Due to excessive B cell proliferation and activation in patients with DCM, TNF-α secretion does not only induce the expression of IL-6 gene and protein in various cell types, but it also produces anti-myocardial autoantibodies that indirectly participate in cardiomyocyte fibrosis and aggravate the disease process (34,35). Here, TNF is linked to familial dilated cardiomyopathy.