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Galectin-3

Galectin-3 is a β-galactoside-binding and the sole member of the chimera-type galectin subfamily, encoded by the LGALS3 gene located on human chromosome 14q21–22. This multifunctional protein, with a molecular weight of approximately 30 kDa and comprising 250 , features a modular structure including a C-terminal (CRD) that binds β-galactosides such as N-acetyllactosamine, and a flexible N-terminal domain with tandem repeats (e.g., Pro-Gly-Ala-Tyr-Pro-Gly) that facilitates oligomerization and interactions with glycoproteins and glycolipids. Expressed ubiquitously in adult tissues—particularly in epithelial s, macrophages, and immune s—and secreted via non-classical , galectin-3 plays pivotal roles in cellular processes like and –matrix , , , , pre-mRNA splicing, and . In physiological contexts, galectin-3 contributes to tissue homeostasis, , and innate immune responses by acting as both a pattern-recognition receptor (PRR) for microbial structures (e.g., lipopolysaccharides and fungal oligomannans) and a (DAMP) that amplifies . It promotes , neutrophil recruitment, and macrophage polarization toward an M2 anti-inflammatory phenotype, aiding in defense and tissue repair, such as during corneal re-epithelialization or resolution of . During embryogenesis, its expression is tissue-specific, supporting developmental processes like and immune cell activation. Pathologically, galectin-3 is implicated in a wide array of diseases due to its pleiotropic effects, often promoting , tumor progression, and . In cancer, it is overexpressed in malignancies such as , colorectal, and tumors, enhancing through lattice formation on surfaces that modulates and signaling. It drives fibrotic remodeling in organs like the liver (e.g., in non-alcoholic steatohepatitis), kidneys, and lungs, and is elevated in cardiovascular conditions including and , where it correlates with left ventricular dysfunction and poor . Additionally, galectin-3 serves as a prognostic in , systemic sclerosis, and , with serum levels reflecting disease severity and guiding therapeutic strategies. Galectin-3 is also emerging as a therapeutic target, with inhibitors under investigation in clinical trials for , cancer, and other inflammatory diseases as of 2025.

Discovery and nomenclature

Historical identification

Galectin-3 was first identified in 1982 as Mac-2, a novel 32-kDa cell surface specific to a subpopulation of thioglycollate-elicited peritoneal macrophages, by Ho and using monoclonal antibodies. This discovery highlighted its expression on activated macrophages, distinguishing it from other differentiation antigens like Mac-1. Early characterization revealed Mac-2's role in immune responses, as it was induced by specific differentiative signals in mononuclear . In the mid-1980s, the same protein was independently recognized under different names in various types. The Barondes laboratory identified it as carbohydrate-binding protein 35 (CBP35), a 35-kDa β-galactoside-binding abundant in the nuclear and cytoplasmic compartments of 3T3 fibroblasts, with potential involvement in and . Concurrently, in 1986, Leffler and Barondes described L-29 as a soluble lactose-binding from and fibroblasts, demonstrating its affinity for β-galactosides and cooperative binding to glycoconjugates, which linked it to cell-matrix interactions. These identifications preceded the unified understanding of galectin-3, with initial studies emphasizing its activity in pre-galectin nomenclature. Further investigations in the late and early connected these aliases through biochemical and immunological analyses, revealing Mac-2/CBP35/L-29 as the same entity involved in , IgE binding, and interactions in immune and epithelial contexts. The Barondes group played a pivotal role in elucidating its β-galactoside specificity during this period, establishing foundational links to cellular processes like and . The family nomenclature, formalizing it as galectin-3, was introduced in 1994 to resolve these disparate names based on discovery order.

Gene and family classification

Galectin-3 is encoded by the LGALS3 gene, located on the long arm of human chromosome 14 at locus 14q22.3. The gene spans approximately 27 kb (26,671 bp) and consists of six exons separated by five introns. This protein belongs to the galectin family, a group of 15 soluble β-galactoside-binding in humans, classified into three structural subtypes: prototype galectins (non-covalent homodimers with a single carbohydrate-recognition domain, such as galectin-1), tandem-repeat galectins (with two carbohydrate-recognition domains linked by a , such as galectin-9), and chimeric galectins (featuring a unique fusion of a carbohydrate-recognition domain with a distinct N-terminal domain). Galectin-3 is the sole chimeric member of this family. The family exhibits an ancient evolutionary history, with orthologs identified in diverse taxa including sponges, fungi, , and ; itself appears to have arisen specifically within lineages through and divergence events. In , the Galectin Nomenclature Committee formalized the naming convention for these proteins, assigning sequential numbers based on their discovery order while emphasizing their shared β-galactoside-binding properties. Historically, galectin-3 has been referred to by synonyms such as Mac-2 (originally identifying its role as a ) and GALBP (galactoside-binding protein), terms that aid in distinguishing it from other family members like the prototype galectin-1.

