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PubMed2004

Early lactate clearance is associated with improved outcome in severe sepsis and septic shock.

OBJECTIVE: Serial lactate concentrations can be used to examine disease severity in the intensive care unit. This study examines the clinical utility of the lactate clearance before intensive care unit admission (during the most proximal period of disease presentation) as an indicator of outcome in severe sepsis and septic shock. We hypothesize that a high lactate clearance in 6 hrs is associated with decreased mortality rate. DESIGN: Prospective observational study. SETTING: An urban emergency department and intensive care unit over a 1-yr period. PATIENTS: A convenience cohort of patients with severe sepsis or septic shock. INTERVENTIONS: Therapy was initiated in the emergency department and continued in the intensive care unit, including central venous and arterial catheterization, antibiotics, fluid resuscitation, mechanical ventilation, vasopressors, and inotropes when appropriate. MEASUREMENTS AND MAIN RESULTS: Vital signs, laboratory values, and Acute Physiology and Chronic Health Evaluation (APACHE) II score were obtained at hour 0 (emergency department presentation), hour 6, and over the first 72 hrs of hospitalization. Therapy given in the emergency department and intensive care unit was recorded. Lactate clearance was defined as the percent decrease in lactate from emergency department presentation to hour 6. Logistic regression analysis was performed to determine independent variables associated with mortality. One hundred and eleven patients were enrolled with mean age 64.9 +/- 16.7 yrs, emergency department length of stay 6.3 +/- 3.2 hrs, and overall in-hospital mortality rate 42.3%. Baseline APACHE II score was 20.2 +/- 6.8 and lactate 6.9 +/- 4.6 mmol/L. Survivors compared with nonsurvivors had a lactate clearance of 38.1 +/- 34.6 vs. 12.0 +/- 51.6%, respectively (p =.005). Multivariate logistic regression analysis of statistically significant univariate variables showed lactate clearance to have a significant inverse relationship with mortality (p =.04). There was an approximately 11% decrease likelihood of mortality for each 10% increase in lactate clearance. Patients with a lactate clearance> or =10%, relative to patients with a lactate clearance <10%, had a greater decrease in APACHE II score over the 72-hr study period and a lower 60-day mortality rate (p =.007). CONCLUSIONS: Lactate clearance early in the hospital course may indicate a resolution of global tissue hypoxia and is associated with decreased mortality rate. Patients with higher lactate clearance after 6 hrs of emergency department intervention have improved outcome compared with those with lower lactate clearance.

Biomarkers↗
PubMed2001

The re-establishment of the normal blood lactate response to exercise in humans after prolonged acclimatization to altitude.

1. One to five weeks of chronic exposure to hypoxia has been shown to reduce peak blood lactate concentration compared to acute exposure to hypoxia during exercise, the high altitude 'lactate paradox'. However, we hypothesize that a sufficiently long exposure to hypoxia would result in a blood lactate and net lactate release from the active leg to an extent similar to that observed in acute hypoxia, independent of work intensity. 2. Six Danish lowlanders (25-26 years) were studied during graded incremental bicycle exercise under four conditions: at sea level breathing either ambient air (0 m normoxia) or a low-oxygen gas mixture (10 % O(2) in N(2), 0 m acute hypoxia) and after 9 weeks of acclimatization to 5260 m breathing either ambient air (5260 m chronic hypoxia) or a normoxic gas mixture (47 % O(2) in N(2), 5260 m acute normoxia). In addition, one-leg knee-extensor exercise was performed during 5260 m chronic hypoxia and 5260 m acute normoxia. 3. During incremental bicycle exercise, the arterial lactate concentrations were similar at sub-maximal work at 0 m acute hypoxia and 5260 m chronic hypoxia but higher compared to both 0 m normoxia and 5260 m acute normoxia. However, peak lactate concentration was similar under all conditions (10.0 +/- 1.3, 10.7 +/- 2.0, 10.9 +/- 2.3 and 11.0 +/- 1.0 mmol l(-1)) at 0 m normoxia, 0 m acute hypoxia, 5260 m chronic hypoxia and 5260 m acute normoxia, respectively. Despite a similar lactate concentration at sub-maximal and maximal workload, the net lactate release from the leg was lower during 0 m acute hypoxia (peak 8.4 +/- 1.6 mmol min(-1)) than at 5260 m chronic hypoxia (peak 12.8 +/- 2.2 mmol min(-1)). The same was observed for 0 m normoxia (peak 8.9 +/- 2.0 mmol min(-1)) compared to 5260 m acute normoxia (peak 12.6 +/- 3.6 mmol min(-1)). Exercise after acclimatization with a small muscle mass (one-leg knee-extensor) elicited similar lactate concentrations (peak 4.4 +/- 0.2 vs. 3.9 +/- 0.3 mmol l(-1)) and net lactate release (peak 16.4 +/- 1.8 vs. 14.3 mmol l(-1)) from the active leg at 5260 m chronic hypoxia and 5260 m acute normoxia. 4. In conclusion, in lowlanders acclimatized for 9 weeks to an altitude of 5260 m, the arterial lactate concentration was similar at 0 m acute hypoxia and 5260 m chronic hypoxia. The net lactate release from the active leg was higher at 5260 m chronic hypoxia compared to 0 m acute hypoxia, implying an enhanced lactate utilization with prolonged acclimatization to altitude. The present study clearly shows the absence of a lactate paradox in lowlanders sufficiently acclimatized to altitude.

