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Furthermore, Nuclear Factor Kappa B(NFκB), Inhibitor of nuclear factor kappa-B kinase subunit beta, and NF-kappa-B inhibitor alpha expression was increased in granulosa cells from ovarian EMS patients, and the NFκB signaling pathway was significantly activated when granulosa cells were cultured with TNF-α (62)

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Although a causal relationship cannot be established, this finding indicates that MTX resistance in vitro is associated with specific metabolic responses by the cells under drug action