Structure

Domain

Galectin-3 exhibits a chimeric unique among the galectin family, consisting of 250 in humans with a molecular weight of approximately 30 kDa. The protein comprises an N-terminal non-lectin domain (NTD) of about 110 residues and a C-terminal carbohydrate recognition domain (CRD) of roughly 130 residues. This modular design enables diverse interactions, with the NTD featuring a flexible, intrinsically disordered region rich in and residues. The NTD includes 9 collagen-like repeats of the Pro-Gly-Ala-Tyr-Pro-Gly-XXX (where X represents variable residues), which facilitate oligomerization and multivalency upon . These repeats promote the formation of higher-order assemblies, such as pentamers, observed in structures of NTD-containing variants. In contrast, the CRD forms a compact β-sandwich fold typical of galectins, harboring conserved s essential for β-galactoside recognition, including HxNPR and WGxEE sequences that coordinate through bonding and hydrophobic interactions. As a mature protein, Galectin-3 lacks a classical , permitting its localization in the , , and via non-conventional pathways. Crystal structures of the CRD reveal its structural integrity in both apo and ligand-bound states; for instance, the apo form (PDB: 3ZSM) displays an open binding groove at 1.25 , while the lactose-bound (PDB: 1A3K) at 2.1 highlights conserved molecules and residue rearrangements upon . These structures also demonstrate how NTD interactions can drive pentameric or oligomeric assemblies, underscoring the protein's capacity for lattice formation.

Biochemical properties

Galectin-3 undergoes specific post-translational modifications that influence its localization and function. occurs at serine 6 (Ser6) in the N-terminal domain, catalyzed by (CK1), which acts as a promoting nuclear export and enhancing anti-apoptotic activity. kinase 2 (CK2) can also phosphorylate galectin-3, contributing to regulatory signaling. Despite its role as a β-galactoside-binding , galectin-3 exhibits limited , with no definitive experimental evidence of significant N- or O-linked modifications, though predictive models suggest potential sites. The protein demonstrates notable stability and folding characteristics. As a calcium-independent lectin, galectin-3 maintains its carbohydrate-binding affinity without requiring divalent cations, distinguishing it from C-type lectins. Its (pI) is approximately 8.5, rendering it soluble at neutral physiological . The N-terminal domain (NTD) contributes to resistance against , though the protein can be cleaved at specific sites under certain conditions, preserving core functionality. Oligomerization of galectin-3 is mediated by the intrinsically disordered NTD, enabling self-association into trimers or higher-order oligomers at elevated concentrations, which facilitates multivalent interactions and lattice formation on arrays. Spectroscopic analyses reveal the recognition domain (CRD) of galectin-3 to be dominated by β-sheet secondary structure, as evidenced by far-UV (CD) spectra showing characteristic minima around 217 nm. Galectin-3 lacks enzymatic activity, functioning solely as a non-catalytic protein.

Expression and regulation

Tissue and cellular distribution

Galectin-3 displays ubiquitous expression in various tissues and cell types under normal physiological conditions, with particularly high levels observed in epithelial cells of the intestine, , and , as well as in immune cells including macrophages, monocytes, dendritic cells, , mast cells, and activated T and B lymphocytes, and in fibroblasts and endothelial cells. Its expression is notably lower in the and compared to these sites. Galectin-3 is absent from mature erythrocytes, though it appears in erythroid precursors during . At the subcellular level, galectin-3 is primarily localized in the , where it constitutes the majority of the protein pool, with additional distribution to the and via a non-classical pathway that bypasses the endoplasmic reticulum-Golgi apparatus. During , galectin-3 expression is upregulated in embryonic tissues, neural structures such as the , and epithelia lining the respiratory and digestive systems, with patterns first detectable around embryonic day 8.5 in mice and persisting through . These expression profiles are highly conserved across , showing similar distributions in models like mice and rats. In immune cells, baseline expression can be modulated by cytokines such as interferon-γ.

