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class="vector-body" aria-labelledby="firstHeading" data-mw-ve-target-container> <div class="vector-body-before-content"> <div class="mw-indicators"> </div> <div id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Fat-laden M2 macrophages seen in atherosclerosis</div> <p class="mw-empty-elt"> </p> <style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background-color:beige">Foam cell</th></tr><tr><td colspan="2" class="infobox-image"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Histopathology_of_cholesterolosis,_with_annotated_foam_cell.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/91/Histopathology_of_cholesterolosis%2C_with_annotated_foam_cell.jpg/250px-Histopathology_of_cholesterolosis%2C_with_annotated_foam_cell.jpg" decoding="async" width="250" height="187" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/91/Histopathology_of_cholesterolosis%2C_with_annotated_foam_cell.jpg/375px-Histopathology_of_cholesterolosis%2C_with_annotated_foam_cell.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/91/Histopathology_of_cholesterolosis%2C_with_annotated_foam_cell.jpg/500px-Histopathology_of_cholesterolosis%2C_with_annotated_foam_cell.jpg 2x" data-file-width="704" data-file-height="526" /></a></span><div class="infobox-caption">Foam cells (one indicated by arrows) visible in the finger-like projections into the gallbladder lumen in a case of <a href="/wiki/Cholesterolosis" class="mw-redirect" title="Cholesterolosis">cholesterolosis</a></div></td></tr><tr><th colspan="2" class="infobox-header" style="background-color: #efefef">Details</th></tr><tr><th scope="row" class="infobox-label" style="padding-right:0.25em"><a href="/wiki/Embryology" title="Embryology">Precursor</a></th><td class="infobox-data"><a href="/wiki/Monocyte" title="Monocyte">monocyte</a>-derived <a href="/wiki/Macrophage" title="Macrophage">macrophage</a></td></tr><tr><th colspan="2" class="infobox-header" style="background-color: #efefef">Identifiers</th></tr><tr><th scope="row" class="infobox-label" style="padding-right:0.25em"><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></th><td class="infobox-data"><a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D005487">D005487</a></td></tr><tr><th scope="row" class="infobox-label" style="padding-right:0.25em"><a href="/wiki/Foundational_Model_of_Anatomy" title="Foundational Model of Anatomy">FMA</a></th><td class="infobox-data"><a rel="nofollow" class="external text" href="https://bioportal.bioontology.org/ontologies/FMA/?p=classes&conceptid=http%3A%2F%2Fpurl.org%2Fsig%2Font%2Ffma%2Ffma83586">83586</a></td></tr><tr><td colspan="2" class="infobox-below"><a href="/wiki/Anatomical_terms_of_microanatomy" title="Anatomical terms of microanatomy">Anatomical terms of microanatomy</a><div style="text-align: right;"><small class="noprint">[<a href="https://www.wikidata.org/wiki/Q1425962" class="extiw" title="d:Q1425962">edit on Wikidata</a>]</small></div></td></tr></tbody></table> <p><b>Foam cells</b>, also called <b>lipid-laden macrophages</b>, are a type of cell that contain <a href="/wiki/Cholesterol" title="Cholesterol">cholesterol</a>. These can form a <a href="/wiki/Atheroma" title="Atheroma">plaque</a> that can lead to <a href="/wiki/Atherosclerosis" title="Atherosclerosis">atherosclerosis</a> and trigger <a href="/wiki/Myocardial_infarction" title="Myocardial infarction">myocardial infarction</a> and <a href="/wiki/Stroke" title="Stroke">stroke</a>.<sup id="cite_ref-pmid20376052_1-0" class="reference"><a href="#cite_note-pmid20376052-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:1_2-0" class="reference"><a href="#cite_note-:1-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:0_3-0" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>Foam cells are fat-laden cells with a <a href="/wiki/Macrophage" title="Macrophage">M2 macrophage</a>-like phenotype. They contain <a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">low density lipoproteins</a> (LDL) and can be rapidly detected by examining a fatty plaque under a microscope after it is removed from the body.<sup id="cite_ref-pmid21076992_4-0" class="reference"><a href="#cite_note-pmid21076992-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> They are named because the lipoproteins give the cell a foamy appearance.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>Despite the connection with cardiovascular diseases they might not be inherently dangerous.