In parallel, p38 mitogen-activated protein kinase signaling pathway is activated upon MM cell adherence to BMSCs, leading to more secretion of MM cell-supportive factors IL-6 and vascular endothelial growth factor (VEGF), in addition to induction of OC-activating factors (i.e., IL-11, RANKL, MIP-1α) (73). This evidence concerns the gene IL11 and Miyoshi myopathy.