TNF and Sepsis: During sepsis-induced myocardial dysfunction (SIMD), pathogen-associated molecular patterns (PAMPs), such as bacterial lipopolysaccharide (LPS), interact with Toll-like receptor 4 (TLR4) on immune and cardiac cells, activating NF-κB and mitogen-activated protein kinase (MAPK) signaling cascades to produce proinflammatory cytokines, including TNF-α, interleukin-1β and interleukin-6.