Lactate is no longer viewed as a passive end-product of the Warburg effect; instead, it plays an active role in shaping tumor biology and immune responses. In solid tumors, enhanced glycolysis and lactate export, along with proton handling, generate steep lactate and acidosis gradients that exert selective pressure on immune cells. Beyond competition for resources, lactate signals through specific receptors and drives epigenetic changes via lactylation, altering the transcriptional profiles of tumor, stromal, and immune cells. These processes lead to the suppression of cytotoxic T cells and natural killer cells, impair antigen presentation, and promote regulatory T cells and myeloid suppressor cells, which collectively contribute to the development of immune-resistant “cold” microenvironments. Targeting the lactate signaling pathway, whether by inhibiting lactate production, transport, pH buffering, or receptor signaling, provides a promising strategy to counteract metabolic immune suppression. This review integrates recent findings on lactate-driven immune remodeling, identifies potential therapeutic targets, and discusses how these strategies can be combined with immunotherapy and cellular treatments to improve outcomes. We also highlight the need for biomarkers to assess lactate-specific effects and distinguish them from those caused by acidosis.
Wang et al. (Mon,) studied this question.