The top 4 downregulated genes included CD19, a B cell lineage marker gene which has been explored as a therapeutic target in MM31,32, CTSH, CD81, which regulates CD1933 and has been shown by flow cytometry to be downregulated in MM and precursor conditions34, and ITGB2. We also observed upregulation of PSMB4 and HSPB1, which are associated with the proteasome (Fig. 2d). The gene discussed is CTSH; the disease is Miyoshi myopathy.