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Peer-reviewedCC BY 4.0International Journal of Molecular Sciences

HDL Remodeling in Severe Bacterial Infection in Children: A Potential Biomarker for Diagnosis and Therapeutic Monitoring

  • Arianna Finizio1,2
  • Marco Sarno3
  • Chiara Botti4
  • Alice Castaldo2
  • Andrea Catzola5
  • Gustavo Cernera1,2
  • Gilda Crispino3
  • Giovanna Di Nardo5
  • Monica Gelzo1,2
  • Lorenza Lepore6
  • Claudia Mandato3
  • Virginia Mirra7
9 more authors
  • Silvia Moggia8
  • Francesco Nunziata5
  • Francesca Orlando5
  • Antonia Pascarella3
  • Luca Pierri6
  • Margherita Rosa3
  • Fabio Savoia9
  • Paolo Siani10
  • Giuseppe Castaldo1,2
10 affiliations
  1. 1Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
  2. 2CEINGE-Advanced Biotechnologies Franco Salvatore, 80145 Naples, Italy
  3. 3Chronic Diseases, Hepatology and Nutrition Unit, AORN Santobono-Pausilipon IRCCS, 80129 Naples, Italy
  4. 4Clinical Pathology Unit, AORN Santobono-Pausilipon IRCCS, 80129 Naples, Italy
  5. 5General Pediatrics and Immuno-Rheumatology Unit, AORN Santobono-Pausilipon IRCCS, 80129 Naples, Italy
  6. 6Neonatal Intensive Care and Neonatology Unit, AORN Santobono-Pausilipon IRCCS, 80129 Naples, Italy
  7. 7Pediatric Pulmonology and Respiratory Sub-Intensive Care Unit, AORN Santobono-Pausilipon IRCCS, 80129 Naples, Italy
  8. 8Pediatric Intensive Care Unit, AORN Santobono-Pausilipon IRCCS, 80129 Naples, Italy
  9. 9Epidemiology, Biostatistics and Childhood Cancer Registry Unit, AORN Santobono-Pausilipon IRCCS, 80122 Naples, Italy
  10. 10Chronic and Multifactorial Diseases Unit, AORN Santobono-Pausilipon IRCCS, 80129 Naples, Italy
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Abstract

Many pediatric patients with severe bacterial infection (SBI) present with a compromised general clinical picture. Early identification of the infectious and inflammatory state can improve clinical outcomes. Although microbiological culture remains the gold standard for diagnosis, its delayed results highlight the need for early biomarkers to improve clinical decision-making and patient outcomes. During infection, the acute phase response alters lipid metabolism, compromising cholesterol efflux. In this study, we characterized the serum lipid profile and HDL subclasses in 63 children with SBI at hospital admission (T0) and discharge (T1), comparing them with 63 age- and sex-matched healthy subjects. At T0, we found a significant reduction in serum total cholesterol, LDL cholesterol, and HDL cholesterol in subjects with SBI compared to controls. Interestingly, at a cut-off value of 41.5 mg/dL, HDL cholesterol discriminated the two groups with a sensitivity of 76% and a specificity of 86% for SBI. At T1, total and LDL cholesterol increased, while HDL cholesterol remained unchanged. Moreover, we observed at T1 a clear remodeling of HDL classes, with a significant decrease in large HDL with pro-inflammatory activity and an increase in the intermediate and small HDL with anti-inflammatory activity, compared to time T0. This study proposes serum HDL cholesterol as a candidate biomarker and highlights the role of HDL cholesterol and its classes in inflammatory and immune regulation in systemic bacterial infection, potentially identifying patients who could benefit from HDL-based therapies.

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Cite

BibTeXRIS
BibTeX
@article{finizio2026remodeling,
  title = {{HDL Remodeling in Severe Bacterial Infection in Children: A Potential Biomarker for Diagnosis and Therapeutic Monitoring}},
  author = {Arianna Finizio and Marco Sarno and Chiara Botti and Alice Castaldo and Andrea Catzola and Gustavo Cernera and Gilda Crispino and Giovanna Di Nardo and Monica Gelzo and Lorenza Lepore and Claudia Mandato and Virginia Mirra and Silvia Moggia and Francesco Nunziata and Francesca Orlando and Antonia Pascarella and Luca Pierri and Margherita Rosa and Fabio Savoia and Paolo Siani and Giuseppe Castaldo},
  journal = {International Journal of Molecular Sciences},
  year = {2026},
  month = oct,
  doi = {10.3390/ijms27209300},
  url = {https://www.mdpi.com/1422-0067/27/20/9300},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - HDL Remodeling in Severe Bacterial Infection in Children: A Potential Biomarker for Diagnosis and Therapeutic Monitoring
AU  - Arianna Finizio
AU  - Marco Sarno
AU  - Chiara Botti
AU  - Alice Castaldo
AU  - Andrea Catzola
AU  - Gustavo Cernera
AU  - Gilda Crispino
AU  - Giovanna Di Nardo
AU  - Monica Gelzo
AU  - Lorenza Lepore
AU  - Claudia Mandato
AU  - Virginia Mirra
AU  - Silvia Moggia
AU  - Francesco Nunziata
AU  - Francesca Orlando
AU  - Antonia Pascarella
AU  - Luca Pierri
AU  - Margherita Rosa
AU  - Fabio Savoia
AU  - Paolo Siani
AU  - Giuseppe Castaldo
PY  - 2026
DA  - 2026/10/20
JO  - International Journal of Molecular Sciences
DO  - 10.3390/ijms27209300
UR  - https://www.mdpi.com/1422-0067/27/20/9300
AB  - Many pediatric patients with severe bacterial infection (SBI) present with a compromised general clinical picture. Early identification of the infectious and inflammatory state can improve clinical outcomes. Although microbiological culture remains the gold standard for diagnosis, its delayed results highlight the need for early biomarkers to improve clinical decision-making and patient outcomes. During infection, the acute phase response alters lipid metabolism, compromising cholesterol efflux. In this study, we characterized the serum lipid profile and HDL subclasses in 63 children with SBI at hospital admission (T0) and discharge (T1), comparing them with 63 age- and sex-matched healthy subjects. At T0, we found a significant reduction in serum total cholesterol, LDL cholesterol, and HDL cholesterol in subjects with SBI compared to controls. Interestingly, at a cut-off value of 41.5 mg/dL, HDL cholesterol discriminated the two groups with a sensitivity of 76% and a specificity of 86% for SBI. At T1, total and LDL cholesterol increased, while HDL cholesterol remained unchanged. Moreover, we observed at T1 a clear remodeling of HDL classes, with a significant decrease in large HDL with pro-inflammatory activity and an increase in the intermediate and small HDL with anti-inflammatory activity, compared to time T0. This study proposes serum HDL cholesterol as a candidate biomarker and highlights the role of HDL cholesterol and its classes in inflammatory and immune regulation in systemic bacterial infection, potentially identifying patients who could benefit from HDL-based therapies.
SN  - 1422-0067
ER  -