<sup id="cite_ref-:4_6-0" class="reference"><a href="#cite_note-:4-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>Some foam cells are derived from <a href="/wiki/Smooth_muscle_cells" class="mw-redirect" title="Smooth muscle cells">smooth muscle cells</a> and present a limited macrophage-like phenotype.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Formation">Formation</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Foam_cell&action=edit&section=1" title="Edit section: Formation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Foam cell formation is triggered by a number of factors including the uncontrolled uptake of modified <a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">low density lipoproteins</a> (LDL), the upregulation of cholesterol <a href="/wiki/Ester" title="Ester">esterification</a> and the impairment of mechanisms associated with cholesterol release.<sup id="cite_ref-:1_2-1" class="reference"><a href="#cite_note-:1-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Foam cells are a significant component of atherosclerotic lesions, which are formed when circulating <a href="/wiki/Monocyte" title="Monocyte">monocyte</a>-derived cells are recruited to the atherosclerotic lesion site or fat deposits in the blood vessel walls.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Recruitment is facilitated by the molecules <a href="/wiki/P-selectin" title="P-selectin">P-selectin</a> and <a href="/wiki/E-selectin" title="E-selectin">E-selectin</a>, <a href="/wiki/Intercellular_adhesion_molecule" title="Intercellular adhesion molecule">intercellular adhesion molecule</a> 1 (<a href="/wiki/ICAM-1" title="ICAM-1">ICAM-1</a>) and vascular cell adhesion molecule 1 (<a href="/wiki/VCAM-1" title="VCAM-1">VCAM-1</a>).<sup id="cite_ref-:2_11-0" class="reference"><a href="#cite_note-:2-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>In response to the inflammatory recruitment signals, <a href="/wiki/Monocyte" title="Monocyte">monocytes</a> are able to penetrate the arterial wall through transendothelial migration, as they can even in healthy arteries. Once in the sub <a href="/wiki/Endothelium" title="Endothelium">endothelium</a> space, inflammation processes induce the differentiation of monocytes into mature <a href="/wiki/Macrophage" title="Macrophage">macrophages</a>.<sup id="cite_ref-:2_11-1" class="reference"><a href="#cite_note-:2-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Macrophages are then able to internalize modified lipoproteins like βVLDL (beta very low density lipoprotein), <a href="/wiki/ACADL" title="ACADL">AcLDL</a> (acetylated low density lipoprotein) and OxLDL (oxidized low density lipoprotein) through their binding to the <a href="/wiki/Scavenger_receptor_(immunology)" title="Scavenger receptor (immunology)">scavenger receptors</a> (SRs) such as <a href="/wiki/CD36" title="CD36">CD36</a> and SR-A on the macrophage surface.<sup id="cite_ref-:1_2-2" class="reference"><a href="#cite_note-:1-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> These scavenger receptors act as "<a href="/wiki/Pattern_recognition_receptor" title="Pattern recognition receptor">Pattern recognition receptors</a>" (PRR's) on macrophages and are responsible for recognizing and binding to oxLDL, which in turn promotes the formation of foam cells through internalization of these lipoproteins.<sup id="cite_ref-:5_12-0" class="reference"><a href="#cite_note-:5-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p><p>Coated-pit <a href="/wiki/Endocytosis" title="Endocytosis">endocytosis</a>, <a href="/wiki/Phagocytosis" title="Phagocytosis">phagocytosis</a> and <a href="/wiki/Pinocytosis" title="Pinocytosis">pinocytosis</a> are also responsible for lipoprotein internalization.<sup id="cite_ref-:3_13-0" class="reference"><a href="#cite_note-:3-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Once internalized, scavenged lipoproteins are transported to <a href="/wiki/Endosome" title="Endosome">endosomes</a> or <a href="/wiki/Lysosome" title="Lysosome">lysosomes</a> for degradation, whereby the <a href="/wiki/Cholesteryl_ester" title="Cholesteryl ester">cholesteryl esters</a> (CE) are hydrolyzed to unesterified free cholesterol (FC) by <a href="/wiki/Lysosomal_lipase" title="Lysosomal lipase">lysosomal acid lipase</a> (LPL). Free cholesterol is transported to the <a href="/wiki/Endoplasmic_reticulum" title="Endoplasmic reticulum">endoplasmic reticulum</a> where it is re-esterified by <a href="/wiki/ACAT1" title="ACAT1">ACAT1</a> (acyl-CoA: cholesterol acyltransferase 1) and subsequently stored as cytoplasmic lipid droplets. These droplets are responsible for the foamy appearance of the macrophage and thus the name of foam cells.