Factors influencing expression

The expression of Galectin-3, encoded by the LGALS3 gene, is primarily regulated at the transcriptional level through specific elements in its promoter region. The human LGALS3 promoter contains multiple regulatory motifs, including AP-1 binding sites and sites, which facilitate activation in response to inflammatory signals. These elements allow for rapid induction of transcription during stress or immune activation. Additionally, the promoter features GC boxes that serve as binding sites for Sp1 transcription factors, contributing to basal and inducible expression across various cell types. Several cytokines and stimuli upregulate Galectin-3 transcription via these promoter elements, particularly in inflammatory contexts. For instance, (LPS), a component of bacterial cell walls, induces Galectin-3 expression in monocyte-like THP-1 cells, with mRNA levels rising up to 6.3-fold after 24 hours of exposure at 100 ng/mL, accompanied by a 45-65% increase in protein levels over 72 hours. Similarly, transforming growth factor-β (TGF-β) modulates Galectin-3 expression through Smad signaling, though the direction varies by cell type; in nucleus pulposus cells, TGF-β suppresses expression via Smad3 binding to nine sites in the proximal promoter, reducing mRNA and protein levels within 24 hours. Epigenetic mechanisms further fine-tune Galectin-3 expression, often leading to in pathological states. Hypermethylation of CpG islands in the LGALS3 promoter is associated with in early-stage , where stage II tumors exhibit heavy compared to lighter in advanced stages III and IV, correlating with reduced expression. Post-transcriptional repression occurs through microRNAs, such as miR-128, which directly targets the 3' of LGALS3 mRNA, downregulating Galectin-3 protein levels in cells; miR-128 downregulation in tumors inversely correlates with elevated Galectin-3 and poorer . Hormonal and environmental factors also influence Galectin-3 levels. , specifically , upregulates Galectin-3 expression in human endometrial cells, reducing and supporting tissue remodeling, with effects observed alongside progesterone in proliferative phases. In tumor microenvironments, induces Galectin-3 via hypoxia-inducible factor-1α (HIF-1α), which binds to hypoxia response elements in the promoter; this leads to increased transcription in and cells under low-oxygen conditions, enhancing cell survival and migration. Feedback mechanisms involving Galectin-3 itself contribute to regulatory loops. The protein interacts with Sp1 to modulate transcription of target genes, and given the presence of Sp1 binding sites in the LGALS3 promoter, this suggests potential auto-regulatory control, as seen in its enhancement of promoter activity through Sp1 in breast epithelial cells. Species-specific differences exist in promoter architecture; while both and LGALS3 promoters contain conserved elements like binding sites, variations in CpG island density and positioning affect inducibility, with rodent promoters showing distinct regulation in stress responses compared to human counterparts.

Biological functions

Ligand binding and interactions

Galectin-3 primarily recognizes and binds to β-galactoside-containing glycans, such as and N-acetyllactosamine, through its carbohydrate recognition domain (CRD). The for these monosaccharides or disaccharides is typically modest, with constants (Kd) in the range of 100–1000 μM for (Kd ≈ 1 mM) and approximately 200 μM for N-acetyllactosamine. This interaction involves a network of hydrogen bonds between the galactosyl hydroxyl groups and key CRD residues, including 158, 144, and 165, which stabilize the in a shallow binding groove. The affinity of Galectin-3 for β-galactosides is significantly enhanced by multivalency, where clustered presentations on glycoproteins or surfaces lead to effects, reducing effective Kd values to the nanomolar range. For instance, binding to multivalent substrates like asialofetuin demonstrates positive , allowing Galectin-3 to form stable complexes that promote assembly. This multivalent enhancement is crucial for physiological interactions, as single units alone exhibit low-affinity binding insufficient for functional outcomes. Beyond glycans, Galectin-3 engages in protein-protein interactions, both extracellularly and intracellularly. Extracellularly, it binds to such as α5β1, facilitating cell-matrix adhesion and processes like through glycan-mediated cross-linking. It also interacts with CD98, a heterodimeric , promoting its dimerization and downstream signaling in immune cells and placental trophoblasts. Additionally, Galectin-3 associates with BP180 (collagen XVII) in epidermal contexts, contributing to integrity via adhesive interactions. Intracellularly, Galectin-3 binds to anti-apoptotic proteins like , modulating its function through the conserved NWGR motif, and to activated K-Ras-GTP, stabilizing oncogenic signaling. A hallmark of Galectin-3 function is its ability to form lattices on surfaces by cross-linking N-glycosylated glycoproteins, creating dynamic microdomains that compartmentalize receptors and modulate their and . These lattices arise from the multivalent binding of Galectin-3 to β-galactoside-terminated on multiple glycoproteins, such as and receptors, resulting in clustered signaling platforms. The formation of these microdomains is reversible and sensitive to branching, with hyperbranched N-glycans promoting stable assembly. Binding interactions of Galectin-3 have been characterized using techniques like () and (), which reveal cooperative effects in multivalent contexts and modest enthalpic contributions from single-ligand binding. For example, measurements confirm that binding is enthalpically driven with negative , while assays demonstrate enhanced on-rates for multivalent . Inhibition studies often employ thiodigalactoside, a non-hydrolyzable analog that competitively blocks the CRD with a in the micromolar range, disrupting formation and protein interactions. These assays underscore the role of the CRD in both glycan and protein recognition, with brief structural insights showing a preorganized for β-galactosides.

