Clinical success of the proteasome inhibitor established bortezomib as one of the most effective drugs in treatment of multiple myeloma (MM).While survival benefit of bortezomib generated new treatment strategies,the primary and secondary resistance of MM cells to bortezomib remains a clinical conce.This study aimed to highlight the role of p53-induced RING-H2 (Pirh2) in the acquisition of bortezomib resistance in MM and to clarify the function and mechanism of action of Pirh2 in MM cell growth and resistance,thereby providing the basis for new therapeutic targets for MM.The proteasome inhibitor bortezomib has been established as one of the most effective drugs for treating MM.We demonstrated that bortezomib resistance in MM cells resulted from a reduction in Pirh2 protein levels.Pirh2 overexpression overcame bortezomib resistance and restored the sensitivity of myeloma cells to bortezomib,while a reduction in Pirh2 levels was correlated with bortezomib resistance.The levels of nuclear factorkappaB (NF-KB) p65,pp65,pIKBa,and IKKa were higher in bortezomib-resistant cells than those in parental cells.Pirh2 overexpression reduced the levels of pIKBa and IKKa,while the knockdown of Pirh2 via short hairpin RNAs increased the expression of NF-KB p65,pIKBa,and IKKa.Therefore,Pirh2 suppressed the canonical NF-κB signaling pathway by inhibiting the phosphorylation and subsequent degradation of IKBa to overcome acquired bortezomib resistance in MM cells.