In another study in that same year, Ooi et al. (161) suggested that AZIN1 expression reduction induces TGF-β/Smad3 signaling activation in CFs; (III) reduced JNK level would enhance ERK, P38 kinase, and Smad3 phosphorylation, and that is in turn associated with proliferation and differentiation of fibroblast into myofibroblasts. Here, SMAD3 is linked to myalgic encephalomeyelitis/chronic fatigue syndrome.