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Review Open Access

How lactate and lactylation shape the immunity system in atherosclerosis (Review)

  • Authors:
    • Yan Xiong
    • Jie Zhou
    • Junru Wang
    • Hui Huang
  • View Affiliations / Copyright

    Affiliations: Institute of Cardiovascular Diseases and Department of Cardiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, P.R. China, Department of Nephrology and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, P.R. China
    Copyright: © Xiong et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 163
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    Published online on: July 31, 2025
       https://doi.org/10.3892/ijmm.2025.5604
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Abstract

Atherosclerosis is a leading cause of cardiovascular diseases, causing significant morbidity and mortality. This review article examines the role of lactate and lactylation in atherosclerosis, a chronic inflammatory disease closely linked to lipid metabolism and immune system activation. Lactate, a metabolic byproduct and signaling molecule, has emerged as a key regulator of immune cell functions and epigenetic modifications. The article explores the mechanisms through which lactate and lactylation influence macrophage polarization, T‑cell differentiation and B‑cell metabolism, highlighting their complex dual roles in the progression of atherosclerosis. By modulating metabolic reprogramming, functional polarization and epigenetic regulation, lactate and lactylation significantly impact plaque formation and stability. These findings provide a foundation for developing novel therapeutic strategies targeting lactate metabolism and lactylation pathways.
View Figures

Figure 1

Lactate metabolism. As a pivotal
metabolic intermediate, lactate exerts pleiotropic effects in
cellular physiology: Firstly, it participates in cellular energy
metabolism through mitochondrial oxidative pathways, serving as a
substrate for ATP synthesis. Secondly, functioning as a crucial
donor molecule for post-translational modifications, lactate can
covalently modify target proteins such as histones via lactylation,
thereby modulating gene expression profiles. Furthermore, lactate
contributes to the homeostatic regulation of local tissue
microenvironments through mechanisms including extracellular pH
modulation and intercellular signaling. These three interconnected
functions collectively establish lactate's multifaceted role in
cellular metabolic regulation networks. The figure was created
using Adobe Illustrator 2020 (Adobe Inc.). ATP, adenosine
triphosphate; LDH, lactate dehydrogenase; CoA, coenzyme A; TCA,
tricarboxylic acid cycle; MCT1, monocarboxylate transporter 1;
GLUT1, glucose transporter 1F.

Figure 2

Immune system in atherosclerosis. The
immune system critically regulates atherosclerosis through
coordinated innate and adaptive immune responses. Key immune cells
(macrophages, T cells, dendritic cells) undergo metabolic
reprogramming that modulates their inflammatory activation within
plaques. Concurrently, cytokine networks amplify pro-inflammatory
signaling, promoting endothelial dysfunction and foam cell
formation. These interconnected immunometabolic processes sustain
vascular inflammation, driving plaque progression and
destabilization. Therapeutic targeting of these mechanisms holds
promise for atherosclerosis treatment. The figure was created using
Adobe Illustrator 2020 (Adobe Inc.). NK, natural killer.

Figure 3

Three isomers of lysine lactylation
modification. The lactylation process generates three distinct
lysine isomeric modifications: i) Kla, formed by covalent
conjugation of L-lactate to the ε-amino group of lysine; ii) Kce,
characterized by carboxyethylation at the ε-position of lysine; and
iii) Kd-la, representing the stereospecific D-lactate adduct. These
modifications exhibit unique structural characteristics: While both
Kla and Kd-la demonstrate the stereospecificity of their respective
L- and D-lactate precursors, Kce displays distinct electronic
properties due to its carboxylated side chain. The figure was
created using Adobe Illustrator 2020 (Adobe Inc.). Kla, lysine
L-lactylation; Kce, N-ε-(carboxyethyl)-lysine; Kd-la,
D-lactyl-lysine.

Figure 4

Lactate and Lactylation: Their
involvement in the immune system of atherosclerosis. Lactate and
its mediated lactylation modifications play a complex dual role in
atherosclerosis by regulating metabolic reprogramming, functional
polarization and epigenetic modifications of macrophages, T cells
and B cells. Lactate and lactylation exerts multifaceted effects on
immune cell functions, including metabolic reprogramming, cellular
polarization, differentiation, activation, proliferation and
migration. These regulatory effects may play crucial roles in
modulating immune responses, particularly in inflammation-related
and immune-regulated diseases. The figure was created using Adobe
Illustrator 2020 (Adobe Inc.).
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Copy and paste a formatted citation
Spandidos Publications style
Xiong Y, Zhou J, Wang J and Huang H: How lactate and lactylation shape the immunity system in atherosclerosis (Review). Int J Mol Med 56: 163, 2025.
APA
Xiong, Y., Zhou, J., Wang, J., & Huang, H. (2025). How lactate and lactylation shape the immunity system in atherosclerosis (Review). International Journal of Molecular Medicine, 56, 163. https://doi.org/10.3892/ijmm.2025.5604
MLA
Xiong, Y., Zhou, J., Wang, J., Huang, H."How lactate and lactylation shape the immunity system in atherosclerosis (Review)". International Journal of Molecular Medicine 56.4 (2025): 163.
Chicago
Xiong, Y., Zhou, J., Wang, J., Huang, H."How lactate and lactylation shape the immunity system in atherosclerosis (Review)". International Journal of Molecular Medicine 56, no. 4 (2025): 163. https://doi.org/10.3892/ijmm.2025.5604
Copy and paste a formatted citation
x
Spandidos Publications style
Xiong Y, Zhou J, Wang J and Huang H: How lactate and lactylation shape the immunity system in atherosclerosis (Review). Int J Mol Med 56: 163, 2025.
APA
Xiong, Y., Zhou, J., Wang, J., & Huang, H. (2025). How lactate and lactylation shape the immunity system in atherosclerosis (Review). International Journal of Molecular Medicine, 56, 163. https://doi.org/10.3892/ijmm.2025.5604
MLA
Xiong, Y., Zhou, J., Wang, J., Huang, H."How lactate and lactylation shape the immunity system in atherosclerosis (Review)". International Journal of Molecular Medicine 56.4 (2025): 163.
Chicago
Xiong, Y., Zhou, J., Wang, J., Huang, H."How lactate and lactylation shape the immunity system in atherosclerosis (Review)". International Journal of Molecular Medicine 56, no. 4 (2025): 163. https://doi.org/10.3892/ijmm.2025.5604
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