Neutrophil–Galectin-9 Axis Linking Innate and Adaptive Immunity in ATL, Sézary Syndrome, COVID-19, and Psoriasis: An AI-Assisted Integrative Review
Abstract
1. Introduction
2. Materials and Methods
2.1. Literature Search and AI Assistance
2.2. Inclusion and Exclusion Criteria
2.3. Data Synthesis
3. Results and Discussion
3.1. Disease-Specific Features of the Neutrophil–Galectin-9 Axis
- ATL and Neutrophils
3.2. Neutrophil Dysfunction and Immune Dysregulation in SS and ATL
3.3. The Role of Gal-9 as a ‘Diagnostic and Prognostic Biomarker’ in COVID-19
3.4. Neutrophil–Galectin-9 Axis in Psoriasis
3.5. Context-Dependent T-Cell Stimulation by Galectin-9
4. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
| ATL | Adult T-cell leukemia |
| SS | Sézary syndrome |
| Gal-9 | galectin-9 |
| OPN | Osteopontin |
| COVID-19 | coronavirus disease 2019 |
| AI | artificial intelligence |
| NETs | neutrophil extracellular traps |
| PMA | phorbol 12-myristate 13-acetate |
| PKC | Protein kinase C |
References
- Ambreen, S.; McCarthy, A.; Hidalgo, A.; Adrover, J.M. Heart of the matter: Neutrophils, cancer, and cardiovascular disease. J. Exp. Med. 2025, 222, e20242402. [Google Scholar] [CrossRef]
- Xiong, S.; Dong, L.; Cheng, L. Neutrophils in cancer carcinogenesis and metastasis. J. Hematol. Oncol. 2021, 14, 173. [Google Scholar] [CrossRef]
- Zhu, K.; Li, P.; Mo, Y.; Wang, J.; Jiang, X.; Ge, J.; Huang, W.; Liu, Y.; Tang, Y.; Gong, Z.; et al. Neutrophils: Accomplices in metastasis. Cancer Lett. 2020, 492, 11–20. [Google Scholar] [CrossRef]
- Yamamoto, S.; Hattori, T.; Asou, N.; Nishimura, H.; Kawano, F.; Yodoi, J.; Takatsuki, K. Absolute neutrophilia in adult T cell leukemia. Jpn. J. Cancer Res. 1986, 77, 858–861. [Google Scholar] [PubMed]
- Poszepczynska, E.; Martinvalet, D.; Bouloc, A.; Echchakir, H.; Wechsler, J.; Becherel, P.A.; Boumsell, L.; Bensussan, A.; Bagot, M. Erythrodermic cutaneous T-cell lymphoma with disseminated pustulosis. Production of high levels of interleukin-8 by tumour cells. Br. J. Dermatol. 2001, 144, 1073–1079. [Google Scholar] [CrossRef] [PubMed]
- Takasaki, Y.; Iwanaga, M.; Imaizumi, Y.; Tawara, M.; Joh, T.; Kohno, T.; Yamada, Y.; Kamihira, S.; Ikeda, S.; Miyazaki, Y.; et al. Long-term study of indolent adult T-cell leukemia-lymphoma. Blood 2010, 115, 4337–4343. [Google Scholar] [CrossRef]
- Fierro, M.T.; Cuffini, A.M.; Novelli, M.; Banche, G.; Allizond, V.; Comessatti, A.; Brizio, M.; Scalas, D.; Merlino, C.; Quaglino, P.; et al. Functional and phenotypical alterations of polymorphonuclear cells in Sezary syndrome patients. Eur. J. Dermatol. 2011, 21, 921–929. [Google Scholar] [CrossRef]
- Bozorgmehr, N.; Mashhouri, S.; Perez Rosero, E.; Xu, L.; Shahbaz, S.; Sligl, W.; Osman, M.; Kutsogiannis, D.J.; MacIntyre, E.; O’Neil, C.R.; et al. Galectin-9, a Player in Cytokine Release Syndrome and a Surrogate Diagnostic Biomarker in SARS-CoV-2 Infection. mBio 2021, 12, e00384-21. [Google Scholar] [CrossRef]
- Dashti, M.; Mohammadi, M.; Dehnavi, S.; Sadeghi, M. Immunomodulatory interactions between mesenchymal stromal/stem cells and immune cells in psoriasis: Therapeutic potential and challenges. Stem. Cell Res. Ther. 2025, 16, 241. [Google Scholar] [CrossRef] [PubMed]
- Hattori, T. Unlocking medical breakthroughs: The transformative role of case reports in cloinical discovery. Reports 2025, 8, 9. [Google Scholar] [CrossRef]
- Cao, Z.; Leng, P.; Xu, H.; Li, X. The regulating role of galectin-9 in immune cell populations. Front. Pharmacol. 2024, 15, 1462061. [Google Scholar] [CrossRef]
- Tsuda, H.; Takatsuki, K. Specific decrease in T3 antigen density in adult T-cell leukaemia cells: I. Flow microfluorometric analysis. Br. J. Cancer 1984, 50, 843–845. [Google Scholar] [CrossRef]
