“…However, whether ROS derived from mitochondria or from an alternative subcellular source is responsible for perturbing mitochondrial respiratory function by the ECS remains unclear. In addition, insulin resistance has also been associated with an increase in mitochondrial ROS emission, but whether this occurs as a result of enhanced ECS activity remains unknown, although, somewhat paradoxically, ECS stimulation has been shown to decrease proton motive force in mitochondria (4,59,95,158,159). Indeed, it may be the case that the combined effect of enhanced ROS production alongside increased ceramide generation and/or calcium overload may collectively contribute toward an overall reduction in mitochondrial oxidative capacity and/or insulin sensitivity in response to ECS hyperactivation (18,130).…”