TNF is known to induce an enteropathy.46 As TNF-α can also modulate tight junction proteins, it is possible that MT might be exacerbated by increased levels of circulating TNF-α just as it impairs intestinal barrier function in Crohn’s dieases.47,48 We consider it unlikely that an effect of TNF on tight junctions would alone be sufficient to permit MT as this would probably require a larger, cellular defect in the intestinal barrier.29 This evidence concerns the gene TNF and Abnormal intestine morphology.