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Emerging roles of RNA m6A modification in multiple myeloma pathogenesis and treatment resistance (Review)

  • Authors:
    • Yasen Maimaitiyiming
    • Shuoyang Hu
    • Die Bai
    • Yingchao Guan
    • Na Bu
    • Wenhui Hao
    • Mayila Maimaiti
  • View Affiliations / Copyright

    Affiliations: Department of Immunology and Institute of Basic Medical Sciences, School of Basic Medical Sciences, Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China, Xinjiang Key Laboratory of Molecular Biology for Endemic Diseases, Xinjiang Medical University, Urumqi, Xinjiang 830011, P.R. China, Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China, Clinical Nutrition Department, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830013, P.R. China
    Copyright: © Maimaitiyiming et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 40
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    Published online on: February 10, 2026
       https://doi.org/10.3892/ijo.2026.5853
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Abstract

Multiple myeloma (MM) is an incurable hematologic malignancy characterized by the clonal expansion of plasma cells in the bone marrow. Despite advances in therapeutic agents, including proteasome inhibitors, immunomodulatory drugs and immunotherapies, relapse driven by treatment resistance remains a major clinical challenge. This underscores the critical need to elucidate additional molecular mechanisms that drive MM pathogenesis and therapeutic failure. The emerging field of epitranscriptomics, which studies post‑transcriptional RNA modifications, offers a promising perspective. Among these modifications, N6‑methyladenosine (m6A), the most abundant internal mRNA modification, has been implicated in regulating nearly every aspect of RNA metabolism. Growing evidence indicates that dysregulation of the m6A modification machinery plays a pivotal role in MM heterogeneity, disease progression and drug resistance. The present review synthesized current knowledge on how specific m6A regulators contribute to MM oncogenesis by modulating key signaling pathways, interactions with the bone marrow microenvironment and responses to therapy. It also discussed the potential of targeting m6A pathways as a therapeutic strategy to overcome treatment resistance and improve patient outcomes. By highlighting recent advances and future directions, the present review underscored m6A modification as an important frontier in the battle against MM.
View Figures

Figure 1

The m6A methylation
regulatory machinery and its functional roles. The figure depicts
the spatial organization of m6A regulatory proteins
within a eukaryotic cell. In the nucleus, methyltransferase
'writers' (green) deposit m6A modifications on nascent
RNA transcripts, while demethylase 'erasers' (yellow) catalyze
their removal. Nuclear 'readers' (blue) recognize m6A
marks to regulate RNA splicing, export and microRNA processing. In
the cytoplasm, distinct reader proteins mediate translational
enhancement, degradation, or stabilization of target transcripts,
illustrating the functional diversity of m6A signaling
in post-transcriptional control. Protein labels indicate key
factors in each regulatory step. m6A,
N6-methyladenosine; METTL3/5/14/16, methyltransferase-like
3/5/14/16; WTAP, Wilms tumor 1-associated protein; VIRMA, vir-like
m6A methyltransferase associated; RBM15/15B, RNA-binding motif
protein 15/15B; ZC3H13, zinc finger CCCH-type containing 13; FTO,
fat mass and obesity-associated protein; ALKBH5, alkB homolog 5;
YTHDC1/2, YTH domain-containing 1/2; YTHDF1/2/3, YTH domain family
protein 1/2/3; IGF2BPs, insulin-like growth factor 2 mRNA-binding
proteins; HNRNPC/G, heterogeneous nuclear ribonucleoprotein C/G;
HNRNPA2B1, heterogeneous nuclear ribonucleoprotein A2/B1; FMRP,
fragile X messenger ribonucleoprotein; eIF3, eukaryotic translation
initiation factor 3. The figure was created in Figdraw (https://www.figdraw.com).

Figure 2

METTL3-driven oncogenic pathways in
MM tumorigenesis. (A) METTL3 facilitates miR-182-5p maturation
through m6A modification, suppresses CAMK2N1 and
drives MM proliferation and tumorigenesis (Main evidence: in
vitro studies). (B) METTL3 upregulates YY1 and
miR-27a-3p via m6A modification, driving MM
proliferation and stemness (Main evidence: in vitro assays
and patient cohort analysis). (C) METTL3 upregulates BZW2
via m6A modification, promoting MM proliferation and
anti-apoptosis (Main evidence: In vitro functional
validation). m6A, N6-methyladenosine; METTL3,
methyltransferase-like 3; pri-miR-182, primary microRNA-182;
pri-miR-27a, primary microRNA-27a; miR-182-5p, microRNA-182-5p;
miR-27a-3p, microRNA-27a-3p; CAMK2N1, calcium/calmodulin-dependent
protein kinase II inhibitor 1; YY1, Yin Yang 1; BZW2, basic leucine
zipper and W2 domains 2; YTHDF1, YTH domain family protein 1; eIF3,
eukaryotic translation initiation factor 3; eIF2B, eukaryotic
translation initiation factor 2B; 40S, 40S ribosomal subunit. The
figure was created in Biorender (https://BioRender.com).

Figure 3

YTHDF2 promotes MM proliferation
through dual m6A-dependent pathways. (A) YTHDF2 promotes
proliferation via m6A-dependent STAT5A
degradation and subsequent p-ERK activation (Main evidence: In
vitro and in vivo mouse models). (B) YTHDF2 drives MM
proliferation via m6A-dependent EGR1 degradation,
leading to dysregulation of the p21/CDK2-cyclin E1 axis (Main
evidence: In vitro experiments and patient cohort
correlation). m6A, N6-methyladenosine; YTHDF2, YTH domain family
protein 2; STAT5A, signal transducer and activator of transcription
5A; MAP2K2, mitogen-activated protein kinase kinase 2; p-ERK,
phosphorylated extracellular signal-regulated kinase; EGR1, early
growth response protein 1; p21, cyclin-dependent kinase inhibitor 1
(also known as CDKN1A); CDK2, cyclin-dependent kinase 2; cyclin E1,
cyclin E1. The figure was created in Biorender (https://BioRender.com).

