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TNF- amplifies the inflammatory cascade by recruiting immune cells such as neutrophils and monocytes to the liver, further aggravating inflammation.86 Despite its role in driving ALD progression, early attempts to block TNF- as a therapeutic approach were met with disappointing results.87 Clinical trials revealed that TNF- blockade, while initially promising, was associated with severe adverse events, including a higher risk of infections and increased mortality rates in patients with advanced ALD.87 This outcome highlights the critical need for caution when targeting inflammatory pathways in ALD, as immune suppression can lead to life-threatening complications in an already vulnerable population