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DISCUSSION To our knowledge, our evaluation of Gal-9 serum levels in PDAC patients is the first of its kind. According to our data, Gal-9 presents a remarkable expression in both serum and tissue. To date, the role of Gal-9 in PDAC remains incompletely understood, and literature has reported dual functions. In PDAC, Gal-9 overexpression is associatedwith a capacity to promote a tolerogenic macrophage that programs adaptive immune suppression and binding to declin-1 receptors in tumor macrophages. However, Gal-9 is also associated with antitumor effects by suppressing cell proliferation and inducing intrinsic apoptosis through caspase-dependent and caspase-independent pathways.