Multiple myeloma(MM)is the second most prevalent hematological malignancy.Current MM treatment strategies are hampered by systemic toxicity and suboptimal therapeutic efficacy.This study addressed these limitations th...Multiple myeloma(MM)is the second most prevalent hematological malignancy.Current MM treatment strategies are hampered by systemic toxicity and suboptimal therapeutic efficacy.This study addressed these limitations through the development of a potent MM-targeting chemotherapy strategy,which capitalized on the high binding affinity of alendronate for hydroxyapatite in the bone matrix and the homologous targeting of myeloma cell membranes,termed T-PB@M.The results from our investigations highlight the considerable bone affinity of T-PB@M,both in vitro and in vivo.Additionally,this material demonstrated a capability for drug release triggered by low pH conditions.Moreover,T-PB@M induced the generation of reactive oxygen species and triggered cell apoptosis through the poly(ADP-ribose)polymerase 1(PARP1)-Caspase-3-B-cell lymphoma-2(Bcl-2)pathway in MM cells.Notably,T-PB@M preferentially targeted bone-involved sites,thereby circumventing systemic toxic side effects and leading to prolonged survival of MM orthotopic mice.Therefore,this designed target-MM nanocarrier presents a promising and potentially effective platform for the precise treatment of MM.展开更多
Multiple myeloma(MM)is a hematological tumor with high mortality and recurrence rate.Carfilzomib is a new-generation proteasome inhibitor that is used as the first-line therapy for MM.However,the development of drug r...Multiple myeloma(MM)is a hematological tumor with high mortality and recurrence rate.Carfilzomib is a new-generation proteasome inhibitor that is used as the first-line therapy for MM.However,the development of drug resistance is a pervasive obstacle to treating MM.Therefore,elucidating the drug resistance mechanisms is conducive to the formulation of novel therapeutic therapies.To elucidate the mechanisms of carfilzomib resistance,we retrieved the GSE78069 microarray dataset containing carfilzomib-resistant LP-1 MM cells and parental MM cells.Differential gene expression analyses revealed major alterations in the major histocompatibility complex(MHC)and cell adhesion molecules.The upregulation of the tumor necrosis factor(TNF)receptor superfamily member 1A(TNFRSF1A)gene was accompanied by the downregulation of MHC genes and cell adhesion molecules.Furthermore,to investigate the roles of these genes,we established a carfilzomib-resistant cell model and observed that carfilzomib resistance induced TNFRSF1A overexpression and TNFRSF1A silencing reversed carfilzomib resistance and reactivated the expression of cell adhesion molecules.Furthermore,TNFRSF1A silencing suppressed the tumorigenesis of MM cells in immunocompetent mice,indicating that TNFRSF1A may lead to carfilzomib resistance by dampening antitumor immunity.Furthermore,our results indicated that TNFRSF1A overexpression conferred carfilzomib resistance in MM cells and suppressed the expression of MHC genes and cell adhesion molecules.The suppression of MHC genes and cell adhesion molecules may impair the interaction between immune cells and cancer cells to impair antitumor immunity.Future studies are warranted to further investigate the signaling pathway underlying the regulatory role of TNFRSF1A in MM cells.展开更多
Multiple myeloma is a hematological malignancy inwhich clonal plasma cells proliferate and accumulate within the bone marrow. The presence of osteolytic le-sions due to increased osteoclast(OC) activity and sup-presse...Multiple myeloma is a hematological malignancy inwhich clonal plasma cells proliferate and accumulate within the bone marrow. The presence of osteolytic le-sions due to increased osteoclast(OC) activity and sup-pressed osteoblast(OB) function is characteristic of the disease. The bone marrow mesenchymal stromal cells(MSCs) play a critical role in multiple myeloma patho-physiology, greatly promoting the growth, survival, drug resistance and migration of myeloma cells. Here, we specifically discuss on the relative contribution of MSCs to the pathophysiology of osteolytic lesions in light of the current knowledge of the biology of my-eloma bone disease(MBD), together with the reported genomic, functional and gene expression differences between MSCs derived from myeloma patients(pMSCs) and their healthy counterparts(dMSCs). Being MSCs the progenitors of OBs, pMSCs primarily contribute to the pathogenesis of MBD because of their reduced osteogenic potential consequence of multiple OB inhibi-tory factors and direct interactions with myeloma cells in the bone marrow. Importantly, pMSCs also readily contribute to MBD by promoting OC formation and ac-tivity at various levels(i.e., increasing RANKL to OPG expression, augmenting secretion of activin A, uncou-pling ephrinB2-EphB4 signaling, and through augment-ed production of Wnt5a), thus further contributing to OB/OC uncoupling in osteolytic lesions. In this review, we also look over main signaling pathways involved in the osteogenic differentiation of MSCs and/or OB activity, highlighting amenable therapeutic targets; in parallel, the reported activity of bone-anabolic agents(at preclinical or clinical stage) targeting those signaling pathways is commented.展开更多
