Lactate dynamics in Parkinson's disease: striatal circuit vulnerability, biomarker potential, and therapeutic windows.

Abstract

Lactate is a mobile carbon substrate, extracellular signal, and candidate mediator of metabolism-to-gene coupling. These properties make lactate relevant to Parkinson's disease (PD), but current evidence does not support a simple protective or toxic interpretation. In this Review, we synthesize evidence that lactate dynamics may influence PD-relevant striatal biology through substrate provision, redox-sensitive NMDAR-ERK/MAPK-CREB signaling, HCAR1-mediated receptor signaling, and the emerging lactylation-linked modification of inflammatory or transcriptional states. We explicitly distinguish established non-PD mechanisms from direct PD-model evidence and from hypotheses that remain untested in D2 medium spiny neurons (D2-MSNs). We propose that the apparent lactate paradox in PD is best understood as a kinetic and compartmental problem: transient, well-cleared lactate pulses, such as those produced during exercise, may support metabolic flexibility, neurovascular adaptation, and selected forms of plasticity, whereas sustained lactate accumulation in mitochondrially constrained or inflammatory environments may promote acid-ion stress, oxidative injury, neuroimmune activation, and impaired dopaminergic signaling. The D2-MSN axis is therefore presented not as a proven site of lactate-mediated rescue, but as a high-priority experimental test bed for linking lactate dynamics to hypokinetic network states. Translationally, lactate is unlikely to serve as a stand-alone diagnostic biomarker. Its more realistic near-term uses are as a pharmacodynamic readout, a challenge-response variable for exercise dosing, and a target-engagement marker for interventions that modify lactate transport, signaling, or inflammatory metabolic state. This framework defines lactate kinetics, compartment, and disease context as the critical variables for biomarker-guided rehabilitation and future PD trials.