in cytokine expression, and lead to cell cycle arrest, which may all contribute to the suppression of disease activity [5].


  Aim Top


The aim of the present study was to evaluate serum level of Gal-9 in patients with AD before and after treatment with phototherapy.


  Patients and methods Top


This study was carried out on 20 patients with AD and 20 controls who were recruited from the outpatient clinic of AL-Zhraa University Hospital, and a written informed consent form was obtained from them.

The approval from the Research Ethics Committee of the Faculty of Medicine, Al-Azhar University was also obtained.

The patient group included eight males and 12 females. Their ages ranged between 12 and 40 years. They are either newly diagnosed or had not received any systemic or topical treatment for at least 1 month before the present study.

The control group included 10 males and 10 females. Their ages ranged between 15 and 40 years.

Exclusion criteria

The following were the exclusion criteria:
  1. Associated autoimmune diseases or any other dermatological disorders, pregnant women, and breastfeeding.
  2. Contraindication for phototherapy:
    1. Photosensitivity and sun damage.
    2. Immunosuppressive agents: azathioprine and cyclosporine.
    3. Cardiovascular diseases.
    4. Active or latent lupus erythematous.
    5. Eye diseases.
    6. Xeroderma pigmentosa.
  3. Diseases that affected increased galactin-9 level: coronary artery disease, type 2 diabetes and chronic kidney disease, hepatitis C infection, hepatitis B infection, dengue virus infection, endometriosis or pelvic pain, juvenile dermatomyositis, systemic sclerosis, dermal fibroblast, Crohn’s disease, and Hodgkin’s disease.


Patients were subjected to the following:
  1. Complete history taking.
  2. Clinical examination.
  3. Digital photographs were taken from the diseased parts only.
  4. Assessment of severity of AD by the six area, six sign atopic dermatitis (SASSAD) Severity Score.


Interpretation

  1. Minimum score: 0.
  2. Maximum area subscore: 18.
  3. Maximum total body score: 108 (6×6×3).


AD is classified as mild if SASSAD score is below 20, moderate if SASSAD score is 20–40, and severe if SASSAD score is more than 40 [6].

The NB-UVB therapy for the patients

The patient’s Fitzpatrick skin phototype was detected According to a guideline by the American Academy of Dermatology for treatment of AD, the initial dose of NB-UVB therapy can be adjusted according to Fitzpatrick skin type. The initial NB-UVB doses recommended to the cases were 170, 200, and 230 mg/cm2 for skin type 2 through 4, respectively [7]. The patients were subjected to two to three sessions of NB-UVB per week for 6–8 weeks by using NB-UVB-113 cabin (Waldmann made in Europe).

Blood samples collection

Five milliliters of venous blood was collected from each patient and control. The blood samples were left to clot, then subjected to centrifugation for 15 min at 1000 round per minute to separate the serum. Routine laboratory investigations including complete blood count, random blood glucose level, lipid profile, liver, and renal function tests were done. Determination of the serum level of Gal-9 was done by Enzyme-Linked immunosorbent Assay (ELISA) kit for quantitative detection of human Gal-9. It was manufactured by Sun Red Company (USA), kit’s number: 201-12-3236. The kit used a double-antibody sandwich ELISA to assay the level of human Gal-9 in samples. The chroma of color and the concentration of the human substance GAL-9 of sample were positively correlated. The patients’ samples were collected twice: once before NB-UVB therapy and the other sample after 12–20 sessions of NB-UVB therapy.


  Results Top


Regarding the demographic data of the studied group, there is no statistically significant difference between patients and controls according age and sex ([Table 1]).
Table 1 Comparison between studied groups according to sex and age

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Regarding risk factors and disease associations, there were statistically significant relationships between family history and disease; however, no statistically significant relation was found between past history, allergic rhinitis, asthma, allergy to food or drug, and provoking factor ([Table 2]).
Table 2 Demographic data of the studied groups

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The patients in the present study were divided according to skin type II, III, and IV ([Table 3] and [Table 4]).
Table 3 Treatment protocol of patient group by phototherapy (NB-UVB)

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Table 4 Treatment protocol of patient group by phototherapy (NB-UVB)

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There was a statistically significant increase in serum Gal-9 in the patient group compared with the control group ([Table 5], [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5]).
Table 5 Comparison between studied groups according to serum galactin-9 level

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Figure 1 Positive significant correlation between serum galectin and six area, six sign atopic dermatitis. On the contrary, there was no significant correlation between serum galectin level and age or duration of the patient’s disease.

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Figure 2 Nonsignificant correlation between serum galectin and age.

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Figure 3 Nonsignificant correlation between serum galectin and duration.

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Figure 4 A 12-year-old male patient, 5-year duration, takes 12 sessions of phototherapy with excellent results.

