. Ceramide synthase is essential for endonuclease-mediated death of renal tubular epithelial cells induced by hypoxia reoxygenation. Am J Physiol Renal Physiol 288: F308 -F314, 2005. First published October 12, 2004 doi:10.1152/ajprenal.00204.2004.-Ceramide is known to play a role in the cell signaling pathway involved in apoptosis. Most studies suggest that enhanced ceramide generation is the result of hydrolysis of sphingomyelin by sphingomyelinases. However, the role of ceramide synthase in enhanced ceramide generation has not been previously examined in hypoxia-reoxygenation injury. In the present study, we demonstrated that 60-min hypoxia of rat renal tubular epithelial NRK-52E cells in a gas chamber with 95% N2-5% CO2 with glucose deprivation resulted in a significant increase in ceramide generation. The ceramide level further increased after reoxygenation for 60 min. Exposure of cells to hypoxia-reoxygenation resulted in a significant increase in ceramide synthase activity without any significant change in acid or neutral sphingomyelinase. The hypoxia-reoxygenation of NRK-52E cells was also associated with the release of endonuclease G (EndoG) from mitochondria to cytoplasm measured by Western blot analysis and endonuclease activity assay. It further led to the fragmentation of DNA and cell death. A specific inhibitor of ceramide synthase, fumonisin B1 (50 M), suppressed hypoxia-reoxygenationinduced ceramide generation and provided protection against hypoxia-reoxygenation-induced EndoG release, DNA fragmentation, and cell death. Taken together, our data suggest that hypoxia-reoxygenation results in an activation of ceramide synthase rather than sphingomyelinase and that ceramide synthase-dependent ceramide generation is a key modulator of EndoG-mediated cytotoxicity in hypoxiareoxygenation injury to renal tubular epithelial cells. kidney; NRK-52E cells; fumonisin B1; endonuclease G; DNA fragmentation BOTH HYPOXIA-REOXYGENATION of renal cells in vitro and kidney ischemia-reperfusion injury in vivo are strongly associated with cell death (3). Ceramide, a metabolite of sphingolipids, participates in cell death signaling pathways (16,17,22). Although the role of ceramide has been studied in apoptotic cell death in response to a variety of stimuli, there is limited information of a role of ceramide in hypoxia-reoxygenation injury. In vivo studies of ischemic injury to the kidney (39, 40) or brain (19) as well as in vitro study of hypoxic injury to cultured PC12 cells (37) have shown an increase in ceramide level. However, the cause-effect relationship between an alteration of ceramide and cytotoxicity is not known in hypoxiareoxygenation injury to renal tubular epithelial cells, and the pathways for ceramide generation in ischemia-reperfusion or hypoxia-reoxygenation injury remain to be elucidated.Ceramide is generated by the two major pathways: condensation of sphingosine or sphinganine and fatty acyl-CoA by ceramide synthase or by hydrolysis of sphingomyelin by sphingomyelinases (16,17,22). Several studies...