Ceramide as a Promising Tool for Diagnosis and Treatment of Clinical Diseases: A Review of Recent Advances
Abstract
:1. Introduction
1.1. Structure of Ceramide
1.2. Biosynthesis and Metabolism of Ceramide
1.3. Functions of Ceramide in Cell Signaling and Apoptosis
2. Application of Ceramide Measurement
2.1. Ceramide and CVD: Ceramide Scoring Criteria Have Been Established
2.2. Ceramide and Cancer: Insights into Application of Sphingolipid-Based Drugs
2.3. Ceramide and Dermatosis: A Biomarker and Key Component in Skin Permeability Barrier
2.4. Ceramide and Alzheimer’s Disease: Exploring Relationships Between Lipid Dysregulation and Neurodegenerative Diseases’ Mechanism
2.5. Ceramide and Metabolic Syndromes: Promote Better Understanding of Disease and Treatment Mechanism
3. Challenges and Future Directions
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Detective Method | Sample Matrix | Pretreatment Method | Chromatographic COLUMN | Mobile Phase | Gradient Elution | Linear Range | LOD (fmol) on Column |
---|---|---|---|---|---|---|---|
LC-ESI-MS/MS [17] | Serum | Liquid–liquid extraction | Luna C18column (150 mm × 2 mm ID, 5 µm particle size, 100 Å pore size) | Phase A: water: formic acid (100:0.1, v/v); Phase B: acetonitrile: tetrahydrofuran: formic acid (50:50:0.1, v/v/v) | 0~0.6 min: A/B (60%/40%); 0.6~3.9 min: A/B (60%/40%~0/100%); 3.9~10.4 min: A/B (0/100%); 10.4~10.9 min: A/B (60%/40%). | Cer(18:0): 0.18–300 ng/mL; Cer(20:0): 0.24–400 ng/mL; Cer(24:1): 0.24–400 ng/mL; dhCer(24:0): 0.6–1000 ng/mL; dhCer(18:0): 0.3–500 ng/mL; | Not Mentioned |
LC-ESI-MS/MS [18] | Plasma | Protein precipitation technology | Acquity BEH C18 (2.1 × 50 mm, 1.7 μm) | Phase A: 10 mM ammonium acetate + 0.1% formic acid in water; Phase B: 10 mM ammonium acetate + 0.1% formic acid in acetonitrile:2-propanol (4:3) | 0~0.5 min: A/B (15%/85%); 0.5~1.5 min: A/B (15%/85%~0/100%); 1.5~4 min: A/B (0/100%); 4.5~5.0 min: A/B (15%/85%). | Cer(d18:1/16:0): 0.008~2 pmol/μL; Cer(d18:1/18:0): 0.008~2 pmol/μL; Cer(d18:1/24:0): 0.08~20 pmol/μL; Cer(d18:1/24:1): 0.08~20 pmol/μL. | Not Mentioned |
LC-ESI-MS/MS [19] | Plasma | Protein precipitation technology | Water ACQUITY UPLC BEH Phenyl (3 mm × 100 mm, 1.7 nm) | Phase A: 0.2% formic acid, 1 mM ammonium formate aqueous solution Phase B: 0.2% formic acid, 1 mM ammonium formate methanol solution | 0~2 min: A/B (20%/80%); 2~8 min: A/B (5%/95%); 8~9 min: A/B (2%/98%); 9~10 min: A/B (20%/80%). | Cer(d18:1/12:0): 1.953~8000 nM Cer(d18:1/14:0): 1.953~8000 nM Cer(d18:1/14:0): 1.953~8000 nM Cer(d18:1/18:0): 1.953~8000 nM Cer(d18:1/20:0): 1.953~8000 nM Cer(d18:1/22:0): 1.953~8000 nM Cer(d18:1/24:1): 1.953~8000 nM Cer(d18:1/24:0): 1.953~8000 nM | Not Mentioned |
LC-APCI-MS/MS [20] | Fat Tissue | Liquid–liquid extraction and protein precipitation technology | Shimadzu Shim-pack C18 (50 mm × 2.1 mm, 2.0 µm) | Phase A: acetonitrile/water (6:4, ν/ν) + 0.1% formic acid + 0.1% ammonium formate; Phase B: acetonitrile/isopropanol (1:9, ν/ν) + 0.1% formic acid + 0.1% ammonium formate. | 0–3 min: A/B (50%/50%); 4–12.5 min: A/B (30%/70%); 12.5–14 min: A/B (50%/50%). | Cer (d18:1/16:0): 125~5000 ng/mL Cer (d18:1/17:0): 1 µg/mL Cer (d18:1/18:0): 125~5000 ng/mL Cer (d18:1/20:0): 125~5000 ng/mL Cer (d18:1/24:0): 125~5000 ng/mL Cer [d18:1/24:1(15Z)]: 125~5000 ng/mL | Not Mentioned |