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Figure 5 A 24-year-old female patient, with duration of disease of greater than 5 years, takes 15 sessions of phototherapy with good results.

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No statistically significant differentiation was found between serum Gal-9 and age and sex of the patients ([Table 6]).
Table 6 Relation between galactin-9 and sex in patients’ group

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There was no statistically significant relation between serum Gal-9 and duration in patient group ([Table 7]).
Table 7 Relation between galactin-9 and duration in the patient group

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There were statistically significant increases between serum Gal-9 and past history of other atopic diseases ([Table 8]).
Table 8 Relation between galactin-9 and past history

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No statistically significant increase of serum Gal-9 level was found in patients with positive family history of atopy ([Table 9]).
Table 9 Relation between galactin-9 and family history

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There was a statistically significant increase in serum Gal-9 with the disease severity ([Table 10]).
Table 10 Relation between galactin-9 and disease severity in the patient group

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There was a statistically significant increase of serum Gal-9 level in patients with positive to allergy to food or drug ([Table 11]).
Table 11 Relation between galactin-9 and allergy to food or drug in the patient group

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There was a statistically significant increase in serum Gal-9 in patients with the provoking factors such as stress and infection ([Table 12]).
Table 12 Relation between galactin-9 and provoking factor (infection or stress) in the patient group

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Regarding correlations between serum Gal-9 and different parameters in the patient group, age and duration were not significantly correlated but SASSAD was ([Table 13]).
Table 13 Correlation between serum galactin-9 and different parameters in the patient group

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There was a statistically significant decrease in serum Gal-9 level in patients before and after treatment with phototherapy ([Table 14]).
Table 14 Comparison between serum galactin-9 before and after treatment with phototherapy in the patient group

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  Discussion Top


AD is a chronic inflammatory skin disease characterized by periods of remission and relapse [8].

It has been recognized as Th2 disease for the abundant production of Th2 cytokines, IL-4, IL-5, and IL −13 associated with eosinophilia and elevated serum IgE level [9].

Gal-9 is a member of the tandem-repeat galectin family [10]. Gal-9 has been well characterized as an eosinophilic chemoattractant [11]. It alters T-cell balance by negatively regulating Th1 and Th17 cells, resulting in Th2 polarization [12].

Phototherapy is the supervised use of ultraviolet light to treat skin conditions, including AD, which may be used for mild, moderate, or severe cases of AD in adults. It is used only for severe symptoms in children [13].

The present study included 20 patients with AD and 20 healthy participants of matched age and sex who served as controls. The age of the patients in this study was selected between 12 and 40 years, as this age can be compatible with the phototherapy, and this is not owing to the prevalence of the disease, which is more common in children than adults according to El-Naggar et al. [14], Zeppa et al. [15] and Sugiura et al. [16] who recorded that AD occurs most often in infants and children and Johnston et al. [17] and Saito [18] who stated that AD is less common to develop in patients older than 40 years. Moreover, Edan et al. [19] reported that infantile and childhood stages had a higher prevalence ratio than all adulthood groups.

The current study included eight males (40%) and 12 females (60%), which was similar to the studies of Edan et al. [20], Kim et al. [21], and Williams et al. [22], which reported higher AD prevalence in girls than in boys. On the contrary, Thomas and Myall [23] reported that male to female ratio in AD is 1.5 : 1. The studies of Selcuk et al. [24] and Shultz et al. [25] reported male predominance. On the contrary, Johnston et al. [17], Saito [18], and Larsen and Hanifin [26] reported that both sex are equally affected with AD.

In the present study, a positive family history of atopic diseases was found in 60% of the studied patients. Snijders et al. [27], Peroni et al. [28], and Lee-Wong et al. [29] reported the role of family history in development of the disease.

The present study showed a statistically significant increase of mean serum Gal-9 in patients with AD in comparison with controls. A significant positive correlation was reported between serum gal-9 level and the severity of the AD. This result agreed with Nakajima et al. [12] who reported that mean serum gal-9 level was significantly increased in patients with AD than in controls.In this study, the patient’s Fitzpatrick skin phototype was detected for each patient according to a guideline by the American Academy of Dermatology [7].

The patients were subjected to two to three sessions of NB-UVB per week for 6–8 weeks by using NB-UVB-113 cabin. Chia et al. [30] found that UVA-1 phototherapy appears to be efficacious for the treatment of AD.

Few articles have discussed the evaluation of serum Gal-9 level in AD. Sziksz et al. [25] stated that Gal-9 plays a role as a mediator, contributing to the development of allergic airway inflammation and promoter of Th2 dominance.

In this study, we reported decrease in serum galactin-9 after phototherapy, which may be attributed to the role of phototherapy in immune modulation.

Nakajima et al. [12] 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.


  Conclusion Top


Serum Gal-9 level was significantly elevated in patients with AD and decreased after treatment with phototherapy. 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 the future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14]



 

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