“…Alcohol-related liver disease (ALD) is also associated with altered Cer profiles, steatohepatitis, insulin resistance, disruptions in lipid metabolism in hepatocytes, increased proinflammatory cytokines, dysregulated lipid metabolism, ER, and oxidative stress (53, 169,173). Altered lipid metabolism promotes Cer accumulation and oxidative stress, and these can result in a "lipotoxic state" in which there is activation of ER-stress pathways, inflammation, and insulin resistance (54,143,147).…”