The tumor necrosis factor-α (TNF-α), interleukin-18 (IL-18), interleukin-6 (IL-6), interferon-γ (IFN-γ), interleukin-4 (IL-4), and interleukin-10 (IL-10) cytokines represent the key mediators driving CS. Here, TNF is linked to Cowden syndrome 1.