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The pathways of ceramide metabolism examined in relation to insulin sensitivity. A: De novo synthesis. B: Deacylation. C: Phosphorylation of sphingosine (the work of Bruce et al. [15]). D: Hydrolysis of sphingomyelin. E: Conversion to glucosylceramide. F: Phosphorylation. De novo synthesis pathway is distinguished since it supplies all pathways of sphingolipid metabolism with ceramide.
