A positive correlation has been reported between high levels of lactate and tumor progression in a variety of tumors [18, 19]. The relationship between lactate levels in the tumor microenvironment and T cell activation is a new concept in this context [20]. A significant decline in CTL cytolytic activity was observed in the low PH of the Tumor microenvironment in the tumor-bearing mice [21, 22]. In our study, we found that lactic acid decreased the function of T cells in vitro and it has an immunosuppressive impact on the proliferation of T cells. Prior studies have shown the inhibiting effect of lactate on effector T cell proliferation[23]. One of the known mechanisms that tumor cells utilize to limit T cell proliferation is lactate elevation which results in the blocking of glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and 3-phosphoglycerate dehydrogenase, leading to the depletion of subsequent glycolytic intermediates including the 3-phosphoglycerate derivative serine which is known to be an essential factor for proliferation of T cells [16]. We have observed that lactic acid could also impair the IL-2 and IFN-γ secretion of T cells. Consistent with previous findings it has been shown that lactic acid reduces IL-2, IFN-γ, and granzyme B expression in human T cells [24]. Brand et al. proposed that that intracellular acidification restricts NFAT regulation, a significant transcription factor involved in IFN-γ transcriptional control. Besides, acidification can also disrupt the translocation of NFAT to the nucleus [20, 25].
We assessed oxidative stress in T cells because it was previously shown that ROS perform as messengers for T cell receptor signaling in the steady-state and upon antigen recognition. Therefore, ROS play a critical role in T cell activation [26–28]. Here we investigated the production of ROS, superoxide and intracellular levels of GSH in T cells treated with lactate. We also examined gene expression of NOX-gp91phox as an oxidant molecule and SOD1, SOD2, Nrf2 and CAT as antioxidants. Since under normal conditions the levels of endogenous ROS are tightly regulated by different antioxidant systems inside the cell [29]. Significantly lower production of both oxidants and antioxidants was seen in the lactate-treated T cells. The levels of gene expression paralleled this. Our observations were not supported in a recent report showing a rapid and striking elevation of intracellular ROS which was caused by the exposure of activated CD4 + T cells to lactate [30]. However in that report the levels of ROS in T cells were measured in the presence of 10 mM of sodium lactate at three-time points. They assessed ROS at 5, 10 and 30’’ after the exposure of T cells to lactate. The levels of the ROS showed a downward trend from the first-time point to the third-time point. We investigated the amount of oxidant and antioxidant molecules after culturing T cells for 24h in the presence of 20mM of lactate. The duration of our test and lactate concentrations were different from those in the recent study [30]. The mechanism(s) through which lactate interrupts the redox system of T cells remains for future research.
A promising therapeutic strategy is to target the glycolysis pathway of tumor cells as the impairment of glucose metabolism could cause defects in tumor cells growth and survival [31, 32] It further decreases their lactate secretion and acidification of the tumor microenvironment that impairs the T and NK cells' anti-tumor immune responses [20, 22, 33]. Consequently, reducing the amounts of intratumoral lactate and acidification improves immunosurveillance potentially the effectiveness of cancer immunotherapies [12, 34–36].
In recent years DCA which already is used for the treatment of lactic acidosis has been considered as an anticancer agent [37, 38]. DCA targets cancer cells and inhibits pyruvate dehydrogenase kinase, the inhibitor of pyruvate dehydrogenase. Therefore, DCA alters the metabolism of tumors from glycolysis towards oxidative phosphorylation [39]. Activation of PDH induces pyruvate mitochondrial oxidation and limits the metabolic advantage of tumor cells. Besides, DCA could prevent acidosis in the tumor microenvironment by decreasing lactate secretion and thus leading to inhibition of tumor growth [40, 41]. The direct effects of DCA on cancer cells have been tested in most studies to date but here we have focused on evaluating the effects of DCA on tumor-derived lactic acid and its impact on T cells. Our results indicate that DCA can restore the T cell proliferative response and cytokine production from the suppressive effect of tumor-derived lactic acid. DCA also reduced apoptosis in T cells and preserved their viability. These data are in the line with the previous study in which diclofenac promoted anti-tumor response of T cell by reprogramming tumor glycolysis and inhibiting their lactic acid production [36]. Activation, viability, and effector functions of T cells were maintained in vitro following diclofenac treatment. They also showed that treatment of tumor cells with diclofenac caused an increase the in vitro anti- PD-1-mediated T cell killing of tumor cells. Diclofenac also enhanced the response to the anti-PD-1 blockade in tumor-bearing mice [36], as there was a negative correlation between response to anti-PD-1 therapy and metabolic genes overexpression [42]. To better understand the impact of DCA on checkpoint therapy we suggest further studies on using the combination of DCA and immune checkpoint inhibitors to treat tumors are warranted.