CTSL and pancreatic neoplasm: Consistent with previous reports of pancreatic cancer cachexia, skeletal muscle catabolism was associated with elevated expression of E3 ubiquitin ligase-related genes, including Mafbx, Murf1, and Foxo1, while cardiac atrophy was associated with increased autophagy-related genes, including Bnip3, Ctsl, and Gabarapl (Fig. 1e, f)17.