By inhibiting GDH, SIRT4 modulates mitochondrial glutaminolysis.295 In cervical cancer, SIRT4 interacts with the PIK3CA-E545K signaling axis to reduce radiotherapy sensitivity through glutamate metabolism regulation.296 In pancreatic cancer, SIRT4 can also enhance stemness through calcium signaling-stimulated histone lactylation and epigenetic reprogramming of metabolic pathways.297. Here, SIRT4 is linked to familial pancreatic carcinoma.