LC-ESI-MS/MS [21] | Cell | Liquid–liquid extraction | ZORBAX Eclipse XDB-C8 (150.0 mm × 2.1 mm, 3.5 μm) | Phase A: 1 mmol/L ammonium formate and 0.2% formic acid in methanol solution, Phase B: 100% methanol | 0~20 min: A/B (20%/80%~1/99%); 20~35 min: A/B (1%/99%~0/100%). | Cer16: 0.02~1.0 μg/mL; Cer17: 0.02~1.0 μg/mL; Cer24: 0.02~1.0 μg/mL; Cer18: 0.001~1.0 μg/mL. | Not Mentioned |
LC-ESI-MS/MS [22] | Cosmetics | Ultrasound-assisted extraction | Waters XBridge Protein BEH C4 (2.5 μm, 2.1 mm × 50 mm) | Phase A: acetonitrile; Phase B: water. | 0~2 min: A/B (40%/60%); 8~12 min: A/B (100/0%); 12.1~15 min: A/B (60%/40%). | Cer(t18:0/18:1): 5~100 ng/mL | Cer(t18:0/18:1): 0.125 µg/g |
LC-APCI-MS/MS [23] | Fat Tissue | Liquid–liquid extraction | Shimadzu shim-pack GIST C18 (2.0 μm, 2.1 × 50 mm) | Phase A: acetonitrile/water [60:40, v/v] + 0.1%, formic acid + 0.1% formic acid, amine. Phase B: acetonitrile/iso-propanol [1:9, v/v] + 0.1% formic acid + 0.1% formic acid, amine. | 0~1.0 min: A/B (50%/50%); 1.0~7.0 min: A/B (30%/80%); 7.1 ~8.5 min: A/B (50%/50%). | Not Mentioned | Not Mentioned |
LC-ESI-MS/MS [24] | Tissues and Plasma | Liquid–liquid extraction | Zorbax SB-C8 (2.1 ×150 mm, 1.8 μm) | Phase A: 1 mM ammonium formate, 0.1% formic acid in water. Phase B: 2 mM ammonium formate, 0.1% formic acid in methanol. | 0 min: A/B (80%/20%); 0–1.5 min: A/B (80%/20%~90%/10%); 1.5–2.3 min isocratic at A/B (90%/10%); 2.3–9.3 min: A/B (90%/10%~99/1%); 9.3–11 min isocratic at A/B (99/1%); 11–11.3 min:A/B (99%/1%~80%/20%); 11.3–13 min isocratic at A/B (80%/20%). | Not Mentioned | C14:0-Cer: 3.1 μg/mL. C16:0-Cer: 2.9 μg/mL C17:0-Cer: 2.8 μg/mL. C18:1-Cer:2.8 μg/mL. C18:0-Cer: 2.8 μg/mL. C20:0-Cer: 2.6 μg/mL. C24:1-Cer: 2.4 μg/mL. C24:0-Cer: 2.4 μg/mL. |
LC-ESI-MS/MS [25] | Cells | Liquid–liquid extraction | RP C18 Nuecleosil AB column (5 μm, 70 × 2 mm I.D.) | Phase A: water-acetonitrilie-2-propanol (8:1:1, v/v/v); Phase B: acetonitrile-2-propanol (9:1, v/v) | 0~2 min: A/B (35%/65%); 7~13 min: A/B (10%/90%); 15 min: A/B (0/100%); 16~18 min: A/B (35%/65%). | Not Mentioned | C16-Cer:0.253 ng/500 μg proteins. C18-Cer:0.253 ng/500 μg proteins. C20-Cer:0.253 ng/500 μg proteins |
(a) | |||||||
Risk Score Table | Biomarkers | Score | Total Score | ||||
Q1 | Q2 | Q3 | Q4 | ||||
CERT1 | Cer(d18:1/16:0) | 0 | 0 | 1 | 2 | 0~12 | |
Cer(d18:1/18:0) | 0 | 0 | 1 | 2 | |||
Cer(d18:1/24:1) | 0 | 0 | 1 | 2 | |||
Cer(d18:1/16:0)/Cer(d18:1/24:0) | 0 | 0 | 1 | 2 | |||
Cer(d18:1/18:0)/Cer(d18:1/24:0) | 0 | 0 | 1 | 2 | |||
Cer(d18:1/24:1)/Cer(d18:1/24:0) | 0 | 0 | 1 | 2 | |||
CERT2 | Cer(d18:1/24:1)/Cer(d18:1/24:0) | 0 | 1 | 2 | 3 | 0~12 | |
Cer(d18:1/16:0)/PC(16:0/22:5) | 0 | 1 | 2 | 3 | |||
Cer(d18:1/16:0)/PC(14:0/22:6) | 0 | 1 | 2 | 3 | |||
PC(16:0/16:0) | 0 | 1 | 2 | 3 | |||
CERT2-TnT | Cer(d18:1/24:1)/Cer(d18:1/24:0) | 0 | 1 | 2 | 3 | 0~15 | |
Cer(d18:1/16:0)/PC(16:0/22:5) | 0 | 1 | 2 | 3 | |||
Cer(d18:1/16:0)/PC(14:0/22:6) | 0 | 1 | 2 | 3 | |||
PC(16:0/16:0) | 0 | 1 | 2 | 3 | |||
hs-TnT | 0 | 1 | 2 | 3 | |||
(b) | |||||||
Risk Score Table | Risk Rating | ||||||
Low Risk | Medium Risk | Medium-high Risk | High Risk | ||||
CERT1 | 0~2 | 3~6 | 7~9 | 10~12 | |||
CERT2 | 0~3 | 4~6 | 7~9 | 9~12 | |||
CERT2-TnT | 0~4 | 5~7 | 8~10 | 11~15 |
Study | Method | Participants | Sample | Conclusions | Future Perspectives | |
---|---|---|---|---|---|---|
Test | Control | |||||
Grammatikos, 2016 [17] | LC-APCI-MS/MS | n = 122 HCC | n = 127 cirrhosis | Serum | The levels of long-chain and ultra-long-chain ceramides (C16–C24) were significantly higher in patients with HCC than in patients with cirrhosis (p < 0.001). | The C16 ceramide and its metabolite S1P might serve as new diagnostic markers of HCC in patients with liver disease. |