Acclimatization↗
PubMed1997

Effects of lactate on the relative contribution of Ca2+ extrusion mechanisms to relaxation in guinea-pig ventricular myocytes.

1. The aim of this study was to investigate the effects of 20 mM extracellular lactate on Ca2+ regulation mechanisms in enzymatically isolated single guinea-pig cardiac myocytes. 2. The activities of the Ca2+ regulation mechanisms during application of lactate were studied using rapid cooling contractures (RCCs) and fast application of caffeine. Cytoplasmic Ca2+ was monitored using the fluorescent indicator indo-1. 3. After application of 20 mM lactate for 5 min, the diastolic level of Ca2+ was increased. The change in cytoplasmic Ca2+ elicited by stimulation (Ca2+ transient) was also changed. With lactate, the amplitude of the Ca2+ transient was smaller, and its time course was slower compared with control. 4. The recovery of cytoplasmic Ca2+ during rewarming after rapid cooling in lactate was slower than under control conditions. When the rewarming was performed either in Na(+)- and Ca(2+)-free solution or in the presence of 10 mM caffeine, the rate of recovery of cytoplasmic Ca2+ in lactate was slower than under control conditions, suggesting that the activity of both SR Ca2+ uptake and Na(+)-Ca2+ exchange is affected by lactate. 5. Cytoplasmic Ca2+ recovery during application of 10 mM caffeine in lactate was slower than in the control. The rate of recovery of the caffeine-induced transient inward current was also slower supporting the hypothesis of a slower Ca2+ extrusion brought about by Na(+)-Ca2+ exchange. 6. The relative contribution of the Ca2+ extrusion mechanisms in the presence of lactate was investigated using paired RCCs. In lactate, a second RCC (RCC2) induced immediately after recovery from the first (RCC1) was greatly reduced compared with the control. RCC2/RCC1 x 100 in lactate was 39% and RCC2/RCC1 x 100 in control conditions was 60%, suggesting that the net sarcoplasmic reticulum Ca2+ uptake is smaller in the presence of lactate. 7. When Na(+)-free Ca2+ solution was used during the paired RCCs and rewarming, RCC2/RCC1 x 100 was increased to 96 and 95% in lactate and control conditions, respectively, implying that Ca2+ efflux from the cell can be maintained by the Na(+)-Ca2+ exchanger and that other Ca2+ removal mechanisms (mitochondria and sarcolemmal Ca(2+)-ATPase) remain largely unchanged in the presence of lactate.

Animals↗
PubMed1997

Association between blood lactate and acid-base status and mortality in ventilated babies.