This review summarizes the therapeutic strategies and the drugs actually in development for the management of myeloma patients. Multiple myeloma is caused by the expansion of monoclonal plasma cells and secretion of M...This review summarizes the therapeutic strategies and the drugs actually in development for the management of myeloma patients. Multiple myeloma is caused by the expansion of monoclonal plasma cells and secretion of M-protein(immunoglobulins, Bence Jones protein and free light chains). Multiple myeloma still remains an incurable disease with a high incidence rate in the elderly, despite the introduction of several new therapeutic agents(bortezomib, lenalidomide and thalidomide) which have changed its natural history. The high heterogeneity of this disease leads to large differences in clinical responses to treatments. Thus, the choice of the best treatment is a difficult issue. However, the introduction of new drugs has made it possible to achieve high response rates and good quality respons-es with long-term disease control. Interactions between tumor cells and their bone marrow microenvironment play a pivotal role in the development, maintenance, and progression of myeloma, inducing also drug resistance. These knowledges have improved treatment options, leading to the approval of new drugs which not only target the malignant cell itself, but also its microenvironment. These agents are in preclinical/early clinical evaluation and they appear to further improve disease control, but their use is still not approved outside of clinical trials.展开更多
Multiple myeloma(MM) is a cancer caused by uncontrolled proliferation of antibody-secreting plasma cells in bone marrow, which represents the second most common hematological malignancy. MM is a highly heterogeneous d...Multiple myeloma(MM) is a cancer caused by uncontrolled proliferation of antibody-secreting plasma cells in bone marrow, which represents the second most common hematological malignancy. MM is a highly heterogeneous disease and can be classified into a spectrum of subgroups based on their molecular and cytogenetic abnormalities. In the past decade, novel therapies, especially, the first-in-class proteasome inhibitor bortezomib, have been revolutionary for the treatment of MM patients. Despite these remarkable achievements, myeloma remains incurable with a high frequency of patients suffering from a relapse, due to drug resistance. Mutation in the proteasome β5-subunit(PSMB5) was found in a bortezomib-resistant cell line generated via long-term coculture with increasing concentrations of bortezomib in 2008, but their actual implication in drug resistance in the clinic has not been reported until recently. A recent study discovered four resistance-inducing PSMB5 mutations from a relapsed MM patient receiving prolonged bortezomib treatment. Analysis of the dynamic clonal evolution revealed that two subclones existed at the onset of disease, while the other two subclones were induced. Protein structural modeling and functional assays demonstrated that all four mutations impaired the binding of bortezomib to the 20 S proteasome, conferring different degrees of resistance. The authors further demonstrated two potential approaches to overcome drug resistance by using combination therapy for targeting proteolysis machinery independent of the 20 S proteasome.展开更多
The main aim of antineoplastic treatment is to maximize patient benefit by augmenting the drug accumulation within affected organs and tissues,thus incrementing drug effects and,at the same time,reducing the damage of...The main aim of antineoplastic treatment is to maximize patient benefit by augmenting the drug accumulation within affected organs and tissues,thus incrementing drug effects and,at the same time,reducing the damage of non-involved tissues to cytotoxic agents.Mesenchymal stromal cells(MSC)represent a group of undifferentiated multipotent cells presenting wide self-renewal features and the capacity to differentiate into an assortment of mesenchymal family cells.During the last year,they have been proposed as natural carriers for the selective release of antitumor drugs to malignant cll,s thus optimizing cytotoxic action on cancer cll,while significantly reducing adverse side efect on healthy cells.MSC chemotherapeutic drug loading and delivery is an encouraging new area of cell therapy for several tumors,especially for those with unsatisfactory prognosis and limited treatment options available.Although some experim ental models have been sucesfuly developed,phase I dinical studies are needed to confirm this potential application of cell therapy,in particular in the case of primary and secondary lung cancers.展开更多
