IGF1 and Miyoshi myopathy: Highlighting the importance of the microenvironment for the initiation and maintenance of MM, the multi-faceted roles of insulin-like growth factor (IGF)-1 is now emerging, not only as a locally produced survival and growth factor, but also as a protein with novel functions, i.e. regulating gene expression, directly by shuttling to the nucleus (8), or indirectly, altering gene activation by histone modifications (9).