AIM: To investigate the relation between common acid-base parameters and blood lactate concentrations and their prognostic importance in sick, ventilated neonates. METHODS: Two hundred and seventy eight serial simultaneous measurements of arterial acid-base status and blood lactate concentrations were carried out in 75 mechanically ventilated neonates with indwelling arterial catheters (gestational age and birthweight, median (range) -29 (23-40) weeks, and 1340 (550-4080) g, respectively). RESULTS: There were no correlations between arterial blood lactate and pH and base excess within subjects (r = 0.07 and r = -0.06, respectively) and only weakly positive but clinically irrelevant positive correlations between subjects (r = 0.28 and r = 0.27) in this group. Even in those infants who had not received any bicarbonate before their initial measurements (n = 48), there were no correlations between initial blood lactate concentrations and pH (r = 0.27), base excess (r = 0.17), or serum bicarbonate concentrations (r = -0.18). There was no relation between peak lactate concentration (PLC) and base excess (r = 0.16), and only a weak correlation between peak lactate concentration (PLC) and pH (r = 0.28). Negative base excess was an insensitive indicator of raised lactate concentrations. Only two out of 33 (6%) instances of hyperlactataemia (lactate > 2.5 mmol/l) would have been identified with a base excess < -10 mmol/l as a cutoff. Lower cutoff values of base excess or pH performed no better. Raised lactate concentrations were associated with increased mortality at all levels. While six of 53 (11%) infants with a PLC < 2.5 mmol/l died, this proportion increased to four of 15 (27%) with a PLC between 2.5-5.0 mmol/l, and four of seven (57%) with a PLC > 5.0 mmol/l. Infants showing little rise or a substantial fall in blood lactate fared better than those with persistently raised values. A clinically important increase in blood lactate preceded the development of clinical markers of deterioration and complications in six infants. CONCLUSIONS: Contrary to popular belief, pH or base excess cannot be used as proxy measures for blood lactate concentration, and independent measurement of the latter are needed. Blood lactate concentrations may provide an early warning signal and important prognostic information in ill, ventilated neonates. In this regard, serial measurements of blood lactate are more useful than a single value.

Acid-Base Equilibrium↗
PubMed1996

Effect of 2-chloropropionate on initial lactate uptake by rat skeletal muscle sarcolemmal vesicles.

2-Chloropropionate (2-CP) is a halogenated monocarboxylic acid generally used to decrease blood lactate concentration in various metabolic states. To investigate whether it has an inhibitory effect on sarcolemmal lactate transport, we compared the initial rate of lactate transport in sarcolemmal membrane vesicles purified from 20 male Wistar rats with and without 2-CP. Transport by these vesicles was measured as uptake of L-(+)-[U-14C]lactate under pH gradient-stimulated cis inhibition. The time courses of 1 mM L-(+)-lactate uptake into vesicles both with and without 10 mM 2-CP (L- or D-) displayed saturation kinetics. Lactate uptake values were lower with 10 mM L-2-CP and 10 mM D-2-CP in comparison to the control values. Both 10 mM L-2-CP and 10 mM D-2-CP significantly inhibited 1 mM L-(+)-lactate uptake (55.8 +/- 9.1 and 53.5 +/- 12.1%, respectively; P < 0.001), whereas a smaller inhibition was observed with a higher lactate concentration of 50 mM (40.2 +/- 11.2 and 38.7 +/- 12.4%; P < 0.001 and P < 0.05, respectively). However, a higher D-2-CP concentration (50 mM) increased the inhibition of pH-stimulated 1 mM L-(+)-lactate uptake (77.0 +/- 9.4%; P < 0.001). D-2-CP had a trans-stimulation effect on the initial rate of lactate efflux of 1 mM L-(+)-lactate compared with baseline efflux (9.5 +/- 0.8 vs. 5.1 +/- 0.4 nmol.min-1.mg protein-1; P < 0.05). 2-CP significantly inhibited the initial rate of lactate uptake in skeletal muscle sarcolemmal membrane vesicles. This result suggests that 2-CP is a nonstereoselective substrate of the lactate muscle carrier that impairs lactate transport.

Animals↗
PubMed1999

Lactate transport activity in rat skeletal muscle sarcolemmal vesicles after acute exhaustive exercise.

