IntroductionMultiple myeloma (MM), a fetal cancer of the plasma cells in the BM, remains the leading cause of death among patients with hematologic malignancy in the United States. 1 The development of novel therapeutics, in particular rational combinations of therapeutics, have considerably improved patient outcome, 2 but a cure is still elusive.miRs are 19-to 25-nucleotide-long noncoding RNA molecules. RNA polymerase II transcribes miR genes to a long primary transcripts (pri-miRs) in the nucleus. Drosha processes the pri-miR to yield hairpin precursors (pre-miRs) consisting of approximately 70 nt. Sequentially, the pre-miR hairpins are exported to the cytoplasm by Exportin-5 and are processed into approximately 22-nt mature miRs by Dicer. miRs regulate gene expression at the level of both mRNA degradation and translation. They are able to silence gene expression posttranscriptionally by binding to partially complementary target sites in the 3Јuntranslated region (UTR) of targeting mRNAs, leading to repression of translation or reduction of mRNA. [3][4][5] To date, approximately 700 miRs have been discovered in humans. Although studies about the identification of druggable targets and biomarkers have thus far mainly focused on protein-coding genes, increasing data indicate that miRs regulate major biologic process such as development, apoptosis, cell proliferation, and cell differentiation. 6 More importantly, emerging evidence shows that miRs play a critical role in tumor pathogenesis by functioning either as oncogenes or tumor-suppressor genes. 7,8 Nevertheless, little is known about miR regulation in MM. Several recent studies in MM have shown that genome-wide miR expression patterns are correlated with distinct genetic subgroups, drug resistance, and prognosis. 9 For example, the transcription of miR21 is regulated by IL-6 through a STAT-3 mechanism in the IL-6-dependent INA-6 and XG-1 MM cell lines. 10 Furthermore, miR15a and miR16 regulate proliferation, migration, angiogenesis, and growth of MM cells in vitro and in vivo by inhibiting the AKT/ribosomalprotein-6 and MAPK pathways. 1 Therefore, the identification of miRs and delineation of their function in MM may provide novel therapeutic targets.MLN2238, the hydrolyzed, biologically active form of MLN9708, is a selective, orally bioavailable proteasome inhibitor. It is currently being tested in clinical studies and has demonstrated preclinical antitumor activity in both solid-tumor and hematological xenograft models. MLN2238 has improved pharmacokinetics, pharmacodynamics, and antitumor activity compared with bortezomib. 11 Our previous study showed that MLN2238 inhibits growth and triggers apoptosis in MM cells resistant to conventional and bortezomib therapies without affecting the viability of normal cells. In a human plasmacytoma xenograft model, MLN2238 was well tolerated, repressed tumor growth, and prolonged survival and was associated with significantly reduced tumor recurrence. Mechanistic studies have indicated that activation of caspases, the...