CD38 and Miyoshi myopathy: Locally, the tandem CD38/CD203a, chained to the ectonucleotidase (eNT) CD73, composes a pathway for extracellular production of immunosuppressive ADO, as shown in Figure 4A. The metabolic conditions created in the BM by MM malignant cells make it possible to bypass the canonical adenosinergic pathway based on the conversion of ATP to AMP by the ecto-nucleoside triphosphate diphosphohydrolase (ENTPD-1) CD39 [49].