Roles in cellular processes

Galectin-3 plays a key role in cell adhesion and migration by forming extracellular lattices that regulate integrin clustering, thereby facilitating processes such as wound healing and angiogenesis. Specifically, galectin-3 binds to integrin α5β1 on epithelial cells, promoting their migration during skin wound repair through phase separation mechanisms that enhance cell-matrix interactions. In angiogenesis, galectin-3 supports endothelial cell migration and tube formation by interacting with integrins like αvβ3, contributing to vascular remodeling in physiological contexts. These functions rely on galectin-3's carbohydrate recognition domain binding to glycosylated ligands on cell surfaces and extracellular matrix components. Intracellularly, galectin-3 participates in signaling pathways, particularly through its nuclear export, which modulates and transcription. Phosphorylated galectin-3 is exported from the via CRM1-dependent mechanisms, allowing it to interact with anti-apoptotic proteins like in the , thereby suppressing activation and promoting cell survival during stress responses. In the , galectin-3 acts as a co-activator for transcription factors such as Sp1, enhancing promoter activity for genes like and p21, which regulate progression. In immune cells, galectin-3 modulates function by promoting and release, essential for innate immune responses. It enhances the uptake of apoptotic cells and pathogens in through intracellular interactions that stabilize phagocytic cups and activate downstream signaling like PI3K/Akt. Additionally, galectin-3 supports activation induced by IL-4, leading to increased expression of such as IL-10 and TGF-β, which aid in tissue repair and resolution of . Galectin-3 also contributes to pre-mRNA splicing in the by binding to heterogeneous nuclear ribonucleoproteins (hnRNPs), such as hnRNPA2B1, within splicing factor-enriched subnuclear speckles. This interaction facilitates the assembly of the and promotes efficient constitutive splicing of pre-mRNAs, ensuring proper mRNA maturation for cellular .

Pathological roles

Fibrosis

Galectin-3 is upregulated in response to transforming growth factor-β (TGF-β), a key profibrotic cytokine, which enhances its expression in fibroblasts and macrophages during fibrotic remodeling. This upregulation promotes myofibroblast differentiation by stabilizing β-catenin signaling, leading to increased extracellular matrix (ECM) deposition, including collagens I and III. In animal models of fibrosis, genetic knockout of Galectin-3 significantly attenuates these processes, reducing myofibroblast activation and collagen accumulation across multiple organs. In the liver, Galectin-3 contributes to fibrosis progression in non-alcoholic (NASH) and by activating hepatic stellate cells and promoting synthesis. Studies in Galectin-3-deficient mice fed high-fat diets demonstrate reduced , hepatocyte injury, and fibrotic scarring compared to wild-type controls. Similarly, in (IPF), Galectin-3 drives fibroblast-to-myofibroblast transition and lung remodeling, with inhibition preventing β-catenin-mediated TGF-β activation in bleomycin-induced models. Knockout models show decreased collagen deposition and improved lung architecture post-injury. In (CKD), macrophage-derived Galectin-3 exacerbates renal by amplifying TGF-β1 signaling and via Nox4 interaction, leading to tubular atrophy and interstitial buildup. Galectin-3 in normotensive models of renal injury reduces fibrotic markers and preserves tubular integrity. Recent investigations have also implicated Galectin-3 in post-wound , where its increased expression in dermal fibroblasts correlates with excessive scarring and delayed in murine excisional wound models. Early associations between Galectin-3 and emerged in the 1990s through studies identifying its role in and interactions during tissue repair. More recent work from 2023 onward has highlighted Galectin-3 inhibition's potential to limit cardiac post-myocardial infarction, with targeted blockers impeding progressive collagen remodeling and development in models. Serum Galectin-3 levels have been shown to correlate with overall severity scores, such as the Enhanced Liver (ELF) test, in patients with advanced .

