IGF1 and Atrophy: Additional pathways have been suggested to mediate DOX-induced cardiac atrophy including impaired insulin-like growth factor 1 (IGF-1) signaling, reactive oxygen species (ROS)-dependent upregulation of NADPH oxidase 2 (Nox2), altered PI3K-AKT pathway, and activated p38 MAPK (reviewed in [32,33]).