Specifically, in ROAM patients, the decreased abundance of PKM and HBB could affect neutrophils degranulation, dampening response to infections, while the increased level of VCP and CAP1, through augmented proteasome activity, might promote the formation of NETs [40] followed by biofilm generation (as in the case of H. influenzae) and colonization of median ear cavity [41]. The gene discussed is VCP; the disease is infection.