Cardiovascular disease

Galectin-3 plays a significant role in the of s, particularly through its promotion of , , and adverse remodeling in cardiac and vascular tissues. Elevated levels of galectin-3 are associated with increased risk of , where it predicts myocardial remodeling and mortality. In patients with with reduced (HFrEF), plasma galectin-3 concentrations exceeding 17.8 ng/mL are indicative of poor prognosis, correlating with higher rates of hospitalization and death. This threshold has been validated in large cohorts, such as those from the and COACH trials, where changes in galectin-3 levels over time further stratified risk, with persistent elevations signaling progressive deterioration. In , galectin-3, also known as Mac-2, facilitates adhesion to endothelial s and contributes to plaque instability by enhancing infiltration and within lesions (with roles that may be context-dependent). It binds to cell surface glycoconjugates on monocytes, promoting their recruitment and activation, which accelerates formation and vulnerability to rupture. Inhibition of galectin-3 in E-deficient mouse models has demonstrated reduced plaque progression and lesion size, underscoring its pro-atherogenic effects. Recent studies as of 2025 highlight galectin-3's prognostic value in patients undergoing (), where elevated serum levels independently predict , including restenosis and post-procedure with drug-eluting stents. Furthermore, galectin-3 synergizes with aldosterone in hypertension-induced cardiac , amplifying inflammatory signaling and activation that drive left . Blockade of galectin-3 in aldosterone-exposed models attenuates and preserves cardiac function, suggesting a mechanistic link between excess and galectin-3-mediated pathology. At the cellular level, galectin-3 induces cardiomyocyte via activation of stress pathways, including caspase-3 and mitochondrial dysfunction, while simultaneously promoting through deposition by cardiac fibroblasts. In mouse models of , galectin-3 knockout (Gal3-/-) animals exhibit reduced infarct size, decreased infiltration, and improved post-ischemic healing compared to wild-type counterparts, indicating galectin-3's contribution to adverse remodeling. These effects overlap with fibrotic processes in the heart, where galectin-3 exacerbates scar formation following injury.

Cancer

Galectin-3 (Gal-3) plays a prominent pro-oncogenic role in tumor by facilitating neoplastic transformation, progression, and across various malignancies. Overexpressed in approximately 70% of solid tumors, including , colon, and pancreatic cancers, Gal-3 contributes to aggressive phenotypes by modulating key signaling pathways and cellular interactions. Its carbohydrate recognition domain (CRD) binds β-galactoside-containing glycans on cell surface receptors, thereby influencing adhesion, migration, and survival signals that drive oncogenesis. In the tumor microenvironment, Gal-3 promotes immune evasion and immunosuppression by recruiting tumor-associated macrophages (TAMs) and forming glycan-based barriers that shield cancer cells from immune surveillance. Secreted Gal-3 interacts with glycan ligands on immune cells, such as T cells and natural killer cells, inhibiting their activation and cytotoxic functions while enhancing the infiltration of pro-tumorigenic M2-like TAMs via chemokine axes like CCL2-CCR2. This remodeling fosters a permissive niche for tumor growth and metastasis. Additionally, Gal-3 briefly supports angiogenic processes in tumors by inducing endothelial cell proliferation and vascular permeability, further sustaining the hypoxic microenvironment. Gal-3 enhances metastatic progression primarily through resistance to anoikis—a form of programmed cell death triggered by detachment from the extracellular matrix—and induction of epithelial-mesenchymal transition (EMT). In breast and colon cancers, Gal-3 stabilizes integrin signaling and upregulates anti-apoptotic proteins like Bcl-2, enabling circulating tumor cells to survive in suspension and colonize distant sites. Mechanistically, extracellular Gal-3 binds to mucin 1 (MUC1) and integrins (e.g., αvβ3), promoting cell invasion by clustering these receptors and activating downstream pathways like PI3K/Akt that facilitate matrix metalloproteinase secretion and extracellular matrix degradation. Intracellularly, nuclear Gal-3 translocates to the nucleus, where it binds β-catenin and activates Wnt/β-catenin signaling, leading to transcription of pro-metastatic genes such as cyclin D1 and MMP7 in colon and other epithelial cancers. Recent research as of 2025 highlights Gal-3's involvement in extracellular vesicle () glycosylation, which aids cancer . Cancer-derived EVs enriched in Gal-3 binding proteins (e.g., LGALS3BP) exhibit altered N-glycan and patterns that enhance tumor to endothelial surfaces and promote pre-metastatic niche formation in distant organs like the lungs and liver. These advances underscore Gal-3's therapeutic potential in blocking metastatic cascades.

