# Diagnosis and treatment of sarcoidosis based on immunological etiology and mechanisms

**Authors:** Jingshu Zhao, Lixuan Ma, Junwen Luan

PMC · DOI: 10.3389/fmed.2026.1754491 · Frontiers in Medicine · 2026-02-12

## TL;DR

This paper reviews the immune causes and treatment options for pulmonary sarcoidosis, focusing on how immune mechanisms and biomarkers can improve diagnosis and therapy.

## Contribution

The paper systematically discusses the immunological basis and therapeutic strategies for pulmonary sarcoidosis, emphasizing precise diagnosis and treatment.

## Key findings

- Pulmonary sarcoidosis involves genetic and immune factors triggered by environmental antigens.
- Key biomarkers like sIL-2R and CD4+/CD8+ ratio help in diagnosis and disease assessment.
- Therapies range from glucocorticoids to biologics, with emerging anti-fibrotic treatments.

## Abstract

Pulmonary sarcoidosis is a multisystem disease characterized by non-caseating granulomas, and its pathogenesis involves genetic susceptibility and abnormal immune responses triggered by environmental antigens. This article reviews the immunological etiology and mechanisms of pulmonary sarcoidosis, systematically discussing its pathogenetic basis, core immune mechanisms, and the role of key immunological biomarkers (such as sIL-2R, CD4+/CD8+ ratio in BALF, and HRCT) in diagnosis and assessment. It also outlines the step-up therapy, ranging from glucocorticoids to immunomodulators, biologic agents, and emerging anti-fibrotic therapies, aiming to provide an immunological basis for the precise diagnosis and treatment of pulmonary sarcoidosis.

## Linked entities

- **Diseases:** sarcoidosis (MONDO:0008399), pulmonary sarcoidosis (MONDO:0001708)

## Full-text entities

- **Genes:** AP2B1 (adaptor related protein complex 2 subunit beta 1) [NCBI Gene 163] {aka ADTB2, AP105B, AP2-BETA, CLAPB1}, CHRNA7 (cholinergic receptor nicotinic alpha 7 subunit) [NCBI Gene 1139] {aka CHRNA7-2, NACHRA7, a7nAChR, nAChR7}, CD4 (CD4 molecule) [NCBI Gene 920] {aka CD4mut, IMD79, Leu-3, OKT4D, T4}, HIF1A (hypoxia inducible factor 1 subunit alpha) [NCBI Gene 3091] {aka HIF-1-alpha, HIF-1A, HIF-1alpha, HIF1, HIF1-ALPHA, MOP1}, IFNG (interferon gamma) [NCBI Gene 3458] {aka IFG, IFI, IMD69}, IL17A (interleukin 17A) [NCBI Gene 3605] {aka CTLA-8, CTLA8, IL-17, IL-17A, IL17, ILA17}, TNFRSF4 (TNF receptor superfamily member 4) [NCBI Gene 7293] {aka ACT35, CD134, IMD16, OX40, TXGP1L}, CHIT1 (chitinase 1) [NCBI Gene 1118] {aka CHI3, CHIT, CHITD}, CD8A (CD8 subunit alpha) [NCBI Gene 925] {aka CD8, CD8alpha, IMD116, Leu2, p32}, TNFSF4 (TNF superfamily member 4) [NCBI Gene 7292] {aka CD134L, CD252, GP34, OX-40L, OX4OL, TNLG2B}, ACE (angiotensin I converting enzyme) [NCBI Gene 1636] {aka ACE1, CD143, DCP, DCP1}, CD34 (CD34 molecule) [NCBI Gene 947], TNF (tumor necrosis factor) [NCBI Gene 7124] {aka DIF, IMD127, TNF-alpha, TNFA, TNFSF2, TNLG1F}, PTPRC (protein tyrosine phosphatase receptor type C) [NCBI Gene 5788] {aka B220, CD45, CD45R, GP180, IMD105, L-CA}, KRT20 (keratin 20) [NCBI Gene 54474] {aka CD20, CK-20, CK20, K20, KRT21}, IL2RB (interleukin 2 receptor subunit beta) [NCBI Gene 3560] {aka CD122, IL15RB, IMD63, P70-75}, CD38 (CD38 molecule) [NCBI Gene 952] {aka ADPRC 1, ADPRC1, cADPR1}
- **Diseases:** pulmonary fibrosis (MESH:D011658), tuberculosis (MESH:D014376), granuloma (MESH:D006099), Fibrosing Interstitial Lung Diseases (MESH:D017563), lymphoma (MESH:D008223), lung function impairment (MESH:D003072), traction bronchiectasis (MESH:D001987), periphlebitis (MESH:D010689), HP (MESH:C537262), Sarcoidosis (MESH:D012507), IPF (MESH:D054990), infection (MESH:D007239), Fuchs uveitis (MESH:D014605), pulmonary infiltrates (MESH:D017254), hypersensitivity pneumonitis (MESH:D000542), granulomatous disease (MESH:D006105), Pulmonary sarcoidosis (MESH:D017565), granulomatous (MESH:D013968), fibrosis (MESH:D005355), optic disk granuloma (MESH:D009901), pulmonary involvement (MESH:C566343), glucocorticoid resistance (MESH:C564221), granulomatous inflammation (MESH:D007249), lung (MESH:D008171), tumor (MESH:D009369)
- **Chemicals:** minocycline (MESH:D008911), steroid (MESH:D013256), prednisone (MESH:D011241), calcium (MESH:D002118), Nintedanib (MESH:C530716), GC (MESH:C057580), silica (MESH:D012822), prednisolone (MESH:D011239), PAB (-), Leflunomide (MESH:D000077339), nicotine (MESH:D009538), Rifampicin (MESH:D012293), 18F-FDG (MESH:D019788), fluoroquinolones (MESH:D024841), rifabutin (MESH:D017828), ethambutol (MESH:D004977), rituximab (MESH:D000069283), levofloxacin (MESH:D064704), tetracyclines (MESH:D013754), MTX (MESH:D008727), Adalimumab (MESH:D000068879), infliximab (MESH:D000069285), azithromycin (MESH:D017963), beryllium (MESH:D001608), metal (MESH:D008670), Mycophenolate mofetil (MESH:D009173), carbon (MESH:D002244), AZA (MESH:D001379)
- **Species:** Homo sapiens (human, species) [taxon 9606], Cutibacterium acnes (species) [taxon 1747]

## Full text

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## Figures

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## References

62 references — full list in the complete paper: https://tomesphere.com/paper/PMC12935876/full.md

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Source: https://tomesphere.com/paper/PMC12935876