TLCD3B and Insulin resistance: C18:0 in skeletal muscle has been shown to cause insulin resistance in obese mice, and deficiency of the enzyme (ceramide-synthase-1—CerS1) producing C18:0 in skeletal muscle has been shown to be protective of insulin resistance in different studies.38,39 Whether BMI-lowering lifestyle modifications and novel enzyme inhibitors for ceramide synthases might contribute to normalization of ceramide levels in CCS are important questions that need to be addressed in future studies.40,41