A 64-Year-Old Man Comes to the Office Due to Several

A 64-year-old man comes to the office due to several weeks of worsening back pain, fatigue, and polyuria.  Physical examination reveals mucosal pallor and diffuse bony tenderness.  Laboratory studies are significant for normocytic anemia, hypercalcemia, and renal failure.  Serum protein electrophoresis demonstrates a monoclonal spike in the gamma globulin region.  Bone marrow biopsy shows a large number of abnormal plasma cells.  Treatment with lenalidomide is started; this medication increases affinity of E3 ubiquitin ligase enzyme to substrate transcription factors.  Which of the following is the most likely effect of this medication on these transcription factors?

A) Decreased cell surface expression
B) Decreased lysosomal proteolysis
C) Increased binding to promoter region
D) Increased intracellular degradation
E) Increased nuclear translocation

Correct Answer:

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