Thus, the mechanisms underlying DCM pathogenesis are extremely complex and involve changes in 1), signal transduction (insulin signal, renin-angiotensin signal); 2), metabolism (glucose and lipid metabolism), calcium homeostasis, and mitochondrial function; 3), gene regulation (activation of transcription factors and epigenetic mechanisms); 4), post-translational modification of signaling proteins; 5), homeostasis of cellular processes such as apoptosis, autophagy, and endoplasmic reticulum stress (Figure 1). This evidence concerns the gene REN and familial dilated cardiomyopathy.