Peripheral metabolic signatures in patients with neuropsychiatric long COVID syndrome

Neuropsychiatric symptoms are considered the most common feature of long COVID disease. Recent studies have demonstrated structural brain changes and highlighted the importance of neuroinflammation in the development of cognitive deficits as seen in long COVID patients. In addition, peripheral studies have demonstrated heterogeneous molecular subtypes of long COVID pathology. However, it is unknown which peripheral metabolomic alterations occur in patients with neuropsychiatric long COVID syndrome and how these relate to symptom severity. In the present study, we investigated differences in the peripheral serum metabolome profiles of healthy controls and patients with long COVID syndrome with neuropsychiatric symptoms. We found that patients with long COVID showed peripheral alterations in lipid species such as triacylglycerides and acylcarnitines. Furthermore, metabolites altered in patients with long COVID syndrome were also associated with depressive and fatigue symptom burden as well as with differences in cortical thickness in multiple brain regions. Our results demonstrate a metabolic phenotype of long COVID patients that may reflect a dysregulation of lipid metabolism and deficits in mitochondrial energy production as potential contributors to symptom burden and brain structural alterations. These data may serve as a resource and basis for further studies aimed at investigating peripheral molecular alterations in patients with neuropsychiatric long COVID syndrome.