Kayo H M Santos

Background: Sarcoidosis is a granulomatous disease affecting multiple organ systems and poses a diagnostic challenge due to its diverse clinical manifestations and absence of specific diagnostic tests. Currently, blood biomarkers such as ACE, sIL-2R, CD163, CCL18, serum amyloid A, and CRP are employed to aid in the diagnosis and monitoring of sarcoidosis. Metabolomics holds promise for identifying highly sensitive and specific biomarkers. This study aimed to leverage metabolomics for the early diagnosis of sarcoidosis and to identify metabolic phenotypes associated with disease progression. Methods: Serum samples from patients with sarcoidosis (n = 40, including stage 1 to stage 4), were analyzed for metabolite levels by semi-untargeted liquid chromatography–mass spectrometry (LC-MS). Metabolomics data from patients with sarcoidosis were compared with those from patients with COVID-19 and healthy controls to identify distinguishing metabolic biosignatures. Univariate and multivariate analyses were applied to obtain diagnostic and prognostic metabolic phenotypes. Results: Significant changes in metabolic profiles distinguished stage 1 sarcoidosis from healthy controls, with potential biomarkers including azelaic acid, itaconate, and glutarate. Distinct metabolic phenotypes were observed across the stages of sarcoidosis, with stage 2 exhibiting greater heterogeneity compared with stages 1, 3, and 4. Conclusions: we explored immunometabolic phenotypes by comparing patients with sarcoidosis with patients with COVID-19 and healthy controls, revealing potential metabolic pathways associated with acute and chronic inflammation across the stages of sarcoidosis.

The Nucleocapsid Protein (N Protein) of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV2) is located in the viral core. Immunoglobulin G (IgG) targeting N protein is detectable in the serum of infected patients. The effect of high titers of IgG against N-protein on clinical outcomes of SARS-CoV2 disease has not been described. We studied 400 RT-PCR confirmed SARS-CoV2 patients to determine independent factors associated with poor outcomes, including MICU admission, prolonged MICU stay and hospital admissions, and in-hospital mortality. We also measured serum IgG against the N protein and correlated its concentrations with clinical outcomes. We found that several factors, including Charlson comorbidity Index (CCI), high levels of IL6, and presentation with dyspnea were associated with poor clinical outcomes. It was shown that higher CCI and higher IL6 levels were independently associated with in-hospital mortality. Anti-N protein IgG was detected in the serum of 55 (55%) patients at the time of admission. A high concentration of antibodies, defined as signal to cut off ratio (S/Co)> 1.5 (75 percentile of all measurements), was found in 25 (25%) patients. The multivariable logistic regression models showed that between being an African American, higher CCI, lymphocyte counts, and S/Co ratio> 1.5, only S/Co ratio were independently associated with MICU admission and longer length of stay in hospital. This study recommends that titers of IgG targeting N-protein of SARS-CoV2 at admission is a prognostic factor for the clinical course of disease and should be measured in all patients with SARS-CoV2 infection.