Insights into the Role of Galectin-3 as a Diagnostic and Prognostic Biomarker of Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is an irregular atrial activity and the most prevalent type of arrhythmia. Although AF is easily diagnosed with an electrocardiogram, there is a keen interest in identifying an easy-to-dose biomarker that can predict the prognosis of AF and its recurrence. Galectin-3 (Gal-3) is a beta-galactoside binding protein from the lectin family with pro-fibrotic and -inflammatory effects and a pivotal role in a variety of biological processes, cell proliferation, and differentiation; therefore, it is implicated in the pathogenesis of many cardiovascular (e.g., heart failure (HF)) and noncardiovascular diseases. However, its specificity and sensitivity as a potential marker in AF patients remain debated and controversial. This article comprehensively reviewed the evidence regarding the interplay between Gal-3 and patients with AF. Clinical implications of measuring Gal-3 in AF patients for diagnosis and prognosis are mentioned. Moreover, the role of Gal-3 as a potential biomarker for the management of AF recurrence is investigated. The association of Gal-3 and AF in special populations (coronary artery disease, HF, metabolic syndrome, chronic kidney disease, and diabetes mellitus) has been explored in this review. Overall, although further studies are needed to enlighten the role of Gal-3 in the diagnosis and treatment of AF, our study demonstrated the high potential of this molecule to be used and focused on by researchers and clinicians.

Figure 1

Schematic representation of structure and functions of galectin-3. (a) Galectin-3 belongs to the chimera-type group presenting carbohydrate recognition domains (CRDs) at the C-terminus (CT) linked to an N-terminus collagen-like domain that participates in the formation of oligomers like the pentamer of galectin-3. (b) Extracellular and (c) intracellular (cytosolic and nuclear) functions of Galectin-3.

Figure 2

Summary of studies investigating the association of Gal-3 and AF in special populations. AF, atrial fibrillation; CAD, coronary artery disease; CKD, chronic kidney disease.

Figure 3

The association between galectin-3, atrial fibrillation, and heart failure in recurrence and prognosis of AF (matching colors show associations). (a) Higher Gal-3 is associated with paroxysmal AF, persistent AF, and paroxysmal-to-persistent AF. (b) Higher levels of Gal-3 in AF recurrence based on preclinical studies.