Rehabilitating lactate: From poison to cure

Indigophoton · May 23, 2018

George Brooks has been trying to reshape thinking about lactate—in the lab, the clinic and on the training field—for more than 40 years, and finally, it seems, people are listening. Lactate, it's becoming clear, is not a poison, it's the antidote.

In a recent article in the journal Cell Metabolism, Brooks, a professor of integrative biology at the University of California, Berkeley, reviews the history of the misunderstanding of lactate—often called lactic acid—a small molecule that plays a big role in metabolism. Typically labeled a "waste" product produced by muscles because lactate rises to high levels in the blood during extreme exercise, athletic trainers and competitive athletes think of lactate as the cause of muscle fatigue, reduced performance and pain.

Starting in the 1970s, however, Brooks, his students, postdoctoral fellows and staff were the first to show that lactate wasn't waste. It was a fuel produced by muscle cells all the time and often the preferred source of energy in the body: The brain and heart both run more efficiently and more strongly when fueled by lactate than by glucose, another fuel that circulates through the blood.

"It's a historic mistake," Brooks said. "It was thought that lactate is made in muscles when there is not enough oxygen. It has been thought to be a fatigue agent, a metabolic waste product, a metabolic poison. But the classic mistake was to note that when a cell was under stress, there was a lot of lactate, then blame it on lactate. The proper interpretation is that lactate production is a strain response, it's there to compensate for metabolic stress. It is the way cells push back on deficits in metabolism."
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The article, https://phys.org/news/2018-05-lactate-poison.amp

Abstract

Once thought to be a waste product of anaerobic metabolism, lactate is now known to form continuously under aerobic conditions. Shuttling between producer and consumer cells fulfills at least three purposes for lactate: (1) a major energy source, (2) the major gluconeogenic precursor, and (3) a signaling molecule. “Lactate shuttle” (LS) concepts describe the roles of lactate in delivery of oxidative and gluconeogenic substrates as well as in cell signaling. In medicine, it has long been recognized that the elevation of blood lactate correlates with illness or injury severity. However, with lactate shuttle theory in mind, some clinicians are now appreciating lactatemia as a “strain” and not a “stress” biomarker. In fact, clinical studies are utilizing lactate to treat pro-inflammatory conditions and to deliver optimal fuel for working muscles in sports medicine. The above, as well as historic and recent studies of lactate metabolism and shuttling, are discussed in the following review.
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The paper, https://www.cell.com/cell-metabolism/fulltext/S1550-4131(18)30186-4?

Full paper here, http://sci-hub.tw/10.1016/j.cmet.2018.03.008

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