Acid Stress-induced plasma membrane ceramide arises from lysosome-plasma membrane fusion

Plasma membrane ceramide (PMCer) is a recognized cellular signal that regulates stress responses, such as chemotherapy and membrane damage, triggering apoptosis and plasma membrane repair. Acid sphingomyelinase (ASM) has been proposed to generate PMCer by directly hydrolyzing plasma membrane sphingomyelin into ceramide. However, the enzymatic requirements of ASM are difficult to reconcile with the extracellular environment on the outer leaflet of the plasma membrane. Here, we identify several cellular stress inducers, with acidic stress yielding a stronger response in PMCer generation. Using this inducer, we defined a lysosome-to-plasma membrane pathway for stress-induced PMCer generation. Acidic stress increased PMCer in an ASM-dependent manner, whereas ASM loss or catalytic inactivation abolished this response. Although secreted ASM was enzymatically active when tested in vitro, neither secreted nor exogenous recombinant ASM generated PMCer. Instead, acidic stress induced lysosomal exocytosis, while disruption of lysosomal fusion reduced PMCer accumulation. Modulating lysosomal ceramide translated into PMCer, showing that lysosomal ceramide is directly transferred into the plasma membrane. These findings redefine stress-related PMCer signaling through lysosomal ceramide exocytosis.