Dubois N, 2016 [38] | LC-ESI-MS/MS | n = 35 colorectal CA before treatment | n = 35 colorectal CA after treatment | Plasma | Patients with controlled tumors within 1 year had higher ceramide levels, whereas 50% of patients with decreased ceramide levels experienced an increase in tumor volume. | Total plasma ceramide may serve as a biomarker of liver and lung oligometastases of colorectal cancer, enabling the classification of high-risk patients. |
Kazuki Moro, 2017 [39] | LC-ESI-MS/MS | n = 44 breast CA | n = 36 peri-tumor and n = 44 normal breast tissues | Breast tissue | Cer(14:0), Cer(16:0), Cer(18:1), Cer(18:0), Cer(20:0), Cer(22:0), Cer(24:1), Cer(24:0), Cer(26:1), and Cer(26:0) were higher in breast cancer than in peritumor or normal breast tissue. Ceramide levels in cancer tissue were significantly negatively correlated with the nuclear grade (p = 0.04) and Ki-67 index (p = 0.09). The Area Under the Curve (AUC) scores of Receiver Operating Characteristic Curve (ROC) were 0.7226 for normal tissue and 0.7228 for peritumor tissue, respectively, showing that breast cancer tissue may be distinguished from normal breast tissue by ceramide levels. | Ceramide levels were higher in breast cancer tissue than in other tissues and were negatively correlated with aggressive phenotypes. Higher gene expressions of ceramide-related enzymes had a worse prognosis in breast cancer. |
Jiang, 2018 [40] | LC-ESI-MS/MS | n = 15 hepatitis B related-AFP-negative HCC | n = 49 patients with hepatitis B cirrhosis | Serum | The expression level of Cer(d18:1/8:0)-1-P in patients with AFP-negative HCC was 2.177 nmol/mL, which was significantly higher than that in patients with hepatitis B cirrhosis (p < 0.05). The level of Cer(d18:1/8:0)-1-P can be used to identify hepatitis B-related AFP-negative HCC, with a sensitivity of 81.6% and a specificity of 86.7%. | Upregulated peripheral serum Cer(d18:1/8:0)-1-P might serve as a diagnostic marker of hepatitis B-related AFP-negative HCC. |
Adam R. Markowski, 2020 [41] | LC-ESI-MS/MS | Colorectal tumor | Normal colorectal tissue | Colorectal tissue | The levels of sphingolipids in colorectal cancer tissues differed from those in surrounding healthy tissues, with increased levels of SPA, S1P, and Cer(14:0) and significantly lower levels of Cer(18:0) and Cer(20:0) in tumors. The levels of specific ceramides in colorectal cancer tissues and plasma depended on the stage of colorectal cancer. In ROC, sensitivities of plasma Cer(16:0), Cer(18:1), Cer(20:0), Cer(24:1) were 0.085, 0.092, 0.088, 0.088, respectively, in CRC(TNM III+IV). | Combined measurement of the plasma concentrations of several ceramides facilitates the differentiation between early and advanced lesions of colorectal cancer and is useful as a screening test for the detection of early colorectal cancer. |
Xuewei Zhang, 2021 [42] | LC-ESI-MS/MS | CerS2-knockout cells | Control cells | Cell lipid | The CerS2-Cer(24:1) ceramide pathway limits ovarian cancer metastasis by restricting lamellipod formation in ovarian cancer cells. CerS2-Cer(24:1) | Provides insights for the development of ceramide-based therapies and the identification of biomarkers of metastatic ovarian cancer. |
Fatty Acid | Non-Hydroxy Fatty Acid [N] | α-HYDROXY Fatty Acid [A] | β-HYDROXY Fatty Acid [B] | ω-Hydroxy Fatty Acid [O] | Esterified ω-Hydroxy Fatty Acid [EO] | Protein-Bound Fatty Acid [PO] | |
