Moreover, increased expression of both ketogenic and ketolytic enzymes (acetyl-CoA acetyltransferase 1, ACAT1; 3-hydroxybutyrate dehydrogenase 1, BDH1; 3-hydroxymethyl-3-methylglutaryl-CoA lyase, HMGCL; and 3-oxoacid CoA-transferase 1, OXCT1) was reported with PC progression, gradually increasing with the tumor grade [58,59]. The gene discussed is HMGCL; the disease is pachyonychia congenita.