TNF and Menkes disease: Considering that increases in IFN-γ, TNF-α and IL-6 levels were observed in the luminal fluid of ES in these patients with MD, this could indicate that a specialized mechanism independent of the systemic cytokine response may be causing the abnormal cytokine-mediated inflammatory response at the ES, demonstrating increased levels of IFN-γ, TNF-α and IL-6 in the ES lumen and a positive expression of TNF-α, IL-6 and IFN-γ in the epithelial cells lining the sac.