Inflammation and other conditions

Galectin-3 exhibits a in , promoting acute responses while also facilitating resolution in certain contexts. In acute , such as , galectin-3 acts as an alarmin that augments the inflammatory cascade by functioning as an endogenous ligand for (TLR4), thereby enhancing production and immune cell activation in response to bacterial infections like Francisella novicida. Conversely, during the resolution phase of , galectin-3 promotes effects, including the induction of apoptosis in allergic conditions, which helps dampen prolonged immune responses. In chronic , galectin-3 sustains immune activation by modulating release and immune cell recruitment, contributing to persistent tissue damage across various inflammatory states. In autoimmune diseases, galectin-3 predominantly exerts pro-inflammatory effects. In , galectin-3 is upregulated in synovial tissues, where it drives and production, exacerbating joint destruction through activation in fibroblasts and immune cells. Similarly, in (IBD), galectin-3 amplifies the induction phase of acute by activating the and promoting pro-inflammatory secretion, as evidenced by reduced disease severity in galectin-3 knockout mice subjected to dextran sulfate sodium-induced models. These findings highlight galectin-3's contribution to autoimmune , though its role can vary by disease stage and tissue context. Beyond and , galectin-3 influences several other conditions. In aging-related processes, galectin-3 serves as a marker of and is implicated in metabolic disorders, where its elevated expression correlates with and tissue dysfunction in and , as noted in recent reviews. Neurologically, galectin-3 associates with pathology, where it is elevated in and promotes amyloid-β oligomerization and plaque formation, intensifying microglial activation around deposits. In wound healing, galectin-3 facilitates by binding integrin α5β1, enhancing endothelial cell motility and vascular remodeling essential for tissue repair. Emerging research underscores galectin-3's relevance in additional disorders. As of 2025, galectin-3 has been identified as a novel for type III (GSD III), reflecting muscle impairments due to its upregulation in affected skeletal tissues. In viral infections, galectin-3 contributes to the in severe by amplifying pro-inflammatory signaling and immune hyperactivation, with higher serum levels predicting disease severity and poor outcomes.

