Much attention has been devoted to the role of ceramide and derived sphingolipids in the sensitivity of tumors to chemo-and radiotherapy. [1][2][3] In particular, the cytotoxic effects of those treatments decrease when the generation of ceramide is impaired but increase when the degradation of ceramide is blocked.Ceramide homeostasis is controlled by several metabolic events leading to its deacylation, phosphorylation or glycosylation or to sphingomyelin synthesis. Ceramide is now recognized as a major component of the programmed cell death machinery triggered in response to different stimuli, including anti-Fas, chemotherapeutic agents, UV radiation and ␥-radiation. 4,5 Derivative molecules, such as sphingosine, sphingosine-1-phosphate and ceramide-1-phosphate, also appear to be active intracellular mediators. 6 Conversely, glucosylceramide synthesis is an important mechanism by which ceramide-induced apoptosis is averted. 7 It was first demonstrated in this context that high cellular levels of glucosylceramide correlate with multidrug resistance. 8,9 Experiments conducted subsequently with glucosylceramide synthase antisense cDNA restored the sensitivity of breast carcinoma cells to anthracycline. 10 Conversely, the apoptotic response induced by the addition of short-chain ceramide to cell cultures is potentiated by the inhibition of glycosylceramide synthase. 11 Different strategies have been applied to understand ceramidemediated cell signaling by increasing its endogenous levels. The addition of short-chain ceramide to cell cultures first demonstrated 12 the involvement of ceramide in the apoptotic process, but it is not clear whether exogenous ceramide has the same cellular targets as the relevant endogenous species. 13 C 6 -ceramide accumulates in the Golgi apparatus, where it is converted to sphingomyelin and glycosphingolipids. 14,15 It also induces endocytic vesicle formation, resulting in enlarged late endosomes and lysosomes. 16 In situ generation of ceramide by bSMase appeared to be an alternative to the use of nonphysiologic ceramide species. However, bSMase probably generates ceramide in the external leaflet of the plasma membrane, which requires subsequent translocation in the membrane for propagation of the apoptotic signal. 17 The last option involves pharmacologic agents that elicit ceramide production. 1,3 Ceramide elevation should occur by blocking either its glycosylation or its hydrolysis into sphingosine. For example, DL-PDMP (a specific inhibitor of glucosylceramide synthase) either increases cellular ceramide levels 18 or does not 19,20 depending on the cellular model and the concentration used. D-MAPP functions as an inhibitor of alkaline ceramidase, resulting in elevation of ceramide levels in HL60 cells, with consequent growth suppression and cell-cycle arrest. 21 Imipramine can affect ceramide metabolism by inducing the proteolytic degradation of acid sphingomyelinase 22 and disturbing lipid turnover in biologic membranes. [23][24][25] Several studies have reported the killing of ca...