<sup id="cite_ref-:1_2-3" class="reference"><a href="#cite_note-:1-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> At this point, foam cells can either be degraded though the de-esterification and secretion of cholesterol, or can further promote foam cell development and plaque formation – a process that is dependent on the balance of free cholesterol and esterified cholesterol.<sup id="cite_ref-:1_2-4" class="reference"><a href="#cite_note-:1-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Composition">Composition</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Foam_cell&action=edit&section=2" title="Edit section: Composition"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Low-density lipoprotein (LDL) cholesterol (LDL-C — also known as “bad” cholesterol) and particularly modified forms of LDL cholesterol such as oxidized, glycated, or acetylated LDL, is contained by a foam cell - a marker of atherosclerosis.<sup id="cite_ref-:0_3-1" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The uptake of LDL-C alone does not cause foam cell formation; however, the co-internalization of LDL-C with modified LDL in macrophages can result in foam cell development. Modified LDL affects the intracellular trafficking and metabolism of native LDL, such that not all LDL need to be modified for foam cell formation when LDL levels are high.<sup id="cite_ref-:3_13-1" class="reference"><a href="#cite_note-:3-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>The maintenance of foam cells and the subsequent progression of plaque build-up is caused by the secretion of <a href="/wiki/Chemokine" title="Chemokine">chemokines</a> and <a href="/wiki/Cytokinesis" title="Cytokinesis">cytokines</a> from macrophages and foam cells. Foam cells secrete pro-inflammatory cytokines such as interleukins: IL-1, IL-6; tumour necrosis factor (TNF); chemokines: chemokines ligand 2, CCL5, CXC-chemokine ligand 1 (CXCL1); as well as macrophage retention factors.<sup id="cite_ref-:5_12-1" class="reference"><a href="#cite_note-:5-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Macrophages within the atherosclerotic legion area have a decreased ability to migrate, which further promotes plaque formation as they are able to secrete cytokines, chemokines, <a href="/wiki/Reactive_oxygen_species" title="Reactive oxygen species">reactive oxygen species</a> (ROS) and growth factors that stimulate modified lipoprotein uptake and <a href="/wiki/Vascular_smooth_muscle" title="Vascular smooth muscle">vascular smooth muscle cell</a> (VSMC) proliferation.<sup id="cite_ref-:2_11-2" class="reference"><a href="#cite_note-:2-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:4_6-1" class="reference"><a href="#cite_note-:4-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid11798013_14-0" class="reference"><a href="#cite_note-pmid11798013-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> VSMC can also accumulate cholesteryl esters.<sup id="cite_ref-:4_6-2" class="reference"><a href="#cite_note-:4-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>In chronic <a href="/wiki/Hyperlipidemia" title="Hyperlipidemia">hyperlipidemia</a>, <a href="/wiki/Lipoprotein" title="Lipoprotein">lipoproteins</a> aggregate within the <a href="/wiki/Tunica_intima" title="Tunica intima">intima</a> of <a href="/wiki/Blood_vessel" title="Blood vessel">blood vessels</a> and become oxidized by the action of oxygen <a href="/wiki/Free_radical" class="mw-redirect" title="Free radical">free radicals</a> generated either by <a href="/wiki/Macrophage" title="Macrophage">macrophages</a> or endothelial cells. The macrophages engulf oxidized <a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">low-density lipoproteins</a> (LDLs) by <a href="/wiki/Endocytosis" title="Endocytosis">endocytosis</a> via scavenger receptors, which are distinct from LDL receptors. The oxidized LDL accumulates in the macrophages and other <a href="/wiki/Phagocytes" class="mw-redirect" title="Phagocytes">phagocytes</a>, which are then known as foam cells.