SummarySarcoidosis is a granulomatous inflammatory disorder of unknown aetiology. The increased frequency of activated lung CD41 T cells with a T helper type 1 (Th1) cytokine profile in sarcoidosis patients is accompanied by a reduced proportion and/or impaired function of regulatory T cells (T regs ). Here we evaluated the expression of the inducible co-stimulator (ICOS) on lung and blood CD4 1 T cell subsets in sarcoidosis patients with different prognosis, by flow cytometry. Samples from the deep airways were obtained by bronchoalveolar lavage (BAL). We show that T regs from the inflamed lung of sarcoidosis patients were characterized by a unique ICOS high phenotype. High-level ICOS expression was restricted to T regs from the inflamed lung and was absent in blood T regs of sarcoidosis patients as well as in lung and blood T regs of healthy volunteers. In addition, lung T regs exhibited increased ICOS expression compared to sarcoid-specific lung effector T cells. Strikingly, ICOS expression on T regs was in particularly high in the lungs of L€ ofgren's syndrome (LS) patients who present with acute disease which often resolves spontaneously. Moreover, blood monocytes from LS patients revealed increased ICOS-L levels compared to healthy donors. Sarcoidosis was associated with a shift towards a nonclassical monocyte phenotype and the ICOS-L high phenotype was restricted to this particular monocyte subset. We propose a potential implication of the ICOS/ICOS-L immune-regulatory axis in disease activity and resolution and suggest to evaluate further the suitability of ICOS as biomarker for the prognosis of sarcoidosis.