---|---|---|---|---|---|---|---|
Sphingoid | |||||||
[DS] | CER[NDS] | CER[ADS] | CER[BDS] | CER[ODS] | CER[EODS] | CER[PODS] | |
[S] | CER[NS] | CER[AS] | CER[BS] | CER[OS] | CER[EOS] | CER[POS] | |
[P] | CER[NP] | CER[AP] | CER[BP] | CER[OP] | CER[EOP] | CER[POP] | |
[H] | CER[NH] | CER[AH] | CER[BH] | CER[OH] | CER[EOH] | CER[POH] | |
[SD] | CER[NSD] | CER[ASD] | CER[BSD] | CER[OSD] | CER[EOSD] | CER[POSD] |
Study | Method | Skin Diseases | Ceramides and Derivatives | Future Perspectives | |
---|---|---|---|---|---|
Test | Control | ||||
Bo-Kyung Kim, 2021 [59] | LC-ESI-MS/MS | Psoriasis-like murine epidermis and human psoriatic stratum corneum | Healthy controls | Long-chain-ceramide ↓ Short-chain-ceramide ↑ | IFN-γ may regulate ELOVL and CerS levels by downregulating transcription factors. Transcription factors, such as PPARs and liver X receptor agonists in the ceramide elongation process, may serve as potential therapeutic agents for lengthening the ceramide FA chain in psoriasis. |
Fölster Holst, 2022 [60] | HPTLC | Ichthyoses lesional skin | Ichthyoses nonlesional skin | CER[EOS] ↓ | Analysis of intercellular lipid lamellae organization and corneocyte membrane undulation may improve the understanding of the epidermal barrier in ichthyoses and assist in evaluating the effects of topical skin preparations. |
Maria Rasmussen Rinnov, 2022 [61] | LS-ESI-MS/MS | Pediatric AD | Healthy controls | CER[DS] ↑ DHS ↑ CER[P] ↓ | CER[P] had the highest prediction accuracy among the biomarkers (accuracy = 75.6%, sensitivity = 84%). The combination of five lipid ratios (CER[DS]-(d17:0)/CER[DS]-(d18:0), CER[DS]-(d18:0)/CER[S]-(d18:1), CER[P]- (t18:0)/CER[S]- (d18:1), CER[DS]- (d17:0)/CER[DS]- (d18:0), CER[S]- (d17:1)/CER[S]- (d18:1)) gave an accuracy of 89.4% to the prediction of AD within the first 12 months. |
Dan Dai, 2022 [62] | LC-ESI-MS/MS | Patients with PVM | Patients with PV | Cer (d18:1/18:0) were positively correlated with the PASI in severe PV | Patients with PV at different severity levels have distinct metabolic profiles, aiding in understanding disease progression and establishing precision treatment strategies for PV. |
Jihyun Kim, 2023 [63] | LC-ESI-MS/MS | AD lesional skin | AD nonlesional skin | C18-CER[NS] N-acylated with C16, C18, and C22 Fas ↑ C24-32 -CER [NS]/C14-22-CER [NS] and total CER[EO]/total CER[NS] were negatively correlated with transepidermal water loss. | Pediatric AD skin showed aberrant lipid profiles associated with microbial dysbiosis and cutaneous barrier dysfunction. |
Evgeny Berdyshev, 2023 [64] | LC-ESI-MS/MS | Children with AD family history | Children without AD family history | CER[PO] ↓ Short-chain CER[N] and CER[A] ↑ | Noninvasive skin tape strip analysis of ceramides can identify asymptomatic children at risk of future AD with high probability. A combination of lipids and cytokines serves as a powerful biomarker for predicting AD development, paving the way for precision medicine in AD. |
Mateusz Matwiejuk, 2023 [65] | LC-ESI-MS/MS | Patients with psoriasis | Healthy controls | Positive associations between CER_t and CER_s, SFA_t and CER_s, and SFO_t and CER_s | Sphingolipid metabolism is impaired in both the affected skin and serum in patients with psoriasis. Skin and serum lipids show interrelationship, suggesting systemic involvement and correlations between specific sphingolipids. |
