IGF1 and neoplasm: Vascular endothelial growth factor is a key angiogenic factor involved in a wide variety of biological processes including embryonic development, tumor progression and metastasis, and regulated by platelet-derived growth factor, insulin, insulin-like growth factor-I, tumor necrosis factor.[33,34] Functional analysis revealed that INSR mutation in ITP patients involved in the PI3K/Akt signaling pathway and HIF-1 signaling pathway in this study.