The increase in adiposity has been associated with metabolic changes in MM cells, such as an increase in the metabolite acetyl-coA synthetase 2 (ACSS2) in MM cells, induced by adipocyte-secreted angiotensin II and driving MM growth in vitro and in vivo at least partly by enhancing the stability of the myeloma oncoprotein IRF4 (74). This evidence concerns the gene IRF4 and Miyoshi myopathy.