Fig. 6.

A flow chart summary for the signaling pathways involved in mucous cell metaplasia by TNFα+RA+Math1 in mMEEC. As judged by AB-PAS and immunohistochemistry data (see Fig. 5), the Erk, p38MAPK, Akt, EGFR, JNK and NF-κB signaling pathways are involved in TNFα+RA+Math1 induced mucous-like cells (AB-PAS positive). In other words, Math1,TNFα and RA may act through the above signaling pathways synergistically to increase the proliferation and differentiation of mucous cells in cultured mMEEC and blockage of the above pathways may lead to therapeutic interventions of mucous cell metaplasia in the middle ear milieu.