Supplementary key words glucosylceramide • harlequin ichthyosis • skin permeability barrier • ABCA12 antibodyHarlequin ichthyosis (HI) is a severe autosomal recessive disease caused by mutations in the ABCA12 lipid transporter ( 1,2 ). HI patients present with a drastically hyperkeratotic epidermis and have a complete loss of the skin permeability barrier function. Poor temperature regulation, enhanced water loss, and bacterial super-infections develop as a consequence of defects in the barrier function of HI skin, making neonatal survival diffi cult without intensive treatment ( 3-6 ).The epidermis is responsible for the formation and maintenance of the skin barrier function ( 7 ). A critical component of this barrier is the extracellular lipid domains that surround the corneocytes of the stratum corneum (SC). These interstitial lipid domains are organized in lamellar structures and consist primarily of cholesterol, fatty acid, and ceramides ( 8 ). Ceramides comprise about half of the total lipids in the SC and are essential for the lamellar structure of this extracellular lipid domain ( 8-10 ). They are synthesized exclusively from glucosylceramide (GlcCer) and sphingomyelin (SM) precursors, which are generated in nucleated keratinocytes and stored in lamellar bodies (LB). As the keratinocyte matures, the contents of the LB are extruded into the interstices of the SC where the GlcCer and SM are enzymatically hydrolyzed to Cer by  -glucocerebrosidase (GCase) and sphingomyelinase Abstract ABCA12 mutations disrupt the skin barrier and cause harlequin ichthyosis. We previously showed Abca12 ؊ / ؊ skin has increased glucosylceramide (GlcCer) and correspondingly lower amounts of ceramide (Cer). To examine why loss of ABCA12 leads to accumulation of GlcCer, de novo sphingolipid synthesis was assayed using [ 14 C]serine labeling in ex vivo skin cultures. A defect was found in  -glucocerebrosidase (GCase) processing of newly synthesized GlcCer species. This was not due to a decline in GCase function. Abca12 ؊ / ؊ epidermis had 5-fold more GCase protein (n = 4, P < 0.01), and a 5-fold increase in GCase activity (n = 3, P < 0.05). As with Abca12 +/+ epidermis, immunostaining in null skin showed a typical interstitial distribution of the GCase protein in the Abca12 ؊ / ؊ stratum corneum. Hence, we tested whether the block in GlcCer conversion could be circumvented by topically providing GlcCer. This approach restored up to 15% of the lost Cer products of GCase activity in the Abca12 ؊ / ؊ epidermis. However, this level of barrier ceramide replacement did not signifi cantly reduce transepidermal water loss function. Our results indicate loss of ABCA12 function results in a failure of precursor GlcCer substrate to productively interact with an intact GCase enzyme, and they support a model of ABCA12 function that is critical for transporting GlcCer into lamellar bodies.