- Kataoka, K.; Nagata, Y.; Kitanaka, A.; Shiraishi, Y.; Shimamura, T.; Yasunaga, J.; Totoki, Y.; Chiba, K.; Sato-Otsubo, A.; Nagae, G.; et al. Integrated molecular analysis of adult T cell leukemia/lymphoma. Nat. Genet. 2015, 47, 1304–1315. [Google Scholar] [CrossRef]
- Mohammed, T.O.; Chagan-Yasutan, H.; Ashino, Y.; Nakayama, W.; Takahashi, Y.; Shimomura, T.; Fujimoto, T.; Watanabe, Y.; Niki, T.; Suzushima, H.; et al. Galectin-9 as a Predictive Marker for the Onset of Immune-Related Adverse Effects Associated with Anti-CCR4 MoAb Therapy in Patients with Adult T Cell Leukemia. Tohoku J. Exp. Med. 2017, 241, 201–208. [Google Scholar] [CrossRef] [PubMed]
- Takeuchi, M.; Miyoshi, H.; Nakashima, K.; Kawamoto, K.; Yamada, K.; Yanagida, E.; Muta, H.; Moritsubo, M.; Umeno, T.; Suzuki, T.; et al. Comprehensive immunohistochemical analysis of immune checkpoint molecules in adult T cell leukemia/lymphoma. Ann. Hematol. 2020, 99, 1093–1098. [Google Scholar] [CrossRef]
- Najidh, S.; Tensen, C.P.; van der Sluijs-Gelling, A.J.; Teodosio, C.; Cats, D.; Mei, H.; Kuipers, T.B.; Out-Luijting, J.J.; Zoutman, W.H.; van Hall, T.; et al. Improved Sezary cell detection and novel insights into immunophenotypic and molecular heterogeneity in Sezary syndrome. Blood 2021, 138, 2539–2554. [Google Scholar] [CrossRef] [PubMed]
- Jonak, C.; Brunner, P.M. Blood will tell: Profiling Sezary syndrome. Blood 2021, 138, 2450–2451. [Google Scholar] [CrossRef]
- Liu, Z.; Wu, X.; Hwang, S.T.; Liu, J. The Role of Tumor Microenvironment in Mycosis Fungoides and Sezary Syndrome. Ann. Dermatol. 2021, 33, 487–496. [Google Scholar] [CrossRef]
- McKenna, E.; Wubben, R.; Isaza-Correa, J.M.; Melo, A.M.; Mhaonaigh, A.U.; Conlon, N.; O’Donnell, J.S.; Ni Cheallaigh, C.; Hurley, T.; Stevenson, N.J.; et al. Neutrophils in COVID-19: Not Innocent Bystanders. Front. Immunol. 2022, 13, 864387. [Google Scholar] [CrossRef] [PubMed]
- Paranga, T.G.; Pavel-Tanasa, M.; Constantinescu, D.; Iftimi, E.; Plesca, C.E.; Miftode, I.L.; Cianga, P.; Miftode, E. Distinct soluble immune checkpoint profiles characterize COVID-19 severity, mortality and SARS-CoV-2 variant infections. Front. Immunol. 2024, 15, 1464480. [Google Scholar] [CrossRef]
- Czerwinska, J.; Owczarczyk-Saczonek, A. The Role of the Neutrophilic Network in the Pathogenesis of Psoriasis. Int. J. Mol. Sci. 2022, 23, 1840. [Google Scholar] [CrossRef]
- Chagan-Yasutan, H.; He, N.; Arlud, S.; Fang, J.; Hattori, T. The elevation of plasma galectin-9 levels in patients with psoriasis and its associations with inflammatory and immune checkpoint molecules in skin tissues. Hum. Immunol. 2024, 85, 110741. [Google Scholar] [CrossRef]
- Chen, H.Y.; Wu, Y.F.; Chou, F.C.; Wu, Y.H.; Yeh, L.T.; Lin, K.I.; Liu, F.T.; Sytwu, H.K. Intracellular Galectin-9 Enhances Proximal TCR Signaling and Potentiates Autoimmune Diseases. J. Immunol. 2020, 204, 1158–1172. [Google Scholar] [CrossRef]
- Gossink, E.M.; Coffer, P.J.; Cutilli, A.; Lindemans, C.A. Immunomodulation by galectin-9: Distinct role in T cell populations, current therapeutic avenues and future potential. Cell. Immunol. 2025, 407, 104890. [Google Scholar] [CrossRef] [PubMed]
- San Jose, E.; Borroto, A.; Niedergang, F.; Alcover, A.; Alarcon, B. Triggering the TCR complex causes the downregulation of nonengaged receptors by a signal transduction-dependent mechanism. Immunity 2000, 12, 161–170. [Google Scholar] [CrossRef]
- Shahbaz, S.; Dunsmore, G.; Koleva, P.; Xu, L.; Houston, S.; Elahi, S. Galectin-9 and VISTA Expression Define Terminally Exhausted T Cells in HIV-1 Infection. J. Immunol. 2020, 204, 2474–2491. [Google Scholar] [CrossRef] [PubMed]
- von Essen, M.; Nielsen, M.W.; Bonefeld, C.M.; Boding, L.; Larsen, J.M.; Leitges, M.; Baier, G.; Odum, N.; Geisler, C. Protein kinase C (PKC) alpha and PKC theta are the major PKC isotypes involved in TCR down-regulation. J. Immunol. 2006, 176, 7502–7510. [Google Scholar] [CrossRef] [PubMed]


| Step | Description | Number of Records |
