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Long-chain (LC) and very long-chain (VLC) ceramides have opposing functions, yet the associations of circulating levels of ceramide species in patients with IBD and primary sclerosing cholangitis (PSC)\u2014as inflammatory biliary-hepatic disease closely linked to IBD\u2014 with disease severity remain poorly studied. This study investigates whether serum levels of ceramide (Cer) and hexosylceramide, a glycated ceramide derivative, are associated with disease severity in these conditions. Serum levels of eight ceramide and five hexosylceramide species were measured in 16 healthy controls, 57 patients with IBD, 7 patients with PSC, and 13 patients with PSC-IBD. Lipid levels were determined using direct flow injection analysis with a triple quadrupole mass spectrometer. Patients with IBD exhibited higher levels of Cer 18:1;O2\/16:0 and Cer 18:1;O2\/18:0 compared to controls. Their LC\/VLC ceramide ratio was elevated and positively correlated with C-reactive protein and fecal calprotectin. However, ceramide and hexosylceramide levels were not associated with stool consistency, disease localization, or extra-intestinal manifestations. Patients with PSC and PSC-IBD also had increased LC\/VLC ceramide ratios, primarily due to a decline in VLC ceramide species. In PSC-IBD, this ratio correlated positively with cholestasis markers. Additionally, serum hexosylceramide 18:1;O2\/16:0 and 24:1 levels were specifically elevated in PSC. This study demonstrates that an altered LC\/VLC ceramide balance is associated with disease severity in IBD, PSC-IBD, and PSC, highlighting its potential as a biomarker for IBD, PSC-IBD, and PSC. As our PSC cohorts were small, a confirmatory study is required.<\/jats:p>","DOI":"10.1038\/s41598-025-07308-8","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T04:39:29Z","timestamp":1750826369000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Elevated long-to-very-long-chain ceramide ratio correlates with disease severity in inflammatory bowel disease and primary sclerosing cholangitis"],"prefix":"10.1038","volume":"15","author":[{"given":"Tanja","family":"Elger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muriel","family":"Huss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard","family":"Liebisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"H\u00f6ring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Loibl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne","family":"Kandulski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hauke Christian","family":"Tews","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christa","family":"Buechler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"7308_CR1","doi-asserted-by":"publisher","first-page":"113","DOI":"10.25122\/jml-2018-0075","volume":"12","author":"SS Seyedian","year":"2019","unstructured":"Seyedian, S. 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