Multiple myeloma(MM)is a clonal expansion of malignant plasma cells,and comprises approximately 10%of hematologic malignancies.Although various therapeutic agents and strategies,such as immunomodulatory agents,proteas...Multiple myeloma(MM)is a clonal expansion of malignant plasma cells,and comprises approximately 10%of hematologic malignancies.Although various therapeutic agents and strategies,such as immunomodulatory agents,proteasome inhibitors,monoclonal antibodies and hematopoietic stem cell transplantation(HSCT)have been evaluated,MM remains largely incurable.It is therefore important to further explore the risk factors for disease progression,and to design trials aimed at improving the patient outcomes.Previous studies have considered the presence of a gain in 1q21 as a risk factor for a poorer overall survival.Gain of 1q21 is one of the most common chromosomal aberrations in MM,being detected by fluorescence in situ hybridization in 36%to 47%of newly-diagnosed patients,as well as 52%and 62%patients with relapsed MM.Although a series of reports identified 1q21 gain in MM as a significant and independent poor prognostic factor,other studies failed to demonstrate any prognostic value.Thus,the prognostic value of 1q21 gain in MM remains controversial.We reviewed the current knowledge about 1q21 gain and its value for the clinical management of MM.展开更多
Objective:To find out how to overcome resistance during multiple myeloma(MM) treatment through establishing a multidrug resistant human multiple myeloma cell line and investigating its biological features.Methods:The ...Objective:To find out how to overcome resistance during multiple myeloma(MM) treatment through establishing a multidrug resistant human multiple myeloma cell line and investigating its biological features.Methods:The parent cell line MOLP-2 was exposed to different concentrations of melphalan and a melphalan-resistant cell line MOLP-2/R was identified by continuous stepwise selection.The cell morphology and growth curves were examined.Protein levels of P-gp, MRP and FANCD2 monoubiquitination were checked by Western blotting.The IC50 of melphalan and resistance index(RI) were detected by MTT assay.Results:A melphalan-resistant cell line MOLP-2/R was finally identified.The RI of MOLP-2/R cells to melphalan was 6.03.Besides melphalan it was cross resistant to other chemotherapeutic agents, including ADM, CTX, DDP and VP-16.The multiplication time was postponed(P < 0.05).Studies showed that FANCD2 protein monoubiquitination was enhanced, but the levels of P-gp and MRP expressions in the MOLP-2/R cells were similar with the parent cells.Conclusion:MOLP-2/R cell line may serve as an ideal model for exploring the mechanism of MDR.Over-expression of FANCD2 protein monoubiquitination might contribute to acquired drug resistance in MOLP-2/R cell line.展开更多
Multiple myeloma(MM)is a type of hematological cancer that occurs when B cells become malignant.Various drugs such as proteasome inhibitors,immunomodulators,and compounds that cause DNA damage can be used in the treat...Multiple myeloma(MM)is a type of hematological cancer that occurs when B cells become malignant.Various drugs such as proteasome inhibitors,immunomodulators,and compounds that cause DNA damage can be used in the treatment of MM.Autophagy,a type 2 cell death mechanism,plays a crucial role in determining the fate of B cells,either promoting their survival or inducing cell death.Therefore,autophagy can either facilitate the progression or hinder the treatment of MM disease.In this review,autophagy mechanisms that may be effective in MM cells were covered and evaluated within the contexts of unfolded protein response(UPR),bone marrow microenvironment(BMME),drug resistance,hypoxia,DNA repair and transcriptional regulation,and apoptosis.The genes that are effective in each mechanism and research efforts on this subject were discussed in detail.Signaling pathways targeted by new drugs to benefit from autophagy in MM disease were covered.The efficacy of drugs that regulate autophagy in MM was examined,and clinical trials on this subject were included.Consequently,among the autophagy mechanisms that are effective in MM,the most suitable ones to be used in the treatment were expressed.The importance of 3D models and microfluidic systems for the discovery of new drugs for autophagy and personalized treatment was emphasized.Ultimately,this review aims to provide a comprehensive overview of MM disease,encompassing autophagy mechanisms,drugs,clinical studies,and further studies.展开更多
基金supported by the National Natural Science Foundation of China(52073145 and 82004081)the Jiangsu Talent Professor Program,Jiangsu Innovation Project of Graduate Student(KYCX23-2192)+1 种基金the National Natural Science Foundation of Nanjing University of Chinese Medicine(NZY82004081)the Special Grants of China Postdoctoral Science Foundation(2021T140792).
