Overall, ISS stage 3 patients had decreased CD4+ T/CD8+ T-cell ratios, and ras-related C3 botulinum toxin substrate 2 (RAC2) and proteasome 20S subunit beta 9 (PSMB9) expression was upregulated in NK cells of progressive versus non-progressive MM [283]. This evidence concerns the gene PSMB9 and Miyoshi myopathy.