The effect of a single bout of exhaustive exercise on muscle lactate transport capacity was studied in rat skeletal muscle sarcolemmal (SL) vesicles. Rats were assigned to a control (C) group (n = 14) or an acutely exercised (E) group (n = 20). Exercise consisted of treadmill running (25 m/min, 10% grade) to exhaustion. SL vesicles purified from C and E rats were sealed because of sensitivity to osmotic forces. The time course of 1 mM lactate uptake in zero-trans conditions showed that the equilibrium level in the E group was significantly lower than in the C group (P < 0.05). The initial rate of 1 mM lactate uptake decreased significantly from 2.44 +/- 0.22 to 1.03 +/- 0.08 nmol. min(-1). mg protein(-1) (P < 0.05) after exercise, whereas that of 50 mM lactate uptake did not differ significantly between the two groups. For 100 mM external lactate concentration ([lactate]), exhaustive exercise increased initial rates of lactate uptake (219.6 +/- 36.3 to 465.4 +/- 80.2 nmol. min(-1). mg protein(-1), P < 0.05). Although saturation kinetics were observed in the C group with a maximal transport velocity of 233 nmol. min(-1). mg protein(-1) and a Michealis-Menten constant of 24.5 mM, saturation properties were not seen after exhaustive exercise in the E group, because initial rates of lactate uptake increased linearly with external [lactate]. We conclude that a single bout of exhaustive exercise significantly modified SL lactate transport activity, resulting in a decrease in 1 mM lactate uptake and was associated with alterations in the saturable properties at [lactate] above 50 mM. These results suggest that changes in sarcolemmal lactate transport activity may alter lactate and proton exchanges after exhaustive exercise.

Animals↗
PubMed1996

Lactation after augmentation mammoplasty.

OBJECTIVE: To compare the lactation outcomes of breast-augmented women and nonaugmented women. METHODS: This study used a retrospective, comparative design. Demographic and descriptive data were obtained from client records maintained by a lactation support program at a large children's hospital in the southwest United States. The association between breast augmentation and lactation outcome in the two groups was investigated by obtaining data from these existing records. RESULTS: A significantly greater incidence of lactation insufficiency was found in augmented women compared with nonaugmented women (P < .001). Among 42 augmented women, 27 (64%) had insufficient lactation, compared with only three (less than 7%) of the 42 nonaugmented women. Augmented women who experienced sufficient lactation were equivalent in age, ethnicity, type of delivery, smoking, previous breast-feeding experience, and lactation course compared to augmented women with lactation insufficiency. However, the type of breast incision was significantly associated with lactation outcome. More specifically, it was the periareolar approach that was most significantly associated with lactation insufficiency (P < .01). The incidence of lactation insufficiency with the submammary-axillary approach was only statistically significant when compared with nonaugmented women. CONCLUSION: A significantly greater incidence of insufficient lactation was found among augmented women compared with nonaugmented women. The periareolar approach was most significantly associated with lactation insufficiency.

Adult↗
PubMed1991

Transport of lactate in Plasmodium falciparum-infected human erythrocytes.

The intraerythrocytic human malarial parasite Plasmodium falciparum produces lactate at a rate that exceeds the maximal capacity of the normal red cell membrane to transport lactate. In order to establish how the infected cell removes this excess lactate, the transport of lactate across the host cell and the parasite membranes has been investigated. Transport of radiolabeled L-lactate across the host cell membrane was shown to increase ca. 600-fold compared to uninfected erythrocytes. It showed no saturation with [L-lactate] and was inhibited by inhibitors of the monocarboxylate carrier, cinnamic acid derivatives (CADs), but not by the SH-reagent p-chloromercuriphenyl sulfonic acid (PCMBS). These results suggest that L-lactate is translocated through CAD-inhibitable new pathways induced in the host cell membrane by parasite activity, probably by diffusion of the acid form and through a modified native monocarboxylate:H+ symporter. Continuous monitoring of extracellular pH changes occurring upon suspension of infected cells in isoosmotic Na-lactate solutions indicates that part of the lactate egress is mediated by anionic exchange through the constitutive, but modified, anion exchanger. The transport of L-lactate across the parasite membrane is rapid, nonsaturating, and insensitive to either CADs or PCMBS, or to the presence of pyruvate. L-lactate uptake increased transiently when external pH was lowered and decreased when delta pH was dissipated by the protonophore carbonylcyanide m-chlorophenyl hydrazone (CCCP). These results are compatible with L-lactate crossing the parasite membrane either as the undissociated acid or by means of a novel type of lactate-/H+ symport.