文摘Multiple myeloma(MM)is the second most prevalent hematological malignancy.Current MM treatment strategies are hampered by systemic toxicity and suboptimal therapeutic efficacy.This study addressed these limitations through the development of a potent MM-targeting chemotherapy strategy,which capitalized on the high binding affinity of alendronate for hydroxyapatite in the bone matrix and the homologous targeting of myeloma cell membranes,termed T-PB@M.The results from our investigations highlight the considerable bone affinity of T-PB@M,both in vitro and in vivo.Additionally,this material demonstrated a capability for drug release triggered by low pH conditions.Moreover,T-PB@M induced the generation of reactive oxygen species and triggered cell apoptosis through the poly(ADP-ribose)polymerase 1(PARP1)-Caspase-3-B-cell lymphoma-2(Bcl-2)pathway in MM cells.Notably,T-PB@M preferentially targeted bone-involved sites,thereby circumventing systemic toxic side effects and leading to prolonged survival of MM orthotopic mice.Therefore,this designed target-MM nanocarrier presents a promising and potentially effective platform for the precise treatment of MM.
基金Research Projects-Joint Fund for Applied Basic Research of Kunming Medical University,Yunnan Provincial Department of Science and Technology(No.2018FE001(-113),No.202301AY070001-098)Open project of Yunnan Clinical Medical Center(Nos.2020LCZXKF-XY02,XY06,XY16+1 种基金2022LCZXKF-XY02)Yunnan Health Training Project of High Level Talents(No.D–2018018).
文摘Multiple myeloma(MM)is a hematological tumor with high mortality and recurrence rate.Carfilzomib is a new-generation proteasome inhibitor that is used as the first-line therapy for MM.However,the development of drug resistance is a pervasive obstacle to treating MM.Therefore,elucidating the drug resistance mechanisms is conducive to the formulation of novel therapeutic therapies.To elucidate the mechanisms of carfilzomib resistance,we retrieved the GSE78069 microarray dataset containing carfilzomib-resistant LP-1 MM cells and parental MM cells.Differential gene expression analyses revealed major alterations in the major histocompatibility complex(MHC)and cell adhesion molecules.The upregulation of the tumor necrosis factor(TNF)receptor superfamily member 1A(TNFRSF1A)gene was accompanied by the downregulation of MHC genes and cell adhesion molecules.Furthermore,to investigate the roles of these genes,we established a carfilzomib-resistant cell model and observed that carfilzomib resistance induced TNFRSF1A overexpression and TNFRSF1A silencing reversed carfilzomib resistance and reactivated the expression of cell adhesion molecules.Furthermore,TNFRSF1A silencing suppressed the tumorigenesis of MM cells in immunocompetent mice,indicating that TNFRSF1A may lead to carfilzomib resistance by dampening antitumor immunity.Furthermore,our results indicated that TNFRSF1A overexpression conferred carfilzomib resistance in MM cells and suppressed the expression of MHC genes and cell adhesion molecules.The suppression of MHC genes and cell adhesion molecules may impair the interaction between immune cells and cancer cells to impair antitumor immunity.Future studies are warranted to further investigate the signaling pathway underlying the regulatory role of TNFRSF1A in MM cells.
