TNF and Leigh syndrome: An indication for activation of the immune system in premalignant lesions of LS patients has also been reported by Chang et al. who found increased RNA expression levels of CD4, IFNG, LAG3, PDL1, IL12A and TNF in LS-associated compared to Familial Adenomatous Polyposis (FAP)-associated adenomas suggesting immune activation in LS-associated adenomas.