The link between hepatic Cer accumulation, mitochondria-mediated apoptosis and NAFLD was clearly displayed in the study of Jiang et al. where chronic inhibition of the de novo pathway of ceramide synthesis by myriocin (an SPT inhibitor) in HFD-fed NAFLD rats impaired both hepatic ceramide accumulation and apoptosis as well as decreased inflammation and steatosis and improved indices of insulin resistance (116). This evidence concerns the gene AGXT and metabolic dysfunction-associated steatotic liver disease.