基金Supported by Grants from the Spanish Ministry of Economíay Competitividad-Instituto de Salud CarlosⅢ,No.PI12/02591European Funds for Regional Development+3 种基金the Spanish Health Thematic Networks of Cooperative Research in Cancer,No.RTICC RD12/0036/0058Cellular Therapy,No.TerCelRD12/0019/0001,group 8the Network of Centers for Regenera-tive Medicine and Cellular Therapy from Castilla y Leónthe Spanish Society of Hematology and Hemotherapy(to Garcia-Gomez A)
文摘Multiple myeloma is a hematological malignancy inwhich clonal plasma cells proliferate and accumulate within the bone marrow. The presence of osteolytic le-sions due to increased osteoclast(OC) activity and sup-pressed osteoblast(OB) function is characteristic of the disease. The bone marrow mesenchymal stromal cells(MSCs) play a critical role in multiple myeloma patho-physiology, greatly promoting the growth, survival, drug resistance and migration of myeloma cells. Here, we specifically discuss on the relative contribution of MSCs to the pathophysiology of osteolytic lesions in light of the current knowledge of the biology of my-eloma bone disease(MBD), together with the reported genomic, functional and gene expression differences between MSCs derived from myeloma patients(pMSCs) and their healthy counterparts(dMSCs). Being MSCs the progenitors of OBs, pMSCs primarily contribute to the pathogenesis of MBD because of their reduced osteogenic potential consequence of multiple OB inhibi-tory factors and direct interactions with myeloma cells in the bone marrow. Importantly, pMSCs also readily contribute to MBD by promoting OC formation and ac-tivity at various levels(i.e., increasing RANKL to OPG expression, augmenting secretion of activin A, uncou-pling ephrinB2-EphB4 signaling, and through augment-ed production of Wnt5a), thus further contributing to OB/OC uncoupling in osteolytic lesions. In this review, we also look over main signaling pathways involved in the osteogenic differentiation of MSCs and/or OB activity, highlighting amenable therapeutic targets; in parallel, the reported activity of bone-anabolic agents(at preclinical or clinical stage) targeting those signaling pathways is commented.
基金Supported by Associazione Italiana per la Ricerca sul Cancro(Italian Association for Cancer Research-AIRC),Investigator Grant and the 5 per thousand Molecular Clinical Oncology Special Program,No.9965Milan,to AV,the European Commission's Seventh Framework programme(EU-FPT7)under grant agreement(OVER-My R)to AV,No.278706+2 种基金EU FPT7(2007-2013)under grant agreement to DR,No.278570grants from MIUR PRIN to RR,No.2009WCNS5C_004grants from MIUR PRIN to AV,No.2010NECHBX
文摘This review summarizes the therapeutic strategies and the drugs actually in development for the management of myeloma patients. Multiple myeloma is caused by the expansion of monoclonal plasma cells and secretion of M-protein(immunoglobulins, Bence Jones protein and free light chains). Multiple myeloma still remains an incurable disease with a high incidence rate in the elderly, despite the introduction of several new therapeutic agents(bortezomib, lenalidomide and thalidomide) which have changed its natural history. The high heterogeneity of this disease leads to large differences in clinical responses to treatments. Thus, the choice of the best treatment is a difficult issue. However, the introduction of new drugs has made it possible to achieve high response rates and good quality respons-es with long-term disease control. Interactions between tumor cells and their bone marrow microenvironment play a pivotal role in the development, maintenance, and progression of myeloma, inducing also drug resistance. These knowledges have improved treatment options, leading to the approval of new drugs which not only target the malignant cell itself, but also its microenvironment. These agents are in preclinical/early clinical evaluation and they appear to further improve disease control, but their use is still not approved outside of clinical trials.
文摘Multiple myeloma(MM) is a cancer caused by uncontrolled proliferation of antibody-secreting plasma cells in bone marrow, which represents the second most common hematological malignancy. MM is a highly heterogeneous disease and can be classified into a spectrum of subgroups based on their molecular and cytogenetic abnormalities. In the past decade, novel therapies, especially, the first-in-class proteasome inhibitor bortezomib, have been revolutionary for the treatment of MM patients. Despite these remarkable achievements, myeloma remains incurable with a high frequency of patients suffering from a relapse, due to drug resistance. Mutation in the proteasome β5-subunit(PSMB5) was found in a bortezomib-resistant cell line generated via long-term coculture with increasing concentrations of bortezomib in 2008, but their actual implication in drug resistance in the clinic has not been reported until recently. A recent study discovered four resistance-inducing PSMB5 mutations from a relapsed MM patient receiving prolonged bortezomib treatment. Analysis of the dynamic clonal evolution revealed that two subclones existed at the onset of disease, while the other two subclones were induced. Protein structural modeling and functional assays demonstrated that all four mutations impaired the binding of bortezomib to the 20 S proteasome, conferring different degrees of resistance. The authors further demonstrated two potential approaches to overcome drug resistance by using combination therapy for targeting proteolysis machinery independent of the 20 S proteasome.
