Current concepts in lactate exchange.

There are several goals to this introductory paper in the symposium proceedings, "Current Concepts in Lactate Exchange." First, an attempt is made to set the historical context for the symposium and foreshadow how the paper of each participant contributes to our contemporary understanding of the field. As implied in the symposium title, an emphasis will be placed on the exchange of lactate for other metabolites and ions so that utilization can be temporally and spatially disassociated from formation. Thus, rather than a dead-end metabolite, which only accumulates during exercise, there appears to be great usefulness in the formation, exchange between cells, blood and organs, and utilization of lactic acid (lactate). Specific papers will deal with aspects of lactate release and uptake by skeletal muscle, hepatic lactate balance, the flux of dietary carbohydrate through various lactate pools in the synthesis of liver glycogen, lactate metabolism in the heart, properties of the sarcolemmal lactate transporter, and evolution of a model to predict lactate production from blood measurements. Second, in this review an attempt will be made to present and support a unifying hypothesis (the "lactate shuttle") in which the various aspects of lactate exchange may be integrated and understood. Emphasis will be placed on showing several corollaries between muscle and whole-body lactate metabolism. These are: temporal dependence on lactate uptake and release, the effects of beta-adrenergic stimulation on lactate formation and release, the effect of prior endurance training on lactate metabolism, the effect of lactate on glucose uptake and utilization, and the role of low oxygen tension (hypoxia) in loosening the control of glycolysis. The formation, exchange, and utilization of lactate represents a central means by which the coordination of intermediary metabolism in diverse tissues and different cells within tissues can be accomplished.