Metabolomic analyses of COVID-19 patients unravel stage-dependent and prognostic biomarkers

Cell Death Dis. 2021 Mar 11;12(3):258. doi: 10.1038/s41419-021-03540-y.

Abstract

The circulating metabolome provides a snapshot of the physiological state of the organism responding to pathogenic challenges. Here we report alterations in the plasma metabolome reflecting the clinical presentation of COVID-19 patients with mild (ambulatory) diseases, moderate disease (radiologically confirmed pneumonitis, hospitalization and oxygen therapy), and critical disease (in intensive care). This analysis revealed major disease- and stage-associated shifts in the metabolome, meaning that at least 77 metabolites including amino acids, lipids, polyamines and sugars, as well as their derivatives, were altered in critical COVID-19 patient's plasma as compared to mild COVID-19 patients. Among a uniformly moderate cohort of patients who received tocilizumab, only 10 metabolites were different among individuals with a favorable evolution as compared to those who required transfer into the intensive care unit. The elevation of one single metabolite, anthranilic acid, had a poor prognostic value, correlating with the maintenance of high interleukin-10 and -18 levels. Given that products of the kynurenine pathway including anthranilic acid have immunosuppressive properties, we speculate on the therapeutic utility to inhibit the rate-limiting enzymes of this pathway including indoleamine 2,3-dioxygenase and tryptophan 2,3-dioxygenase.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Monoclonal, Humanized / administration & dosage
  • Biomarkers / blood
  • COVID-19 / blood*
  • COVID-19 / diagnosis
  • COVID-19 Drug Treatment
  • Female
  • Humans
  • Male
  • Metabolome*
  • Metabolomics
  • Prognosis
  • SARS-CoV-2 / metabolism*

Substances

  • Antibodies, Monoclonal, Humanized
  • Biomarkers
  • tocilizumab