When the PI3K/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) pathway is activated by insulin signaling, not only protein synthesis is stimulated, but autophagy is also inhibited (Figure 2), which could accelerate the DCM process (Mizushima, 2005; Meijer and Codogno, 2006). The gene discussed is INS; the disease is familial dilated cardiomyopathy.