SIRT4 deacetylates ENO1 at K358, increasing its affinity for 2-phosphoglycerate (2-PG), which boosts glycolysis and lactate production, which shift not only supports the proliferation of pancreatic cancer cells but also leads to broad histone lactylation at H3K9 and H3K18 [176].The interplay between lactate production and lactylation is central to the metabolic reprogramming that supports pancreatic cancer progression. This evidence concerns the gene SIRT4 and familial pancreatic carcinoma.