Comment; I hadn’t realized the role of mast cells in the generation of foam cells and plaque. Fascinating! More to follow for certain!

M. A. W. Hermans,

J. E. Roeters van Lennep,

P. L. A. van Daele, and

I. Bot

Department of Internal Medicine, section of Clinical Immunology, Erasmus MC University Center, 3015 GD Rotterdam, The Netherlands

Department of Internal Medicine, section of Vascular Medicine, Erasmus MC Erasmus MC University Center, 3015 GD Rotterdam, The Netherlands

Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, 2300 RA Leiden, The Netherlands

Correspondence:; Tel.: +31-10-7032169; Fax: +31-11-0703493 Received 2019 Jun 4; Accepted 2019 Jul 8. Copyright © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (


Mast cells are pluripotent leukocytes that reside in the mucosa and connective tissue. Recent studies show an increased prevalence of cardiovascular disease among patients with mastocytosis, which is a hematological disease that is characterized by the accumulation of mast cells due to clonal proliferation. This association suggests an important role for mast cells in cardiovascular disease. Indeed, the evidence establishing the contribution of mast cells to the development and progression of atherosclerosis is continually increasing. Mast cells may contribute to plaque formation by stimulating the formation of foam cells and causing a pro-inflammatory micro-environment. In addition, these cells are able to promote plaque instability by neo-vessel formation and also by inducing intraplaque hemorrhage. Furthermore, mast cells appear to stimulate the formation of fibrosis after a cardiac infarction. In this review, the available data on the role of mast cells in cardiovascular disease are summarized, containing both in vitro research and animal studies, followed by a discussion of human data on the association between cardiovascular morbidity and diseases in which mast cells are important: Kounis syndrome, mastocytosis and allergy.

Dr. Raymond Oenbrink