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The value of serum CARDS toxin and NETs formation in children with MPP

Wanyu Jia1, Ruiyang Sun1, Jiapu Hou1

  • 1Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China.

Frontiers in Cellular and Infection Microbiology
|April 17, 2026
PubMed

Insights

Cardiopulmonary Distress Syndrome Toxin (CARDS TX), myeloperoxidase (MPO), and citrullinated histone 3 (CitH3) are elevated in severe Mycoplasma pneumoniae pneumonia (SMPP). These markers show good predictive value for identifying SMPP in children.

Area of Science:

  • Pediatric Pulmonology
  • Infectious Diseases
  • Immunology

Background:

  • Cardiopulmonary Distress Syndrome Toxin (CARDS TX) is a key virulence factor in Mycoplasma pneumoniae infections.
  • Neutrophil extracellular traps (NETs) are crucial components of the innate immune response.
  • Pediatric severe Mycoplasma pneumoniae pneumonia (SMPP) requires investigation into its underlying pathogenic mechanisms.

Purpose of the Study:

  • To investigate changes in CARDS TX and NETs in pediatric SMPP.
  • To evaluate the predictive value of CARDS TX, MPO, and CitH3 for SMPP.
  • To explore the role of CARDS TX in SMPP pathogenesis.

Main Methods:

  • Serum levels of CARDS TX, citrullinated histone 3 (CitH3), and myeloperoxidase (MPO) were measured in children with Mycoplasma pneumoniae pneumonia (MPP).
  • Patients were categorized into mild (GMPP) and severe (SMPP) groups for comparative analysis.
  • Logistic regression and ROC curve analysis were used to assess diagnostic utility.

Main Results:

  • Serum levels of CARDS TX, MPO, and CitH3 were significantly higher in the SMPP group compared to the GMPP group.
  • CARDS TX, MPO, and CitH3 levels showed a significant positive correlation with SMPP.
  • The AUC values for predicting SMPP were 0.750 for CARDS TX, 0.706 for MPO, and 0.729 for CitH3.

Conclusions:

  • Elevated serum CARDS TX, MPO, and CitH3 are independent risk factors for pediatric SMPP.
  • These markers possess good predictive value for identifying SMPP.
  • CARDS TX may contribute to SMPP by inducing excessive NET formation.
Abstract

Keywords:
CARDS TXcitrullinated histones 3mycoplasma pneumoniae pneumoniamyeloperoxidaseneutrophil extracellular traps

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