This protection was associated with up-regulation of the anti-apoptotic proteins Survivin and myeloid cell leukemia 1 (Mcl-1) in MM cells, which impaired CAR T cell-induced cytotoxicity by suppressing caspase 3 and caspase 7-driven apoptosis and inhibiting sequestration of Bim and Noxa proteins, thereby preventing mitochondrial outer membrane permeabilization and subsequent activation of the intrinsic apoptotic cascade [27]. Here, MCL1 is linked to Miyoshi myopathy.