Figure. 1. Effect of hypoxia and acidosis on immune function.

Hypoxia and acidosis are often associated with each other, and indeed hypoxia can lead to acidosis by upregulation of fermentation and acidosis can exacerbate hypoxia by inducing oxidative metabolism in otherwise non-hypoxic tissues. Under the light of accumulating evidence about the association of hypoxia and low pH with therapy resistance, different strategies have been developed to alleviate/ inhibit their effects (demonstrated on the top of the figure with red arrows). Blue arrows used to show the effects of hypoxia and acidosis on immune cells.