4-Chloromercuribenzenesulfonate↗
PubMed1988

Incubation of mouse sperm with lactate delays capacitation and hyperactivation and lowers fertilization levels in vitro.

Mouse sperm were incubated in medium with or without 24 mM lactate and assessed for 1) motility characteristics including hyperactivation--a computer-assisted motion analysis system was used; 2) capacitation--a chlortetracycline fluorescent dye binding assay was used; and 3) ability to penetrate oocytes. Lactate affected all aspects of motility and delayed the rates of both hyperactivation and capacitation. When a concentration of 8 x 10(3) sperm/ml was used for insemination in vitro, sperm preincubated 60-90 minutes in medium with lactate prior to insemination in lactate-free medium fertilized fewer oocytes than did sperm preincubated in lactate-free medium. Use of a calcium-sensitive electrode demonstrated that lactate chelated appreciable amounts of calcium in the medium. Capacitation was assayed in sperm incubated 60 minutes in medium with various concentrations of lactate or CaCl2. When medium containing lactate was compared to medium without lactate but having a similar level of free calcium, the level of capacitation of sperm incubated with lactate was less than half that of sperm incubated without lactate. These results demonstrate that including 24 mM lactate in the medium can have detrimental effects on mouse sperm hyperactivation and capacitation. The detrimental effects on capacitation are partly but not completely due to the chelation of calcium by lactate.

Animals↗
PubMed1994

Facilitated transport of lactate by rabbit corneal endothelium.

Proton coupled lactate transport across the rabbit corneal endothelium was studied using a pH-sensitive intracellular fluorescent probe. Functional indications that lactate transport is carrier-mediated and coupled to H+ at the apical endothelium (aqueous humor facing) that were found were: (1) proton influx was a saturable function of lactate concentration; (2) L-lactate produced a faster maximal H+ influx and had a higher affinity for the transporter (Vmax = 1.6 mM min-1, apparent K1/2 = 31 mM) than its optical isomer, D-Lactate (Vmax = 0.9 mM min-1, apparent K1/2 = 59 mM); (3) the lactate-induced acidification was inhibitable by apical mersalyl acid. These results are consistent with the presence of an apical lac-:H+ cotransporter. On basolateral addition of lactate to a de-epithelialized cornea, the endothelial cells transiently acidified by 0.05 units, but then alkalinized by 0.07, 0.02 units over baseline. The basolateral lactate-induced acidification was inhibited by 75% by mersalyl acid, while the net alkalinization observed under control conditions was unaffected. The alkalinization was Na(+)-dependent yet amiloride-insensitive. Alkalinization on addition of basolateral lactate could also be inhibited by apical mersalyl. These results suggest that the acidification represents lactate influx through basolateral Lac-:H+ cotransport while the net alkalinization is due to basolateral Na(+)-dependent lactate uptake and lactate efflux through apical Lac-:H+ cotransport. These facilitated transport mechanisms could provide for the efficient removal of lactate from the highly glycolytic cornea.

Animals↗
PubMed1992

The nucleotide metabolism in lactate perfused hearts under ischaemic and reperfused conditions.

