TNF and endothelial dysfunction: Moreover, sFlt-1 sensitizes the endothelial cells of the maternal circulation to pro-inflammatory cytokines such as tumor necrosis factor-α (TNF-α) (Cindrova-Davies et al., 2011), causing generalized endothelial dysfunction and subsequently multisystem damage (Figure 3; Roberts et al., 1989; Llurba et al., 2015; Verdonk et al., 2015).