CASP9 and Miyoshi myopathy: In vitro, they significantly elevate reactive oxygen species production in RPMI8226 cells, upregulate the expression of Apaf-1, Atg5, Atg12, Becn1, Cyt-C, Caspase-3, and Caspase-9, reduce ATP levels, induce G2/M cell cycle arrest, and initiate autophagy signaling pathways, thereby exerting cytotoxic effects on MM cells [118,119].