In esophageal squamous cell carcinoma (ESCC), NAT10-mediated ac4C modification of CTC-490G23.2 increases its stability, which functions as a scaffold to promote the interaction between polypyrimidine tract-binding protein1 (PTBP1) and CD44 pre-mRNA. The gene discussed is PTBP1; the disease is esophageal squamous cell carcinoma.