Galectin-3, a potential predictor and contributor of placenta accreta spectrum pathogenesis by inducing local vascular cell adhesion molecule-1 expression: A longitudinal study

Background: Galectin-3 (Gal-3) is a unique glycoprotein expressed in different tissues with several biological functions. Vascular cell adhesion molecule-1 (VCAM-1) is a cell adhesion molecule, expressed from vascular endothelium, and is implicated in the process of tissue angiogenesis. Both Gal-3 and VCAM-1 are expressed normally in placental tissue to achieve successful trophoblastic invasion. Placenta accreta spectrum (PAS) is a serious pregnancy-related complication, with a progressively rising incidence worldwide. Massive trophoblastic invasion is a major contributor to its pathogenesis, and its diagnosis prenatally depends solely on Doppler ultrasonography. Aim: This study aimed to investigate the possible predictive value of serum Gal-3 in the occurrence of PAS and to highlight the potential involvement of Gal-3, macrophage recruitment, and VCAM-1 in its pathogenesis. Methods: This longitudinal study included 62 pregnant women; divided into group N, comprising31 pregnant women with normal placenta, and group P, comprising 31 pregnant women with PAS. Results: placental Gal-3 increased from 2.597 ± 0.061 to 4.392 ± 0.181 ng/mg protein, placental VCAM-1 increased from 2.901 ± 0.096 to 41.911 ± 1.885 ng/mg protein, and placental macrophage count increased from 2.323 ± 0.106 to 11.174 ± 0.643 /10 HPF. Serum Gal-3 had a significant predictive value for PA with a cutoff value ≥ 8.012 ng/ml. Conclusion: The overexpression of placental Gal-3 and VCAM-1 can be regarded as important key players in the pathogenesis of PAS. Remarkably, the detection of high serum levels of Gal-3 as early as the second trimester can predict the occurrence of PAS .