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Foam cells form the fatty streaks of the plaques of atheroma in the <a href="/wiki/Tunica_intima" title="Tunica intima">tunica intima</a> of arteries. </p><p>Foam cells are not dangerous as such, but can become a problem when they accumulate at particular foci thus creating a <a href="/wiki/Necrotic" class="mw-redirect" title="Necrotic">necrotic</a> centre of <a href="/wiki/Atherosclerosis" title="Atherosclerosis">atherosclerosis</a>. If the fibrous cap that prevents the necrotic centre from spilling into the <a href="/wiki/Lumen_(anatomy)" title="Lumen (anatomy)">lumen</a> of a vessel ruptures, a <a href="/wiki/Thrombus" title="Thrombus">thrombus</a> can form which can lead to <a href="/wiki/Embolus" title="Embolus">emboli</a> occluding smaller vessels. The occlusion of small vessels results in <a href="/wiki/Ischemia" title="Ischemia">ischemia</a>, and contributes to <a href="/wiki/Stroke" title="Stroke">stroke</a> and <a href="/wiki/Myocardial_infarction" title="Myocardial infarction">myocardial infarction</a>, two of the leading causes of cardiovascular-related death.<sup id="cite_ref-:4_6-3" class="reference"><a href="#cite_note-:4-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> However, during the early stages of their pathogenesis, foam cells have also been observed to adopt a pro-fibrotic phenotype in which they increase the stability of a nascent plaque through the up-regulation of the <a href="/wiki/Liver_X_receptor" title="Liver X receptor">Liver X Receptor</a> (LXR) pathway and the increased expression of <a href="/wiki/Extracellular_matrix" title="Extracellular matrix">extra-cellular matrix</a> (ECM) associated genes.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p><p>Foam cells are very small in size and can only be truly detected by examining a fatty plaque under a microscope after it is removed from the body, or more specifically from the heart. Detection usually involves the staining of sections of <a href="/wiki/Aortic_sinus" title="Aortic sinus">aortic sinus</a> or artery with <a href="/wiki/Oil_Red_O" title="Oil Red O">Oil Red O</a> (ORO) followed by computer imaging and analysis; or from Nile Red Staining. In addition, fluorescent microscopy or <a href="/wiki/Flow_cytometry" title="Flow cytometry">flow cytometry</a> can be used to detect OxLDL uptake when OxLDL has been labeled with 1,1′-dioctadecyl-3,3,3′3′-tetra-methylindocyanide percholorate (DiI-OxLDL).<sup id="cite_ref-pmid21076992_4-1" class="reference"><a href="#cite_note-pmid21076992-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>Autoimmunity occurs when the body starts attacking itself. The link between atherosclerosis and autoimmunity is <a href="/wiki/Plasmacytoid_dendritic_cells" class="mw-redirect" title="Plasmacytoid dendritic cells">plasmacytoid dendritic cells</a> (pDCs). PDCs contribute to the early stages of the formation of atherosclerotic lesions in the blood vessels by releasing large quantities of type 1 <a href="/wiki/Interferon" title="Interferon">interferons</a> (INF). Stimulation of pDCs leads to an increase of macrophages present in plaques. However, during later stages of lesion progression, pDCs have been shown to have a protective effect by activating <a href="/wiki/T_cell" title="T cell">T cells</a> and <a href="/wiki/Regulatory_T_cell" title="Regulatory T cell">Treg</a> function; leading to disease suppression.<sup id="cite_ref-pmid22754539_17-0" class="reference"><a href="#cite_note-pmid22754539-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Degradation">Degradation</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Foam_cell&action=edit&section=3" title="Edit section: Degradation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Foam cell degradation or more specifically the breakdown of esterified cholesterols, is facilitated by a number of efflux receptors and pathways. Esterified cholesterol from cytoplasmic liquid droplets are once again hydrolyzed to free cholesterol by acid cholesterol esterase. Free cholesterol can then be secreted from the macrophage by the efflux to <a href="/wiki/Apolipoprotein_A1" class="mw-redirect" title="Apolipoprotein A1">ApoA1</a> and <a href="/wiki/Apolipoprotein_E" title="Apolipoprotein E">ApoE</a> discs via the <a href="/wiki/ABCA1" title="ABCA1">ABCA1</a> receptor. This pathway is usually used by modified or pathological lipoproteins like AcLDL, OxLDL and βVLDL. FC can also be transported to a recycling compartment through the efflux to ApoA1 containing HDLs (high density lipoproteins) via aqueous diffusion or transport through the SR-B1 or <a href="/wiki/ABCG1" title="ABCG1">ABCG1</a> receptors. While this pathway can also be used by modified lipoproteins, LDL derived cholesterol can only use this pathway to excrete FC. The differences in excretory pathways between types of lipoproteins is mainly a result of the cholesterol being segregated into different areas.