ZFP36 and hyperinsulinemic hypoglycemia, familial, 4: Given the evidence suggesting that TTP is one major regulator of the expression of TNF-α and other mediators [28;49–53] and that persistent inflammation is firmly associated with COPD development [4;7–10], TTP deficiency is likely to magnify the detrimental effect of cigarette smoke exposure, including second hand smoke, on lung tissue injury.