Howard Chu, 2023 [66] | LC-ESI-MS/MS | AD with HND | AD without HND | CER[EOS] ↓ CER[EOP] ↓ | |
Qianqian Su, 2024 [67] | LC-ESI-MS/MS | Acne in women | Healthy controls | Ceramide chain length ↓ | Skin surface lipids are closely associated with acne development. Lipidomics is a useful tool for analyzing skin surface lipids in different types of acne. |
Stage | Characteristics/Symptoms |
---|---|
Preclinical AD | 1. Measurable biomarkers and detectable changes in the brain, CSF, and blood. |
2. Absence of symptoms such as memory loss. | |
MCI due to AD | 1. Measurable biomarkers and detectable changes in the brain related to AD pathology |
2. Moderate cognitive decline, mainly affecting the performance of small daily tasks (such as paying bills or preparing meals). | |
Dementia | 1. Measurable biomarkers and detectable changes in the brain, related to AD pathology. |
2. Substantial memory loss. | |
3. Behavioral and personality changes. | |
4. Severe impairments in completing daily tasks. |
Study | Method | Skin Diseases/Condition | Sample | Ceramides and Derivatives | Future Perspectives | |
---|---|---|---|---|---|---|
Test | Control | |||||
Michelle M. Mielke, 2010 [78] | LC-ESI-MS/MS | Patients with MCI | Healthy controls | Plasma | Cer(22:0) ↓ Cer(24:0) ↓ | Ultra-long-chain ceramides in the plasma predict memory loss and right hippocampal volume loss in patients with MCI and may be early indicators of AD progression. |
PeñaBautista Carmen, 2022 [76] | LC-ESI-MS/MS | Preclinical AD | Healthy controls | Plasma | Cer↑ | The study of lipid profiles in plasma samples can help identify early stages of AD and potential new biomarkers. |
MCI-AD | Healthy controls | |||||
Daan van Kruining, 2023 [73] | LC-ESI-MS/MS | Men with MCI | Healthy controls | Plasma | Cer(18:0) ↑ Cer(24:1) ↑ Ceramide chain lengths ↑ (Cer(20:0), Cer(22:0), and Cer(24:1) ↑ are associated with larger volume of the hippocampus) | The study highlights the importance of considering sex and age-related factors when examining sphingolipid and CERT metabolism related to cognitive function. No associations of plasma sphingolipids with MCI or brain volumes were found in women. Further analyses of plasma ceramides as potential markers of MCI in middle-aged men are warranted. |
Study | Method | Nervous System Diseases/Condition | Sample | Ceramides and Derivatives | Future Perspectives | |
---|---|---|---|---|---|---|
Test | Controls | |||||
Xing Y, 2016 [83] | LC-ESI-MS/MS | PDD | PD-NC | Plasma | Cer(14:0) ↑ Cer(24:1) ↑ Cer(22:0), Cer(20:0), and Cer(18:0) were associated with hallucinations, anxiety and sleep behavior disturbances, respectively | In PDD, increased ceramide levels were correlated with decreased memory function and a higher odd of multiple neuropsychiatric symptoms. |
Emer R McGrath, 2020 [84] | LC-ESI-MS/MS | Dementia-free Framingham Offspring Study cohort | Plasma | Cer22:0/Cer16:0 ↓ Cer24:0/Cer16:0 ↓ | Circulating ceramide ratios may serve as biomarkers for predicting dementia risk in cognitively healthy adults. | |
Hideki Oizumi, 2022 [85] | LC-ESI-MS/MS | ND groups (including IPD, DLB, MSA, AD, and PSP) | Healthy controls | Plasma | S1P ↓ | The study indicates the important role of abnormal sphingolipid metabolism in neurodegeneration. |
Lv Hong, 2022 [86] | LC-ESI-MS/MS | Patients with PSD | Patients without PSD | Plasma | Cer(16:0) ↑ Cer(18:0) ↑ Cer(24:0) ↑ Cer(24:1) ↑ | Serum ceramides may become an essential candidate biomarker for PSD diagnosis and may aid in monitoring the other biomarkers in the pathway. |
