TNF and the Molecular Pathogenesis of Shock 
ferent locus from that of glucocorticoids. We 
have shown that the two classes of drugs when 
combined assert a synergistic effect. 
Recently the cell-surface receptor for TNF was 
cloned in a number of laboratories. We have engi- 
neered a recombinant molecule in which the TNF 
receptor is attached to a portion of a normal anti- 
body, yielding a new protein molecule in which 
two TNF-binding sites are expressed. This biva- 
lent TNF-binding protein strongly inhibits the bi- 
ological effects of TNF, is highly stable in vivo, 
and may be produced in large quantities by re- 
combinant techniques. We anticipate that this 
type of molecule will allow a through investiga- 
tion of the many effects of TNF in health and dis- 
ease and may also be useful as a therapeutic tool. 
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