Mechanistically it was shown that in colon epithelial cells, CerS4 is downregulated following treatment of the cells with hypoxia, which may be one reason for the decrease in long-chain sphingolipids in colon cancer, considering that hypoxia is a common phenomenon in solid tumours due to improper vascularization [42]. This evidence concerns the gene CERS4 and malignant colon neoplasm.