Patients with PSD | Patients with MD | Cer(16:0) ↑ Cer(18:0) ↑ Cer(24:0) ↑ | ||||
Koushik Mondal, 2024 [87] | LC-ESI-MS/MS | TBI mouse model | Healthy controls | Brain tissue | Sphingosine ↑ C1P ↑ | Alterations in sphingolipid metabolite composition, particularly sphingomyelinases and short chain ceramides, may contribute to the induction and regulation of neuroinflammatory events in the early stages of TBI, suggesting targets for novel diagnostic, prognostic, and therapeutic strategies in the future. |
Plasma | Cer(22:0)) ↓ (at 1 day) Cer (22:0) ↑ (at 7 days) Cer (24:1) ↑ (at 3 days) Cer (24:1) ↓ (at 7 days) Cer (24:0) ↓ SM (22:0) ↓ (at 3 days) SM (22:0) ↑ (at 7 days) |
Study | Method | Participants | Sample | Main Findings | Conclusions | |
---|---|---|---|---|---|---|
Test | Controls | |||||
Haus Jacob, 2009 [101] | LC-ESI-MS/MS | n = 13 T2D | n = 14 healthy control | Plasma | Patients with T2D had higher levels of Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/24:1), and total ceramides. Insulin sensitivity was inversely correlated with Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/24:1), Cer(d18:1/24:0), and total ceramides. | Plasma ceramide levels were increased in patients with obesity and T2D and were positively correlated with insulin resistance. |
Ximena Lopez, 2013 [102] | LC-ESI-MS/MS | n = 14 women with obesity and T2D | n = 14 women with obesity and T2D | Fasting plasma | Cer(d18:1/22:0) and Cer(d18:1/20:0) were elevated, and Cer(d18:1/18:0) and Cer(d18:0/24:1) were twice that in healthy individuals (p < 0.05). | Plasma ceramides were elevated in T2D, reflecting tissue insulin resistance, potentially due to low adiponectin levels. |
Jeremy Warshauer, 2015 [103] | LC-ESI-MS/MS | n = 19 pioglitazone | n = 18 placebo | Plasma | Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/24:1), Cer(d18:0/18:0), Cer(d18:0/24:1), lactosylceramides Cer(d18:1/16:0), hexosylceramides Cer(d18:1/16:0), Cer(d18:1/16:0), and Cer(d18:1/22:0) were markedly reduced after 6 months of pioglitazone treatment (all p < 0.01). | Plasma ceramide levels were markedly decreased in patients with MetS who received pioglitazone for 6 months. Some changes were correlated with insulin resistance and adiponectin levels. |
Jacob Haus, 2017 [104] | LC-ESI-MS/MS | n = 76 SS | n = 76 IMF | Skeletal muscle lipids | SS ceramides, especially those whose chain length was C16 to C18 (Cer(d18:1/16:0) and Cer(d18:1/18:1)) or generated under the stimulation of plasma palmitate, were associated with biomarkers of insulin resistance. However, the IMF level was not correlated with any metabolic parameters. | Skeletal muscle SS ceramides, especially C16~18 chain lengths, and the de novo synthesis of intramyocellular ceramide from plasma palmitate are associated with insulin resistance markers. |
Hady Razak Hady, 2019 [105] | LC-ESI-MS/MS | n = 31 IGT group (women = 12, men = 19), and n = 33 T2D (women = 19, men = 14) | Normal glucose tolerance group (NGT, women = 30, men = 36) | Liver | Hepatic ceramides were higher in women with T2D than in women with NGT (p < 0.05). Glycemic parameters, such as FBG, OGTT at 120 min, and HbA1c, were correlated with ceramides. Hepatic ceramides were higher in men with IGT than in men with NGT, but only Cer(d18:1/22:0) was correlated with all glycemic parameters | Ceramide contributed to the induction of hepatic insulin resistance, and it may differ between men and women. |