<sup id="cite_ref-:1_2-5" class="reference"><a href="#cite_note-:1-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:4_6-4" class="reference"><a href="#cite_note-:4-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid17148552_18-0" class="reference"><a href="#cite_note-pmid17148552-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Infectious_diseases">Infectious diseases</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Foam_cell&action=edit&section=4" title="Edit section: Infectious diseases"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Foamy macrophages are also found in diseases caused by pathogens that persist in the body, such as <i><a href="/wiki/Chlamydia" title="Chlamydia">Chlamydia</a></i>, <i><a href="/wiki/Toxoplasma" class="mw-redirect" title="Toxoplasma">Toxoplasma</a></i>, or <i><a href="/wiki/Mycobacterium_tuberculosis" title="Mycobacterium tuberculosis">Mycobacterium tuberculosis</a></i>. In <a href="/wiki/Tuberculosis" title="Tuberculosis">tuberculosis</a> (TB), bacterial lipids disable macrophages from pumping out excess LDL, causing them to turn into foam cells around the TB <a href="/wiki/Granuloma" title="Granuloma">granulomas</a> in the lung. The cholesterol forms a rich food source for the bacteria. As the macrophages die, the mass of cholesterol in the center of the granuloma becomes a cheesy substance called caseum.<sup id="cite_ref-pmid19692995_19-0" class="reference"><a href="#cite_note-pmid19692995-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Other_conditions">Other conditions</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Foam_cell&action=edit&section=5" title="Edit section: Other conditions"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Foam cells may form around leaked silicone from breast implants.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Lipid-laden_alveolar_macrophage" title="Lipid-laden alveolar macrophage">Lipid-laden alveolar macrophages</a>, also known as pulmonary foam cells, are seen in <a href="/wiki/Bronchoalveolar_lavage" title="Bronchoalveolar lavage">bronchoalveolar lavage</a> specimens in some respiratory diseases.<sup id="cite_ref-Fessler2017_21-0" class="reference"><a href="#cite_note-Fessler2017-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Foam_cell&action=edit&section=6" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-pmid20376052-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid20376052_1-0">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and 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href="https://pubmed.ncbi.nlm.nih.gov/9797723">9797723</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Pathology&rft.atitle=Pathology+of+silicone+leakage+from+breast+implants&rft.volume=51&rft.issue=7&rft.pages=%3Cspan+class%3D%22nowrap%22%3E493-%3C%2Fspan%3E497&rft.date=1998-07&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC500799%23id-name%3DPMC&rft_id=info%3Apmid%2F9797723&rft_id=info%3Adoi%2F10.1136%2Fjcp.51.7.493&rft.aulast=van+Diest&rft.aufirst=PJ&rft.au=Beekman%2C+WH&rft.au=Hage%2C+JJ&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC500799&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFoam+cell" class="Z3988"></span></span> </li> <li id="cite_note-Fessler2017-21"><span class="mw-cite-backlink"><b><a href="#cite_ref-Fessler2017_21-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFessler2017" class="citation journal cs1">Fessler MB (November 2017). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5711269">"A New Frontier in Immunometabolism. Cholesterol in Lung Health and Disease"</a>. <i>Annals of the American Thoracic Society</i>. <b>14</b> (Supplement_5): <span class="nowrap">S399 –</span> <span class="nowrap">S405</span>. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1513%2FAnnalsATS.201702-136AW">10.1513/AnnalsATS.201702-136AW</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5711269">5711269</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/29161079">29161079</a>.