It was examined whether lactate influences postischaemic hemodynamic recovery as a function of the duration of ischaemia and whether changes in high-energy phosphate metabolism under ischaemic and reperfused conditions could be held responsible for impairment of cardiac function. To this end, isolated working rat hearts were perfused with either glucose (11 mM), glucose (11 mM) plus lactate (5 mM) or glucose (11 mM) plus pyruvate (5 mM). The extent of ischaemic injury was varied by changing the intervals of ischaemia, i.e. 15, 30 and 45 min. Perfusion by lactate evoked marked depression of functional recovery after 30 min of ischaemia. Perfusion by pyruvate resulted in marked decline of cardiac function after 45 min of ischaemia, while in glucose perfused hearts hemodynamic performance was still recovered to some extent after 45 min of ischaemia. Hence, lactate accelerates postischaemic hemodynamic impairment compared to glucose and pyruvate. The marked decline in functional recovery of the lactate perfused hearts cannot be ascribed to the extent of degradation of high-energy phosphates during ischaemia as compared to glucose and pyruvate perfused hearts. Glycolytic ATP formation (evaluated by the rate of lactate production) can neither be responsible for loss of cardiac function in the lactate perfused hearts. Moreover, failure of reenergization during reperfusion, the amount of nucleosides and oxypurines lost or the level of high-energy phosphates at the end of reperfusion cannot explain lactate-induced impairment. Alternatively, the accumulation of endogenous lactate may have contributed to ischaemic damage in the lactate perfused hearts after 30 min of ischaemia as it was higher in the lactate than in the glucose or pyruvate perfused hearts. It cannot be excluded that possible beneficial effects of the elevated glycolytic ATP formation during 15 to 30 min of ischaemia in the lactate perfused hearts are counterbalanced by the detrimental effects of lactate accumulation.

Adenosine↗
PubMed1993

Lactate disposal in resting trained and untrained forearm skeletal muscle during high intensity leg exercise.

At a given oxygen uptake (VO2) and exercise intensity blood lactate concentrations are lower following endurance training. While decreased production of lactate by trained skeletal muscle is the commonly accepted cause, the contribution from increased lactate removal, comprising both uptake and metabolic disposal, has been less frequently examined. In the present study the role of resting skeletal muscle in the removal of an arterial lactate load (approximately 11 mmol.l-1) generated during high intensity supine leg exercise (20 min at approximately 83% maximal oxygen uptake) was compared in the untrained (UT) and trained (T) forearms of five male squash players. Forearm blood flow and the venoarterial lactate concentration gradient were measured and a modified form of the Fick equation used to determine the relative contributions to lactate removal of passive uptake and metabolic disposal. Significant lactate uptake and disposal were observed in both forearms without any change in forearm VO2. Neither the quantity of lactate taken up [UT, 344.2 (SEM 118.8) mumol.100 ml-1; T, 330.3 (SEM 85.3) mumol.100 ml-1] nor the quantity disposed of [UT, 284.0 (SEM 123.3) mumol.100 ml-1, approximately 83% of lactate uptake; T, 300.8 (SEM 77.7) mumol.100 ml-1, approximately 91% of lactate uptake] differed between the two forearms. It is concluded that while significant lactate disposal occurs in resting skeletal muscle during high intensity exercise the lower blood lactate concentrations following endurance training are unlikely to result from an increase in lactate removal by resting trained skeletal muscle.

Adult↗
PubMed2005

Clinical evaluation of a portable lactate meter in type I glycogen storage disease.

High lactate concentrations occur in type I glycogen storage disease (GSD) whenever glycogenolysis occurs. Not only does hyperlactataemia cause acute clinical deterioration, but chronic lactate elevations have also been associated with many of the long-term complications in GSD. A portable finger-stick blood lactate meter has recently been marketed as a training tool for high-performance athletes, but it has not been tested as a clinical diagnostic tool. This study was performed to assess the accuracy of the portable lactate meter in subjects with GSD I who are predisposed to high lactate concentrations. A total of 166 intravenous and 39 capillary samples from 13 subjects were tested concomitantly on three different lactate meters. The meter readings were compared with the lactate concentration determined by the laboratory gold-standard enzymatic colorimetric assay. Almost no inter-meter variability was found. The lactate meter values had outstanding correlation with the laboratory lactate determination, although the meters were found to run 0.5 mmol/L higher than the laboratory assay. The meter deviation was independent of lactate concentration. More variability was noted with finger-stick capillary lactate determinations, but monitoring of trends with capillary samples should prove valuable as a method for determining long-term control or acute deterioration. The portable lactate meter is a highly accurate tool for monitoring lactate concentrations, and should prove valuable for monitoring metabolic control in patients with GSD type I and other disorders associated with hyperlactataemia.

Adolescent↗
PubMed1991

Inhibition of lactate-induced swelling by dichloroacetate in human astrocytoma cells.

