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. This evidence concerns the gene TNF and hyperinsulinemic hypoglycemia, familial, 4.