Furthermore, in hepatocellular carcinoma, accumulated βHB upregulates the expression levels of CD44, CD133, SOX9 and EpCAM by increasing the β-hydroxybutyrylation level of histone H3K9bhb and then significantly improves the proportions of CSCs for in vivo tumor formation and increases the abilities of colony formation and tumorsphere formation [80] (Fig. 2A). The gene discussed is CD44; the disease is neoplasm.