Johnson ML, Emhoff CW, Horning MA, Brooks GA. Transpulmonary lactate shuttle. Am J Physiol Regul Integr Comp Physiol 302: R143-R149, 2012. First published October 26, 2011 doi:10.1152/ajpregu.00402.2011.-The shuttling of intermediary metabolites such as lactate through the vasculature contributes to the dynamic energy and biosynthetic needs of tissues. Tracer kinetic studies offer a powerful tool to measure the metabolism of substrates like lactate that are simultaneously taken up from and released into the circulation by organs, but in each circulatory passage, the entire cardiac output traverses the pulmonary parenchyma. To determine whether transpulmonary lactate shuttling affects whole-body lactate kinetics in vivo, we examined the effects of a lactate load (via lactate clamp, LC) and epinephrine (Epi) stimulation on transpulmonary lactate kinetics in an anesthetized rat model using a primedcontinuous infusion of [U-13 C]lactate. Under all conditions studied, control 1.2 (SD 0.7) (Con), LC 1.9 (SD 2.5), and Epi 1.9 (SD 3.5) mg/min net transpulmonary lactate uptake occurred. 3) conditions, but negative during Epi stimulation, Ϫ25.3% (SD 45.5) when there occurred a transpulmonary production, the conversion of mixed central venous pyruvate to arterial lactate. Further, isotopic equilibration between L and P occurred following tracer lactate infusion, but depending on compartment (v or a) and physiological stimulus, [L]/[P] concentration and isotopic enrichment ratios ranged widely. We conclude that pulmonary arterial-vein concentration difference measurements across the lungs provide an incomplete, and perhaps misleading picture of parenchymal lactate metabolism, especially during epinephrine stimulation. lactate metabolism; lung; pyruvate metabolism; lactate kinetics EARLY RESEARCHERS DEMONSTRATED the ability of the lungs to produce lactate from glucose under fully aerobic conditions (9). Subsequent work identified the lungs as a complex metabolic organ with respect to carbohydrate intermediary metabolism; at times, the lungs were net consumers of lactate, while at other times, such as in patients with acute respiratory distress syndrome, the lungs released lactate on a net basis (1-3, 7, 20). In contrast, many studies were unable to show transpulmonary net uptake or release. Such determinations are complicated due to the high blood flow through the pulmonary circulation in relation to metabolic requirements of lung parenchyma (11, 23).
Using [U-14 C]glucose and an isolated perfused rat lung preparation Longmore and Mourning (22) demonstrated that the majority of lactate released during aerobic conditions was derived from glucose. However, upon exposure to hypoxia, lactate production nearly doubled in the preparation, but with only 60% of the lactate produced coming from glucose. When previously hypoxic lungs were reexposed to aerobic conditions, lactate release reverted to production exclusively from glucose. The work of Longmore and Mourning illustrates the diverse metabolic properties of lungs under condit...