TNF and Fabry disease: In addition to increased activated and degranulating duodenal eosinophils in FD, now an established biomarker, increased duodenal permeability and systemic immune activation have been documented in the disorder.39,77,78 Further, we have reported a Th2 and Th17 signature in the human duodenal mucosa in FD and identified the presence of effector and memory cells suggesting that the duodenal eosinophilia in FD is food or bacterial antigen-driven.56 Cytokine (e.g., TNF alpha) and neuropeptide release may account for extra-intestinal symptoms including anxiety.50,79