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Background: Recent in-vitro studies have suggested that mast cells are involved in Dengue virus infection. To clarify the role of mast cells in the development of clinical Dengue fever, we compared the plasma levels of several mast cell-derived mediators (vascular endothelial cell growth factor [VEGF], soluble VEGF receptors [sVEGFRs], tryptase, and chymase) and -related cytokines (IL-4, -9, and -17) between patients with differing severity of Dengue fever and healthy controls. Methodology/Principal Findings: The study was performed at Children's Hospital No. 2, Ho Chi Minh City, and Vinh Long Province Hospital, Vietnam from 2002 to 2005. Study patients included 103 with Dengue fever (DF), Dengue hemorrhagic fever (DHF), and Dengue shock syndrome (DSS), as diagnosed by the World Health Organization criteria. There were 189 healthy subjects, and 19 febrile illness patients of the same Kinh ethnicity. The levels of mast cell-derived mediators and -related cytokines in plasma were measured by ELISA. VEGF and sVEGFR-1 levels were significantly increased in DHF and DSS compared with those of DF and controls, whereas sVEGFR-2 levels were significantly decreased in DHF and DSS. Significant increases in tryptase and chymase levels, which were accompanied by high IL-9 and -17 concentrations, were detected in DHF and DSS patients. By day 4 of admission, VEGF, sVEGFRs, and proteases levels had returned to similar levels as DF and controls. In-vitro VEGF production by mast cells was examined in KU812 and HMC-1 cells, and was found to be highest when the cells were inoculated with Dengue virus and human Dengue virus-immune serum in the presence of IL-9. Conclusions: As mast cells are an important source of VEGF, tryptase, and chymase, our findings suggest that mast cell activation and mast cell-derived mediators participate in the development of DHF. The two proteases, particularly chymase, might serve as good predictive markers of Dengue disease severity. Author Summary: To clarify the involvement of mast cells in the development of severe Dengue diseases, plasma levels of mast cell-derived mediators, namely vascular endothelial cell growth factor (VEGF), tryptase, and chymase, were estimated in Dengue patients and control subjects in Vietnam. The levels of the mediators were significantly increased in Dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS) patients compared with those of Dengue fever (DF) and control (febrile illness and healthy subjects) patients, and the soluble form of VEGF receptors (sVEGFR)-1 and -2 levels were significantly changed in the patients with severe disease. After 2–4 days of admission, the mediator levels had returned to similar levels as those of DF and control subjects. Furthermore, the levels of the Th17 cell-derived mast-cell activators IL-9 and -17 were increased in DHF and DSS. In-vitro production of VEGF in human mast cells was significantly enhanced in the presence of IL-9 when these cells were inoculated with Dengue virus in the presence of human Dengue virus-immune serum. As mast cells are an important source of VEGF, and tryptase and chymase are considered to be specific markers for mast cell activation, mast cells and mast cell-derived mediators might participate in the development of DHF/DSS. [ABSTRACT FROM AUTHOR]