High levels of tissue lactate exacerbate tissue damage that results from cerebral ischemia and reperfusion injury that follows. Post-ischemic treatment with dichloroacetate (DCA) facilitates a decrease in lactate in the central nervous system (CNS) of animals during reperfusion following experimental ischemia, thus it may help to ameliorate ischemic cell damage. It has been suggested that the lactate lowering effect is mediated through a stimulatory effect of DCA on pyruvate dehydrogenase (PDHC) activity. We have studied such a hypothesis in a human astrocytoma derived cell line, UC-11MG. Under conditions resembling those of the ischemic tissue (i.e. high lactate and low pH) these cells accumulate lactate, driven by the inwardly directed proton gradient, and swell as a consequence of the osmotic effect of intracellular lactate. We have demonstrated that DCA increases PDHC activity and also reduces lactate-induced swelling. However, we also found that these two effects could be uncoupled and that the ability of DCA to prevent swelling is still present in the absence of any stimulation of PDHC. We also demonstrated that DCA competitively inhibits the uptake of lactate (Ki = 1.9 mM) and increases the efflux of lactate in a trans-acting manner that suggests the presence of a lactate-DCA exchange. We present a mechanism by which reduction in the rate of lactate uptake could account for the observed inhibition of swelling. This effect of DCA on lactate transport indicates another possible mechanism of action for DCA in facilitating the decrease in lactate observed in vivo during reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Astrocytoma↗
PubMed1987

Regulation of T-cell functions by L-lactate.

Lactate is a product of glycolytically active macrophages. After stimulation with concanavalin A accessory cell-depleted splenic T-cell populations were found to produce only minute amounts of T-cell growth factor (TCGF); but substantial amounts of TCGF were produced if the cultures were supplemented either with splenic adherent cells or with lactate but not with interleukin-1 (IL-1). IL-1 was capable, however, of supporting TCGF production by the thymoma subline EL4-6.1. TCGF production in cultures of accessory cell-depleted splenic T-cell populations was demonstrable with 10(-3) M L-lactate, and optimal responses (plateau level) were obtained with 4-6 X 10(-2) M L-lactate. Cultures of macrophages were found to accumulate up to 5 X 10(-2) M lactate. Our experiments indicate, therefore, that lactate serves as a regulatory signal by which macrophage-like accessory cells enhance helper-T-cell functions. Lactate is apparently not the only mediator of accessory cell function since plateau levels of TCGF production were markedly lower with lactate than with splenic accessory cells; but L-lactate was found also to determine the magnitude of T-cell-mediated immune responses in vivo and in cultures of unfractionated lymphocyte populations. The production of interferon in accessory cell-depleted and concanavalin A-treated T-cell cultures, however, was not significantly affected by lactate. Concanavalin A-stimulated splenic T-cell populations were found to consume glucose rapidly and to release lactate into the supernatant. This indicates that the cells contain more lactate and pyruvate than they can utilize by their respiratory metabolism. The administration of external lactate or pyruvate was found to inhibit the utilization of glucose by the mitogenically stimulated T cells.

Animals↗
PubMed1994

Control of lactate utilization by extracellular pH in isolated rat liver cells.

This study reports the influence of external pH on lactate balance in hepatocytes isolated from fed and 24-hour-starved rats. The effects of changes in extracellular pH on the utilization of lactate by liver cells has been studied in conditions simulating metabolic acidosis (pH 7.15, 10 mmol/L bicarbonate). The addition of lactate to a suspension of liver cells from fed rats shifted the lactate balance from net release to net utilization; the threshold of this shift was about 3 mmol/L in the presence of 10 mmol/L glucose. In these cells, acidic external pH (7.15) played a crucial role in stimulating the lactate utilization as shown by (1) a diminished release of lactate in the absence of lactate addition (-60%); (2) a marked decrease of the threshold of lactate utilization down to 1.2 mmol/L; and (3) a net stimulation of the lactate utilization for concentrations in the physiologic range (2 to 3 mmol/L). The effect of acidosis was mediated by an inhibition of glycolysis (-40%). Besides that, at pH 7.45, the addition of 100 mumol/L AICA-riboside 5-amino-4-imidazolecarboxamide riboside, (an inhibitor of hepatic glycolysis) mimicked the effect of acidosis. Moreover, differences in lactate fluxes between the two pH conditions were decreased in the absence of glucose. In liver cells from starved rats, regardless of the concentration of added lactate, the lactate balance was always directed toward net utilization. Accordingly, a change in external pH from 7.45 to 7.15 had a lesser effect on lactate metabolism than in liver cells from fed rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Aminoimidazole Carboxamide↗
PubMed2004

Milk production and composition in reindeer (Rangifer tarandus): effect of lactational stage.

