WWP2, a member of the NEDD4 family, increases in the presence of gamabufotalin and plays an important role in inhibiting the growth of MM cells and apoptosis in vitro.37 MM patients with methylated Smurf2 promoters are correlated with an increased risk of death, advanced stages and a reduced risk of extramedullary disease.38 The increased availability of effective therapies has been accompanied by an increase in acquired drug resistance. Here, SMURF2 is linked to Miyoshi myopathy.