Sang-Nae cho 3,4 , Young Ae Kang 2,3* & Sang-Guk Lee 1* Although tuberculosis (TB) is a severe health problem worldwide, the current diagnostic methods are far from optimal. Metabolomics is increasingly being used in the study of infectious diseases. We performed metabolome profiling to identify potential biomarkers in patients with active TB. Serum samples from 21 patients with active pulmonary TB, 20 subjects with latent TB infection (LTBI), and 28 healthy controls were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS) followed by multivariate and univariate analyses. Metabolic profiles indicated higher serum levels of glutamate, sulfoxy methionine, and aspartate and lower serum levels of glutamine, methionine, and asparagine in active TB patients than in LTBI subjects or healthy controls. The ratios between metabolically related partners (glutamate/glutamine, sulfoxy methionine/methionine, and aspartate/asparagine) were also elevated in the active TB group. There was no significant difference in the serum concentration of these metabolites according to the disease extent or risk of relapse in active TB patients. Novel serum biomarkers such as glutamate, sulfoxy methionine, aspartate, glutamine, methionine, and asparagine are potentially useful for adjunctive, rapid, and noninvasive pulmonary TB diagnosis. According to the World Health Organization report, Tuberculosis (TB) caused approximately 10.0 million patients and 1.6 million deaths globally in 2017 1. Timely diagnosis and treatment are critical in controlling TB successfully. Currently, TB exposure is evaluated with two methods: a tuberculin skin test (TST) and an interferon-gamma release assay (IGRA). However, existing diagnostic techniques cannot distinguish latent tuberculosis infection (LTBI) from active TB because they indirectly identify TB infection through detection of the immunologic reaction to the Mycobacterium tuberculosis (Mtb) antigen 2. Therefore, the identification of blood markers representing the actual TB bacterial presence/burden in the human body is needed to tailor treatment options for patients with positive TST or IGRA results. Recently, metabolomics has emerged as a potential tool making remarkable progress in novel biomarker research. It can execute multiplexed profiling and compare multiple metabolites in a biological sample 3. It aims the comprehensive measurement of the metabolites; therefore, highly specialized analytical techniques in combination with sophisticated statistical, mathematical, and bioinformatics analyses are required 4. Accordingly, metabolomics technologies have been widely utilized in various diseases to screen novel biomarkers, understand the biologic processes and metabolic pathways, and comprehend the response of the host, which enables researchers to develop improved diagnostic tools and treatment strategies 5,6. Several metabolomics studies used sputum 7,8 , blood 9-14 , breath 15,16 , and urine 17 to identify new markers of TB infection or treatment response. However, the number...