Summary: 

Cancer is a disease characterized by uncontrollable cell growth, where the proliferating cells develop into a tumor. This can happen anywhere in your body and the type of cancer depends on where the cells are growing. Multiple myeloma is one form of cancer. In particular, for this specific form, the cells are growing uncontrollably in the bone marrow. Normally the bone marrow is a major contributor to the immune system. It contains B-cells which, once stimulated by an infection, develop into plasma cells. These plasma cells can then produce antibodies in order to fight the infection [2]. However, in multiple myeloma, these plasma cells grow out of control and form tumors in the bone marrow [1]. Some symptoms of this disease include bone lesions, low blood count, hypercalcemia, and impaired kidney function [3]. The reason behind this is that the cancerous form of these cells aren’t able to form active antibodies and instead create deformed proteins that cause even more problems such as kidney damage along with increased susceptibility to infections due to the lack of fully functioning plasma cells. The multiple myeloma cells will even cause osteolytic lesions in the bones by forcing healthy cells to remove solid regions. This can result in weak bones and an increased risk of fractures [3].

Normally, cells will be cycled out for new cells to develop without tumor growth. This will occur via apoptosis of the older cells. However, Multiple myeloma has been shown to be influenced by multiple anti-apoptotic pathways that aid in this accumulation. The pathway network that is involved in multiple myeloma. Just to name a few, some major pathways include the JAK/STAT, RAS/MAPK, ERK, and PI-3K/AKT. The all signal for either cell survival, proliferation, migration, or drug tolerance [6]. There are many different signaling molecules that initiate these pathway. One, in particular, is CD40. The production of CD40 activates phosphatidylinositol 3–kinase (PI3K) which then induces a downstream effector AKT. CD40 is also involved in another pathway by activating the MAP kinase pathway by phosphorylating the extracellular signal-regulated mitogen-activated protein kinase (ERK) [4]. These pathways along with some other CD40 mediated pathways result in migration of multiple myeloma cells. Studies have also shown that these pathways are activated in clusters of varying influence [5].

Understanding the molecular signaling pathways in an instrumental step in the development of treatment for this disease. It allows for the identification of what steps exactly have become dysregulated. These can then become markers that can be used for earlier diagnosis which can have a profound impact on the patient’s prognosis. These dysregulated step also become targets for specific areas for drug intervention in order to treat the problem at the source.