Elevated serum apolipoprotein B and lipoprotein remodelling distinguish adults with HLH from HLH mimics and controls

Haemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome characterised by uncontrolled immune activation. Reduced high- and low-density lipoprotein cholesterol and hypertriglyceridaemia are reported in HLH, suggesting lipid metabolism disturbances although in-depth serum metabolomic analysis is lacking in HLH. Here a lipid-focused NMR spectroscopy platform was used to define the serum metabolomic landscape of adults hospitalised with HLH compared to adults with sepsis (HLH-mimic) and rheumatic disease (potential HLH drivers/triggers), following surgical resection of solid organ cancer (non-infectious acute inflammation controls) and healthy controls (H