</cite><span 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href="/wiki/Template:Vascular_diseases" title="Template:Vascular diseases"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Vascular_diseases" title="Template talk:Vascular diseases"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Vascular_diseases" title="Special:EditPage/Template:Vascular diseases"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Cardiovascular_disease_(vessels)151" style="font-size:114%;margin:0 4em"><a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">Cardiovascular disease</a> (vessels)</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Artery" title="Artery">Arteries</a>, <a href="/wiki/Arteriole" title="Arteriole">arterioles</a><br /> and <a href="/wiki/Capillary" title="Capillary">capillaries</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Inflammation" title="Inflammation">Inflammation</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arteritis" title="Arteritis">Arteritis</a> <ul><li><a href="/wiki/Aortitis" title="Aortitis">Aortitis</a></li></ul></li> <li><a href="/wiki/Thromboangiitis_obliterans" title="Thromboangiitis obliterans">Buerger's disease</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Arteriosclerosis" title="Arteriosclerosis">Arteriosclerosis</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Atherosclerosis" title="Atherosclerosis">Atherosclerosis</a> <ul><li><a class="mw-selflink selflink">Foam cell</a></li> <li><a href="/wiki/Fatty_streak" title="Fatty streak">Fatty streak</a></li> <li><a href="/wiki/Atheroma" title="Atheroma">Atheroma</a></li> <li><a href="/wiki/Cholesterol" title="Cholesterol">Cholesterol</a></li> <li><a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">LDL</a></li> <li><a href="/wiki/Oxycholesterol" title="Oxycholesterol">Oxycholesterol</a></li> <li><a href="/wiki/Trans_fat" title="Trans fat">Trans fat</a></li></ul></li> <li><a href="/wiki/Monckeberg%27s_arteriosclerosis" title="Monckeberg's arteriosclerosis">Monckeberg's arteriosclerosis</a></li> <li><a href="/wiki/Hyaline_arteriolosclerosis" class="mw-redirect" title="Hyaline arteriolosclerosis">Hyaline arteriolosclerosis</a></li> <li><a href="/wiki/Hyperplastic_arteriolosclerosis" class="mw-redirect" title="Hyperplastic arteriolosclerosis">Hyperplastic arteriolosclerosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Peripheral_artery_disease" title="Peripheral artery disease">Peripheral artery disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Stenosis" title="Stenosis">Stenosis</a> <ul><li><a href="/wiki/Carotid_artery_stenosis" title="Carotid artery stenosis">Carotid artery stenosis</a></li> <li><a href="/wiki/Renal_artery_stenosis" title="Renal artery stenosis">Renal artery stenosis</a></li></ul></li> <li><a href="/wiki/Aortoiliac_occlusive_disease" title="Aortoiliac occlusive disease">Aortoiliac occlusive disease</a></li> <li><a href="/wiki/Critical_limb_ischemia" class="mw-redirect" title="Critical limb ischemia">Critical limb ischemia</a></li> <li><a href="/wiki/Degos_disease" title="Degos disease">Degos disease</a></li> <li><a href="/wiki/Erythromelalgia" title="Erythromelalgia">Erythromelalgia</a></li> <li><a href="/wiki/Fibromuscular_dysplasia" title="Fibromuscular dysplasia">Fibromuscular dysplasia</a></li> <li><a href="/wiki/Hepatic_artery_thrombosis" title="Hepatic artery thrombosis">Hepatic artery thrombosis</a></li> <li><a href="/wiki/Intermittent_claudication" title="Intermittent claudication">Intermittent claudication</a></li> <li><a href="/wiki/Raynaud%27s_phenomenon" class="mw-redirect" title="Raynaud's phenomenon">Raynaud's phenomenon</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Aneurysm" title="Aneurysm">Aneurysm</a> / <a href="/wiki/Dissection_(medical)" class="mw-redirect" title="Dissection (medical)">dissection</a> /<br /> <a href="/wiki/Pseudoaneurysm" title="Pseudoaneurysm">pseudoaneurysm</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i>torso</i>: <a href="/wiki/Aortic_aneurysm" title="Aortic aneurysm">Aortic aneurysm</a> <ul><li><a href="/wiki/Abdominal_aortic_aneurysm" title="Abdominal aortic aneurysm">Abdominal aortic aneurysm</a></li> <li><a href="/wiki/Thoracic_aortic_aneurysm" title="Thoracic aortic aneurysm">Thoracic aortic aneurysm</a></li> <li><a href="/wiki/Aneurysm_of_sinus_of_Valsalva" title="Aneurysm of sinus of Valsalva">Aneurysm of sinus of Valsalva</a></li></ul></li> <li><a href="/wiki/Aortic_dissection" title="Aortic dissection">Aortic dissection</a></li> <li><a href="/wiki/Aortic_rupture" title="Aortic rupture">Aortic rupture</a></li> <li><a href="/wiki/Coronary_artery_aneurysm" title="Coronary artery aneurysm">Coronary artery aneurysm</a></li> <li><i>head / neck</i> <ul><li><a href="/wiki/Intracranial_aneurysm" title="Intracranial aneurysm">Intracranial aneurysm</a></li> <li><a href="/wiki/Intracranial_berry_aneurysm" class="mw-redirect" title="Intracranial berry aneurysm">Intracranial berry aneurysm</a></li> <li><a href="/wiki/Carotid_artery_dissection" title="Carotid artery dissection">Carotid