FIGURE 5.

The dual role of lactate in central and peripheral functions. Lactate produced by skeletal muscle enters the periphery through MCTs to provide energy, resist lipolysis, promote osteoblast differentiation, and promote muscle hypertrophy. Upon entering the central region, lactate undergoes enzymatic conversion to pyruvate by lactate dehydrogenase, serving as a vital energy source within the tricarboxylic acid cycle (TCA). Concurrently, lactate activates the AMPK/SIRT1/PGC-1α pathways, leading to the mitigation of oxidative stress, inflammation, and apoptosis. In a distinct role, lactate functions as a signaling molecule. A portion of it engages with the lactate receptor GPR81, modulating ERK1/2 signaling, while another portion influences the glutamate receptor NMDAR via intracellular signaling. These integrated actions collectively foster neurogenesis, angiogenesis, and synaptic plasticity, ultimately enhancing the prognosis for patients afflicted by NDs.