Clinical applications

Biomarker utility

Galectin-3 serves as a prognostic and diagnostic across multiple pathologies, particularly those involving , due to its measurable elevation in and reflecting severity. It is quantified primarily via enzyme-linked immunosorbent (ELISA), including the FDA-cleared BG Galectin-3 test developed by BG Medicine, which detects levels in human or with high . This demonstrates excellent stability, with samples remaining viable for up to 48 hours at ambient temperature post-centrifugation, up to 15 days at 2–8°C or 22–28°C, and indefinitely when frozen at −20°C or −70°C. In (HF), Galectin-3 facilitates risk stratification, with levels exceeding 17.8 ng/mL—based on the assay's FDA labeling—indicating heightened risk of mortality, hospitalization, and disease progression. For (CKD), higher Galectin-3 concentrations correlate with accelerated progression and tubulointerstitial , offering utility in monitoring renal decline and identifying high-risk patients for early intervention. In , particularly , Galectin-3 overexpression in tumor tissue and signifies advanced staging, aggressive malignancy, and reduced survival, supporting its role in prognostic staging. As of 2025, emerging data highlight Galectin-3's predictive power for post-percutaneous coronary intervention (PCI) outcomes, where elevated levels independently forecast major adverse cardiovascular events in patients receiving drug-eluting stents. Combining Galectin-3 with NT-proBNP improves accuracy in forecasting cardiovascular events and HF incidence in stable coronary artery disease, enhancing risk models for revascularized patients. In liver fibrosis, Galectin-3 is gaining traction as a non-invasive marker, with serum levels rising proportionally to cirrhosis severity (e.g., 25.9 ng/mL in compensated vs. 81 ng/mL in decompensated cases), positioning it as a potential alternative or complement to the Enhanced Liver Fibrosis (ELF) panel for assessing progression in metabolic dysfunction-associated steatotic liver disease. Despite its strengths, Galectin-3 interpretation is limited by renal clearance dynamics, as impaired kidney function elevates circulating levels independently of primary pathology, requiring adjustments for accurate prognostic assessment. It exhibits no significant circadian variation, ensuring consistent measurements across sampling times, though transient post-exercise increases (resolving within 1–3 hours) may warrant controlled conditions in active patients.

Therapeutic development

Therapeutic development for galectin-3 (Gal-3) focuses on inhibiting its pathological functions in , cancer, and through targeted small molecules, natural compounds, and biologics. Early efforts emphasized carbohydrate-based inhibitors that bind the carbohydrate recognition domain (CRD) to block interactions, while more recent advances explore non-carbohydrate scaffolds and alternative mechanisms to enhance selectivity and efficacy. Preclinical and clinical studies have demonstrated potential in reducing progression and tumor growth, though translation to approved therapies remains ongoing due to specificity challenges. Small-molecule inhibitors represent a primary class, with GB1211, a synthetic Gal-3 , advancing in Phase I/II trials for advanced liver since 2022, showing safety and preliminary antifibrotic effects in patients with compensated . Natural inhibitors like modified (MCP), a galactoside-rich , have exhibited Gal-3 blockade in preclinical models of , , and , reducing adhesion and tumor proliferation by disrupting extracellular Gal-3 signaling. Antibody-based approaches include monoclonal antibodies targeting Gal-3, though inhaled small-molecule mimics like TD139 (also known as GB0139), a thiodigalactoside derivative, demonstrated tolerability and Gal-3 inhibition in early Phase II trials for (IPF); however, the subsequent Phase 2b GALACTIC-1 trial failed to meet its primary efficacy endpoint in 2023, leading to discontinuation of development. Recent innovations include non-carbohydrate small molecules such as and , identified in 2025, which potently inhibit Gal-3 binding to ligands like thrombospondin-1 in cancer models without affecting other galectins. Therapeutic strategies target distinct domains: CRD blockers, such as TD139 and belapectin (GR-MD02), prevent carbohydrate-mediated interactions essential for remodeling and immune modulation. N-terminal domain (NTD) disruptors aim to interfere with Gal-3 oligomerization and intracellular signaling, as the NTD facilitates multimerization that amplifies pro-fibrotic effects in preclinical cardiac and hepatic models. via (siRNA) has shown promise in preclinical settings, downregulating Gal-3 expression to suppress proinflammatory cytokines like IL-6 and IL-1β in monocyte-derived dendritic cells stimulated by Toll-like receptors. Clinical trials highlight mixed progress, with belapectin, a galactoarabino-rhamnogalacturonate , discontinued in 2021 for nonalcoholic steatohepatitis ()-associated cancer due to lack of efficacy but continuing in the Phase 2b/3 NAVIGATE trial for , where 2025 interim results indicated reduced and biomarkers in compensated patients. Analogs and next-generation inhibitors, guided by quantitative structure-activity relationship (QSAR) modeling in 2025 studies, emphasize improved CRD selectivity to minimize with Gal-1 or Gal-7. Biomarker-guided patient selection, using serum Gal-3 levels, has been integrated in trials like NAVIGATE to enrich for high-risk cohorts. Key challenges include off-target effects, as many inhibitors bind homologous galectins, potentially disrupting physiological roles in immune , and delivery barriers for intracellular Gal-3 functions, where poor cell penetration limits efficacy against nuclear or cytoplasmic activities in cancer and neurodegeneration. Ongoing research prioritizes highly selective, orally bioavailable agents to address these hurdles.

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