artery dissection</a></li> <li><a href="/wiki/Vertebral_artery_dissection" title="Vertebral artery dissection">Vertebral artery dissection</a></li> <li><a href="/wiki/Familial_aortic_dissection" title="Familial aortic dissection">Familial aortic dissection</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vascular_malformation" title="Vascular malformation">Vascular malformation</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arteriovenous_fistula" title="Arteriovenous fistula">Arteriovenous fistula</a></li> <li><a href="/wiki/Arteriovenous_malformation" title="Arteriovenous malformation">Arteriovenous malformation</a></li> <li><a href="/wiki/Telangiectasia" title="Telangiectasia">Telangiectasia</a> <ul><li><a href="/wiki/Hereditary_hemorrhagic_telangiectasia" title="Hereditary hemorrhagic telangiectasia">Hereditary hemorrhagic telangiectasia</a></li> <li><a href="/wiki/Generalized_essential_telangiectasia" title="Generalized essential telangiectasia">Generalized essential telangiectasia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Nevus#Vascular_nevus" title="Nevus">Vascular nevus</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cherry_hemangioma" class="mw-redirect" title="Cherry hemangioma">Cherry hemangioma</a></li> <li><a href="/wiki/Halo_nevus" title="Halo nevus">Halo nevus</a></li> <li><a href="/wiki/Spider_angioma" title="Spider angioma">Spider angioma</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vein" title="Vein">Veins</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Inflammation" title="Inflammation">Inflammation</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Phlebitis" title="Phlebitis">Phlebitis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Venous_thrombosis" title="Venous thrombosis">Venous thrombosis</a> /<br /> <a href="/wiki/Thrombophlebitis" title="Thrombophlebitis">Thrombophlebitis</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i>primarily lower limb</i> <ul><li><a href="/wiki/Deep_vein_thrombosis" title="Deep vein thrombosis">Deep vein thrombosis</a></li></ul></li> <li><i>abdomen</i> <ul><li><a href="/wiki/Hepatic_veno-occlusive_disease" title="Hepatic veno-occlusive disease">Hepatic veno-occlusive disease</a></li> <li><a href="/wiki/Budd%E2%80%93Chiari_syndrome" title="Budd–Chiari syndrome">Budd–Chiari syndrome</a></li> <li><a href="/wiki/May%E2%80%93Thurner_syndrome" title="May–Thurner syndrome">May–Thurner syndrome</a></li> <li><a href="/wiki/Portal_vein_thrombosis" title="Portal vein thrombosis">Portal vein thrombosis</a></li> <li><a href="/wiki/Renal_vein_thrombosis" title="Renal vein thrombosis">Renal vein thrombosis</a></li></ul></li> <li><i>upper limb / torso</i> <ul><li><a href="/wiki/Mondor%27s_disease" class="mw-redirect" title="Mondor's disease">Mondor's disease</a></li> <li><a href="/wiki/Paget%E2%80%93Schroetter_disease" title="Paget–Schroetter disease">Paget–Schroetter disease</a></li> <li><a href="/wiki/Pulmonary_embolism" title="Pulmonary embolism">Pulmonary embolism</a></li></ul></li> <li><i>head</i> <ul><li><a href="/wiki/Cerebral_venous_sinus_thrombosis" title="Cerebral venous sinus thrombosis">Cerebral venous sinus thrombosis</a></li></ul></li> <li><a href="/wiki/Post-thrombotic_syndrome" title="Post-thrombotic syndrome">Post-thrombotic syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Varicose_veins" title="Varicose veins">Varicose veins</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gastric_varices" title="Gastric varices">Gastric varices</a></li> <li><a href="/wiki/Portacaval_anastomosis" title="Portacaval anastomosis">Portacaval anastomosis</a> <ul><li><a href="/wiki/Caput_medusae" title="Caput medusae">Caput medusae</a></li> <li><a href="/wiki/Esophageal_varices" title="Esophageal varices">Esophageal varices</a></li> <li><a href="/wiki/Hemorrhoid" 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title="Vasculitis">Vasculitis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Blood_pressure" title="Blood pressure">Blood pressure</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hypertension" title="Hypertension">Hypertension</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypertensive_heart_disease" title="Hypertensive heart disease">Hypertensive heart disease</a></li> <li><a href="/wiki/Hypertensive_emergency" title="Hypertensive emergency">Hypertensive emergency</a></li> <li><a href="/wiki/Hypertensive_nephropathy" class="mw-redirect" title="Hypertensive nephropathy">Hypertensive nephropathy</a></li> 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