Figure 4

ALKBH5 promotes multiple oncogenic
pathways in MM. (A) ALKBH5 stabilizes SNHG15 to upregulate
SETD2 and modify the epigenetic landscape (Main evidence: in
vitro mechanistic studies). (B) ALKBH5 suppresses SAV1
to inactivate the HIPPO pathway and activate YAP, while also
reducing stemness (Main evidence: In vitro and in
vivo models). (C) ALKBH5 hypomethylates TRAF1 to
activate NF-κB and MAPK signaling (Main evidence: In vitro
assays and clinical sample analysis). ALKBH5, AlkB homolog 5;
m6A, N6-methyladenosine; ALKBH5, alkB homolog 5; SNHG15,
small nucleolar RNA host gene 15; SETD2, SET domain-containing 2;
H3K36me3, histone H3 lysine 36 trimethylation; SAV1, Salvador
homolog 1; YAP, yes-associated protein; P21, cyclin-dependent
kinase inhibitor 1 (also known as CDKN1A); PUMA, p53-upregulated
modulator of apoptosis; BAX, BCL2-associated X protein; TRAF1, TNF
receptor-associated factor 1; NF-κB, nuclear factor
kappa-light-chain-enhancer of activated B cells; MAPK,
mitogen-activated protein kinase. The figure was created in
Biorender (https://BioRender.com).

Figure 5

A proposed model for FTO-mediated
drug resistance in MM. (A) Schematic representation of FTO
expression and m6A levels in bone marrow tissues of MM
patients and healthy donors. (B) Mechanistic model of the FTO-SOD2
axis in driving bortezomib resistance. Upregulated FTO demethylates
m6A on SOD2 mRNA, accelerating its decay and
reducing antioxidant defense. The resulting chronic oxidative
stress triggers compensatory activation of pro-survival pathways
(such as NF-κB/MAPK), which desensitizes MM cells to
bortezomib-induced apoptosis. m6A, N6-methyladenosine;
FTO, fat mass and obesity-associated protein; SOD2, superoxide
dismutase 2; NF-κB, nuclear factor kappa-light-chain-enhancer of
activated B cells; MAPK, mitogen-activated protein kinase; ROS,
reactive oxygen species; PI3K, phosphatidylinositol 3-kinase; Akt,
protein kinase B. The figure was created in Biorender (https://BioRender.com).
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Copy and paste a formatted citation
Spandidos Publications style
Maimaitiyiming Y, Hu S, Bai D, Guan Y, Bu N, Hao W and Maimaiti M: Emerging roles of RNA m<sup>6</sup>A modification in multiple myeloma pathogenesis and treatment resistance (Review). Int J Oncol 68: 40, 2026.
APA
Maimaitiyiming, Y., Hu, S., Bai, D., Guan, Y., Bu, N., Hao, W., & Maimaiti, M. (2026). Emerging roles of RNA m<sup>6</sup>A modification in multiple myeloma pathogenesis and treatment resistance (Review). International Journal of Oncology, 68, 40. https://doi.org/10.3892/ijo.2026.5853
MLA
Maimaitiyiming, Y., Hu, S., Bai, D., Guan, Y., Bu, N., Hao, W., Maimaiti, M."Emerging roles of RNA m<sup>6</sup>A modification in multiple myeloma pathogenesis and treatment resistance (Review)". International Journal of Oncology 68.4 (2026): 40.
Chicago
Maimaitiyiming, Y., Hu, S., Bai, D., Guan, Y., Bu, N., Hao, W., Maimaiti, M."Emerging roles of RNA m<sup>6</sup>A modification in multiple myeloma pathogenesis and treatment resistance (Review)". International Journal of Oncology 68, no. 4 (2026): 40. https://doi.org/10.3892/ijo.2026.5853
Copy and paste a formatted citation
x
Spandidos Publications style
Maimaitiyiming Y, Hu S, Bai D, Guan Y, Bu N, Hao W and Maimaiti M: Emerging roles of RNA m<sup>6</sup>A modification in multiple myeloma pathogenesis and treatment resistance (Review). Int J Oncol 68: 40, 2026.
APA
Maimaitiyiming, Y., Hu, S., Bai, D., Guan, Y., Bu, N., Hao, W., & Maimaiti, M. (2026). Emerging roles of RNA m<sup>6</sup>A modification in multiple myeloma pathogenesis and treatment resistance (Review). International Journal of Oncology, 68, 40. https://doi.org/10.3892/ijo.2026.5853
MLA
Maimaitiyiming, Y., Hu, S., Bai, D., Guan, Y., Bu, N., Hao, W., Maimaiti, M."Emerging roles of RNA m<sup>6</sup>A modification in multiple myeloma pathogenesis and treatment resistance (Review)". International Journal of Oncology 68.4 (2026): 40.
Chicago
Maimaitiyiming, Y., Hu, S., Bai, D., Guan, Y., Bu, N., Hao, W., Maimaiti, M."Emerging roles of RNA m<sup>6</sup>A modification in multiple myeloma pathogenesis and treatment resistance (Review)". International Journal of Oncology 68, no. 4 (2026): 40. https://doi.org/10.3892/ijo.2026.5853
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