TNF and Sepsis: A compensatory anti-inflammatory response to counter-regulate the immune response in sepsis can result in a phase of immuno-paralysis (Muenzer et al, 2010), which is characterized by decreased human leukocyte antigen-DR (HLA-DR) expression, impaired TNF-α production (Volk et al, 1996, 2000), immune effector cell apoptosis, a shift from a TH1 to a TH2 immune phenotype, and upregulation of Treg cells (Oberholzer et al, 2001; Hotchkiss & Karl, 2003).