Luis Felipe León-Aguilar, 2019 [106] | LC-ESI-MS/MS | n = 91 docosahexaenoic acid | n = 92 placebo | Plasma | The total abundance of plasma ceramides in overweight and obese mothers, especially Cer(d18:1/20:0), Cer(d18:1/22:0), Cer(d18:1/23:0), and Cer(d18:1/24:0), was significantly decreased. Compared with children of normal weight mothers, the levels of Cer(d18:1/22:0), Cer(d18:1/23:0), and Cer(d18:1/24:0) were similar in the 4-year-old children of overweight or obese mothers. | Maternal obesity led to long-term changes in plasma ceramide levels of their offspring, and lipids may serve as early predictors of metabolic disease risk that result from maternal obesity. |
Yuan, 2021 [107] | LC-APCI-MS/MS | n = 56 OD | n = 144 OND | Abdominal adipose tissue | Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/24:0), Cer(d18:1/24:0), and total ceramides in the fat tissue of OD group were higher than those in the OND group (p < 0.05), whereas the difference in Cer(d18:1/20:0) was not statistically significant (p > 0.05). IL-1 and IL-18 in serum and fat tissue of OD group were higher than those in the OND group (p < 0.05). | Ceramide level in the fat tissue of patients with obesity was associated with the inflammation of fat tissue and increased diabetes risk. |
Jakub Morze, 2022 [108] | Meta-analysis | n = 11,771 T2D | n = 59,425 healthy controls | Plasma, serum, and urine | Higher plasma and serum levels of phosphatidylethanolamines and ceramides included in the meta-analysis were associated with a higher risk of type 2 diabetes. | Several plasma and serum metabolites, including amino acids, lipids, and carbohydrates, were associated with the risk of type 2 diabetes. |
Kelli Lytle, 2023 [109] | LC-ESI-MS/MS | n = 25 obesity | Liver, plasma, and VLDL particles | (i) The proportion of Cer(14:0), Cer(18:0), Cer(20:0), and Cer(24:1) in the liver and whole plasma were positively correlated. (ii) Hepatic fat was positively correlated with the proportion of hepatic Cer18:1, Cer18:0, and Cer20:0 but not with total hepatic ceramide concentration. (iii) The proportions of whole plasma ceramide subspecies, especially Cer(14:0), Cer(18:0), Cer(20:0), and C(24:1) chain length, are reflective of those of hepatic ceramide subspecies in individuals with obesity. | A correlation was observed between the levels of ceramides in the liver and plasma of patients with obesity. |
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Shen, X.; Feng, R.; Zhou, R.; Zhang, Z.; Liu, K.; Wang, S. Ceramide as a Promising Tool for Diagnosis and Treatment of Clinical Diseases: A Review of Recent Advances. Metabolites 2025, 15, 195. https://doi.org/10.3390/metabo15030195
Shen X, Feng R, Zhou R, Zhang Z, Liu K, Wang S. Ceramide as a Promising Tool for Diagnosis and Treatment of Clinical Diseases: A Review of Recent Advances. Metabolites. 2025; 15(3):195. https://doi.org/10.3390/metabo15030195
Chicago/Turabian StyleShen, Xueping, Rui Feng, Rui Zhou, Zhaoyang Zhang, Kaiyong Liu, and Sheng Wang. 2025. "Ceramide as a Promising Tool for Diagnosis and Treatment of Clinical Diseases: A Review of Recent Advances" Metabolites 15, no. 3: 195. https://doi.org/10.3390/metabo15030195
APA StyleShen, X., Feng, R., Zhou, R., Zhang, Z., Liu, K., & Wang, S. (2025). Ceramide as a Promising Tool for Diagnosis and Treatment of Clinical Diseases: A Review of Recent Advances. Metabolites, 15(3), 195. https://doi.org/10.3390/metabo15030195