TNF and atrial fibrillation: Dudli et al. (2016) confirmed that EP injury and autoimmunity are potential risk factors for Modic changes, and the number of protein gene product 9.5 (PGP9.5) nerve fibers and TNF-α positive cells in Type I and Type II changes in EP significantly increased. Yamamoto et al. (2022) reported that bone marrow derived macrophages (BMDMs) infiltrate the outer AF and EP in the degenerative IVD, and tissue-resident macrophages appear in the AF and NP.