What Is Tumor Necrosis Factor (TNF)?

Several IBD Medications Target TNF Proteins To Treat Inflammation

White Blood Cells
There are several different types of white blood cells. A few of them are highlighted in this blood smear.. Image © CDC / Dr. Candler Ballard

Tumor necrosis factor (TNF) is a type of messenger protein known as a cytokine that is produced by white blood cells. TNF is important to the body because it helps regulate the response of the immune system to a foreign object, especially to the present cancerous tumor. It promotes inflammation, produces other cells used in the inflammatory response, and can help cells heal. TNF is also sometimes referred to as tumor necrosis factor-alpha.

Why TNF-alpha Is Important In IBD

TNF is an important topic for treating inflammatory bowel disease (IBD). TNF is found in higher amounts in people with Crohn's disease than it is people who do not have Crohn's disease. TNF is also found, to a lesser degree, in the stool of people who have ulcerative colitis. Because of this association, it's thought that TNF plays a role in the development and/or continuing Crohn's disease and ulcerative colitis. This is why drugs called biologics have been developed to treat IBD and other inflammatory conditions. Targeting the TNF shows a benefit for some patients in reducing the symptoms of IBD and in healing the inflammation in the intestinal tract.

Fecal calprotectin and lactoferrin are two markers that are used to evaluate the present inflammation in people who have IBD. These two proteins can be measured by testing the stool. It's been discovered that when there are more of these proteins in the stool, there is more inflammation in the intestines of people with IBD.

When the amounts of these proteins are lower in the stool, there could be healing taking place in the intestine. A lower fecal calprotectin and lactoferrin amount could mean that a treatment is working and that a patient is approaching, or is in remission. Studies have shown that fecal calprotectin and lactoferrin levels are lower in patients who have taken anti-TNF drugs.

Different Types of TNF

Genetic studies have shown that there are different types of TNF, and TNF is actually considered a "superfamily." Various types of TNF have been associated with particular autoimmune diseases, cancers, and diabetes. Finding the types of TNF-associated with particular conditions can help in  developing drugs to treat those diseases. 

Not everyone with IBD responds to the same drugs in the same way. This could be, and it is now thought to be the case by experts, that there are many subtypes of IBD. TNF may play a role in this too, because some people with IBD respond very well to anti-TNF blocker drugs, while other people do not. The genotype of a particular patient's TNF may be associated with a greater or a lesser response to a particular anti-TNF drug. This is an emerging area of research, and there is still much more to be understood about TNF before it can be applied to patient care. 

TNF-alpha In Colon Cancer

TNF may also have an important role developing colon cancer and other gastric cancers.

The research into this effect of TNF is still inconclusive, but it may also provide some clues into the connection between ulcerative colitis and colon cancer. 

Anti-TNF-alpha Medications

Some medical treatments for Crohn's disease involve targeting the TNF protein and binding it. When the protein is thus bound, it is not able to produce inflammation. Some anti-TNF drugs are Remicade (infliximab)Humira (adalimumab)Cimzia (certolizumab pegol)Enbrel (etanercept), and Simponi (golimumab)

The Bottom Line

There is still much that is not understood regarding TNF and its relationship to inflammatory conditions such as IBD. However, several anti-TNF drugs have been developed for use in people with IBD, and may have improved outcomes for the course of these diseases.


Sipponen T, Savilahti E, Kärkkäinen P, et al. "Fecal calprotectin, lactoferrin, and endoscopic disease activity in monitoring anti-TNF-alpha therapy for Crohn's disease." Inflamm Bowel Dis. 14:1392-1398.

Subramaniam K, Richardson A, Dodd J, et al. "Early predictors of colectomy and long-term maintenance of remission in ulcerative colitis patients treated using anti-tumour necrosis factor therapy." Intern Med J. 2014 May;44:464-470.

Taylor KD, Plevy SE, Yang H, et al. "ANCA pattern and LTA haplotype relationship to clinical responses to anti-TNF antibody treatment in Crohn's disease." Gastroenterology. 2001 May;120:1347-1355.

Yang JP, Hyun MH, Yoon JM, et al. "Association between TNF-α-308 G/A gene polymorphism and gastric cancer risk: a systematic review and meta-analysis." Cytokine. 2014 Dec;70:104-114.

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