文摘The main aim of antineoplastic treatment is to maximize patient benefit by augmenting the drug accumulation within affected organs and tissues,thus incrementing drug effects and,at the same time,reducing the damage of non-involved tissues to cytotoxic agents.Mesenchymal stromal cells(MSC)represent a group of undifferentiated multipotent cells presenting wide self-renewal features and the capacity to differentiate into an assortment of mesenchymal family cells.During the last year,they have been proposed as natural carriers for the selective release of antitumor drugs to malignant cll,s thus optimizing cytotoxic action on cancer cll,while significantly reducing adverse side efect on healthy cells.MSC chemotherapeutic drug loading and delivery is an encouraging new area of cell therapy for several tumors,especially for those with unsatisfactory prognosis and limited treatment options available.Although some experim ental models have been sucesfuly developed,phase I dinical studies are needed to confirm this potential application of cell therapy,in particular in the case of primary and secondary lung cancers.
基金This study was funded by the National Natural Science Foundation of China(No.81870150)the National Natural Science Foundation of China(No.81670102)the Youth Fund of the Second Hospital of Tianjin Medical University(No.2019 ydey 06).
文摘Multiple myeloma(MM)is a clonal expansion of malignant plasma cells,and comprises approximately 10%of hematologic malignancies.Although various therapeutic agents and strategies,such as immunomodulatory agents,proteasome inhibitors,monoclonal antibodies and hematopoietic stem cell transplantation(HSCT)have been evaluated,MM remains largely incurable.It is therefore important to further explore the risk factors for disease progression,and to design trials aimed at improving the patient outcomes.Previous studies have considered the presence of a gain in 1q21 as a risk factor for a poorer overall survival.Gain of 1q21 is one of the most common chromosomal aberrations in MM,being detected by fluorescence in situ hybridization in 36%to 47%of newly-diagnosed patients,as well as 52%and 62%patients with relapsed MM.Although a series of reports identified 1q21 gain in MM as a significant and independent poor prognostic factor,other studies failed to demonstrate any prognostic value.Thus,the prognostic value of 1q21 gain in MM remains controversial.We reviewed the current knowledge about 1q21 gain and its value for the clinical management of MM.
文摘Objective:To find out how to overcome resistance during multiple myeloma(MM) treatment through establishing a multidrug resistant human multiple myeloma cell line and investigating its biological features.Methods:The parent cell line MOLP-2 was exposed to different concentrations of melphalan and a melphalan-resistant cell line MOLP-2/R was identified by continuous stepwise selection.The cell morphology and growth curves were examined.Protein levels of P-gp, MRP and FANCD2 monoubiquitination were checked by Western blotting.The IC50 of melphalan and resistance index(RI) were detected by MTT assay.Results:A melphalan-resistant cell line MOLP-2/R was finally identified.The RI of MOLP-2/R cells to melphalan was 6.03.Besides melphalan it was cross resistant to other chemotherapeutic agents, including ADM, CTX, DDP and VP-16.The multiplication time was postponed(P < 0.05).Studies showed that FANCD2 protein monoubiquitination was enhanced, but the levels of P-gp and MRP expressions in the MOLP-2/R cells were similar with the parent cells.Conclusion:MOLP-2/R cell line may serve as an ideal model for exploring the mechanism of MDR.Over-expression of FANCD2 protein monoubiquitination might contribute to acquired drug resistance in MOLP-2/R cell line.
基金funded by TUBITAK(Turkish Scientific and Technological Council)grant number 121C417.
文摘Multiple myeloma(MM)is a type of hematological cancer that occurs when B cells become malignant.Various drugs such as proteasome inhibitors,immunomodulators,and compounds that cause DNA damage can be used in the treatment of MM.Autophagy,a type 2 cell death mechanism,plays a crucial role in determining the fate of B cells,either promoting their survival or inducing cell death.Therefore,autophagy can either facilitate the progression or hinder the treatment of MM disease.In this review,autophagy mechanisms that may be effective in MM cells were covered and evaluated within the contexts of unfolded protein response(UPR),bone marrow microenvironment(BMME),drug resistance,hypoxia,DNA repair and transcriptional regulation,and apoptosis.The genes that are effective in each mechanism and research efforts on this subject were discussed in detail.Signaling pathways targeted by new drugs to benefit from autophagy in MM disease were covered.The efficacy of drugs that regulate autophagy in MM was examined,and clinical trials on this subject were included.Consequently,among the autophagy mechanisms that are effective in MM,the most suitable ones to be used in the treatment were expressed.The importance of 3D models and microfluidic systems for the discovery of new drugs for autophagy and personalized treatment was emphasized.Ultimately,this review aims to provide a comprehensive overview of MM disease,encompassing autophagy mechanisms,drugs,clinical studies,and further studies.