Milk yield and composition of major milk constituents were measured in captive, nursing reindeer. Registration of milk production was performed during two successive lactations (2001 and 2002). The milk yield was significantly affected by week of lactation (P<0.001) and by individual (P<0.001). The lactation curve had an asymmetrical peak 3 weeks postpartum and the milk yield at peak lactation was 983 g/day (range 595-1239). The length of lactation varied from 24 to 26 weeks and average total milk production was 99.5 kg. From peak lactation the milk production decreased linearly (P<0.001) until milk production was terminated. Mean values for content of major milk constituents were 15.5% fat, 9.9% protein and 2.5% lactose. The content of fat and protein increased markedly with the lactation stage (P<0.001), while lactose showed a slight decrease (P<0.001). The milk composition was significantly affected by stage of lactation (P<0.001). There was a marginally significant decrease in protein:fat ratio (P=0.06) as protein was substituted by fat with stage of lactation. The caloric value of the milk averaged 8.7 kJ/g and increased significantly with the stage of lactation (P<0.001). The overall increase in milk gross energy content during lactation was 67.6%. The energy output averaged 7996 kJ/day at peak lactation and decreased significantly during the course of lactation (P=0.002).

Animals↗
PubMed1997

ED use of rapid lactate to evaluate patients with acute chest pain.

STUDY OBJECTIVE: To test the hypothesis that ED arrival venous lactate levels can be used to diagnose acute myocardial infarction (AMI) and to identify patients with critical illness in the triage of ED patients presenting with chest pain. METHODS: This was a prospective, double-blind, clinical study in an urban, academic ED. We enrolled a convenience sample of adult patients who had chest pain or cardiac symptoms suggesting AMI that began within 24 hours of presentation. Patients underwent standard medical management for their chest pain. Venous lactate samples were analyzed in the ED on whole blood. An abnormal lactate level of 1.5 mmol/L or higher at the time of arrival was prospectively defined as indicating the presence of acute cardiac disease. ECG findings, levels of creatine phosphokinase (CK) and CK-MB, hospital stay data, and diagnosis of AMI by the cardiology admitting team were recorded. RESULTS: Of the 129 patients included in the study, 73 had an initial lactate level of 1.5 mmol/L or higher. The mean lactate level (+/- SD) for all patients was 1.8 +/- 1.2 mmol/L. A total of 28 patients (21%) were diagnosed with AMI and had a mean lactate level of 2.2 +/- .7 mmol/L, compared with 1.7 +/- 1.3 mmol/L in those patients who were not diagnosed with AMI (P < .03). The sensitivity of this lactate level in diagnosing AMI was 96% (95% confidence interval [CI], 89% to 100%), and the specificity was 55% (95% CI, 45% to 64%). The negative predictive value of blood lactate was 98% (95% CI, 95% to 100%). Lactate was elevated independent of the duration of chest pain symptoms, with a median time from onset to sampling of 3 hours. Lactate was elevated in patients who either died or required longer than 48 hours of ICU care, compared with survivors not requiring ICU care (4.5 +/- 4.3 mmol/L versus 1.4 +/- .6 mmol/L, respectively; P < .01). CONCLUSION: The blood lactate concentration obtained on ED arrival identifies those chest pain patients with critical cardiac illness (eg, AMI, severe congestive heart failure [CHF], decompensated arrhythmias). A normal blood lactate result has a high negative predictive value for AMI. An elevated lactate level used in conjunction with ECG and history distinguishes patients with significant myocardium at risk who are likely to benefit from more urgent attention and interventions by the attending physician. Additionally, hyperlactatemia clearly correlates with mortality and the need for ICU management in the acute cardiac patient presenting to the ED.

Adult↗