|---|---|---|
| 1. Initial AI-assisted retrieval | Comprehensive literature search using GPT-5 and Adobe Acrobat AI Assistant covering ATL, Sézary syndrome, COVID-19, psoriasis, neutrophils, Galectin-9, and TCR signaling. | 312 |
| 2. Title and abstract screening | AI-based clustering followed by manual exclusion of irrelevant or non-mechanistic studies. | 142 |
| 3. Full-text eligibility assessment | Evaluation of study design, disease relevance, and mechanistic contribution focusing on Gal-9, neutrophil biology, and TCR regulation. | 67 |
| 4. Final inclusion for synthesis | Studies selected for integration into the mechanistic and conceptual framework of this integrative review. | 20 |
| Disease Context | Neutrophil Activation/Status | Primary Source of Galectin-9 | Gal-9 Levels | Effects on T Cells/ATL | TCR Expression/Signaling | Innate–Adaptive Crosstalk | Clinical Correlations/Biomarkers | Key References |
|---|---|---|---|---|---|---|---|---|
| Adult T-cell leukemia/lymphoma (ATL) | Neutrophilia driven by Tax-mediated cytokine storm and infection-associated inflammation. | Leukemic + stromal cells; possible contribution from activated neutrophils. | High prior to therapy; declines with sIL-2R after chemotherapy. | Tim-3-mediated immunoregulation; potential driver of ATL activation. | Surface TCR downregulated; pathway chronically stimulated (noncanonical, cytokine- and Gal-9–associated). | Neutrophil-Gal-9 bridges myeloid activation and leukemic T-cell signaling. | Neutrophilia ≥ 7.5 × 109/L predicts poor survival; Gal-9 correlates with tumor load. | [4,6,12,13,14,15] |
| Sézary syndrome (SS) | Elevated counts with reduced antimicrobial function; ↑CD11b, ↑CD66b, ↓CD62L phenotype. | Not clearly defined (limited direct evidence). | Not well quantified in SS-specific studies. | T-cell dysfunction with enhanced MDSC suppression. | Downregulation of THEMIS and LAIR1. | Aberrant neutrophil-T-cell signaling and MDSC-driven suppression. | Impaired microbicidal activity despite neutrophilia. | [16,17,18] |
| COVID-19 | Hyperactivated neutrophils with NETosis; contribute to ARDS and thrombosis. | Activated neutrophils (major source). | Elevated; correlates with sTREM-1, MCP-1, IL-6, NLR, PLR, ESR. | Induces T-cell exhaustion and reduced CD3-TCR expression. | Downregulated CD3-TCR complex. | Neutrophil-derived Gal-9 links innate hyperactivation to adaptive suppression. | Severity and mortality correlate with Gal-9. | [8,19,20] |
| Psoriasis | Abundant NET-forming neutrophils; drive IL-17-dependent inflammation. | Lesional keratinocytes (LGALS9) and circulating cells. | Increased; correlates with inflammatory/checkpoint molecules. | Promotes IL-17-mediated T-cell activation. | TCR modulation is indirect via cytokine milieu. | NETs amplify Th17 and autoantigen responses. | Neutrophil decline parallels clinical remission. | [9,21,22] |
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Hattori, T. Neutrophil–Galectin-9 Axis Linking Innate and Adaptive Immunity in ATL, Sézary Syndrome, COVID-19, and Psoriasis: An AI-Assisted Integrative Review. Reports 2026, 9, 16. https://doi.org/10.3390/reports9010016
Hattori T. Neutrophil–Galectin-9 Axis Linking Innate and Adaptive Immunity in ATL, Sézary Syndrome, COVID-19, and Psoriasis: An AI-Assisted Integrative Review. Reports. 2026; 9(1):16. https://doi.org/10.3390/reports9010016
Chicago/Turabian StyleHattori, Toshio. 2026. "Neutrophil–Galectin-9 Axis Linking Innate and Adaptive Immunity in ATL, Sézary Syndrome, COVID-19, and Psoriasis: An AI-Assisted Integrative Review" Reports 9, no. 1: 16. https://doi.org/10.3390/reports9010016
APA StyleHattori, T. (2026). Neutrophil–Galectin-9 Axis Linking Innate and Adaptive Immunity in ATL, Sézary Syndrome, COVID-19, and Psoriasis: An AI-Assisted Integrative Review. Reports, 9(1), 16. https://doi.org/10.3390/reports9010016
