A 62-Year-Old Man Is Examined Because His Cough, Breathlessness, and Episodic

A 62-year-old man is examined because his cough, breathlessness, and episodic hemoptysis have gotten worse during the previous six months. In the same time frame, the patient also lost 15 kg (33 lb) of weight without changing his diet or level of activity. He has smoked 50 packs a year for the past 50 years, but he doesn't drink or use drugs. 18 kg/m² is the BMI. The patient displays temporal wasting, widespread loss of muscular mass, and cachectic appearance. Chest x-ray reveals a large lung mass with mediastinal lymphadenopathy and pleural effusion.  Which of the following cellular processes is most likely responsible for this patient's muscle loss?

A) Covalent attachment of ubiquitin to muscle proteins
B) Plasma membrane rupture with leakage of cellular contents
C) Plasma membrane instability due to defective dystrophin
D) Progressive shortening of chromosomal telomeres
E) Reprogramming of undifferentiated mesenchymal cells