Our results showed that even for the resting state, [LA]RBC was lower than [LA]plasma. The ratio [LA]RBC/[LA]plasma was about 0.5 for the resting state which is in accordance with most of the studies (Böning et al., 2007; Foxdal et al., 1990; Gladden et al., 1994; Harris and Dudley, 1989; Juel et al., 1990; Sara et al., 2006; Smith et al., 1997; 1998). In contrast Hildebrandt et al. (2000) and Buono and Yeager, 1986 found equal lactate concentrations in plasma and RBCs. Most studies explain this gradient between plasma and RBCs as a result of a Donnan equilibrium (Böning et al., 2007; Smith et al., 1997; 1998) or according to the membrane potential (Juel et al., 1990) respectively. Under resting conditions, there is also a significant pH gradient between the RBC (7. 2) and plasma (7.4), which conforms to the Donnan distribution of H+ ions caused by the negative charge of haemoglobin (Harris et al. 1989; Jensen 2004). The RBC/plasma [LA] ratio of ~0.5 at rest is mirrored by a plasma/RBC [H+] ratio of 0.62 ± 0.01 and 0.47, reported by Smith et al. and Harris et al. respectively (Harris et al. 1989; Smith et al., 1997; 1998). Different transport systems and the membrane potential possibly avoid a homogenous distribution of lactate. Minor variations in resting values between different studies as well as between the subjects in our study, may be caused by measurements near the accuracy of measurement/detection. The maximal exercise caused a more rapid increase of [LA]plasma than of [LA]RBC during and shortly after the exercise, causing a decrease in the ratio. This is in accordance with the results of Juel et al., 1990 and McKelvie et al., 1991. In contrast, studies using an incremental step test found no changes in the ratio (Sara et al., 2006; Smith et al., 1997). It seems that only in the presence of a fast and high congestion of [LA]plasma, the transport across RBC membrane is saturated. The contradictory results in resting values as well as in recovery values might be caused by several reasons: 1. Different exercise protocols with more or less time for equilibrium between plasma and RBCs (half time for equilibration is about 50-120 s at 37 °C (Böning et al., 2007)) and with more or less fast and high increases in plasma [LA]. 2. Differences in the blood samples (venous, arterial, and capillary). [LA] is higher in capillary/arterial blood due to lactate elimination and more time for equilibration in venous blood. The use of capillary blood might as well be an advantage for plasma lactate determination because of the shorter time to take blood samples (minimized time for lactate distribution) (Hildebrand et al., 2000) 3. Differences in blood sample treatment to interrupt lactate transport between plasma and RBCs by rapid cooling and/or rapid centrifugation. 4. Variations in the determination of [LA]RBC (measured or calculated). [LA]RBC reached its peak later than [LA]plasma reached its peak. As expected, the comparison of the points in time of peak [LA]WB, [LA]plasma and [LA]RBC shows that the lactate transport across RBC membrane is delayed. The peak [LA]RBC was reached 2-4 min later than the peak [LA]plasma. This is in accordance with the results of Böning et al., 2007 and Hildebrand et al., 2000 where [LA]RBC reached its peak value 3 min and 5 min later than [LA]plasma during recovery after an incremental step test respectively (Böning et al., 2007; Hildebrand et al., 2000). Juel et al., 1990 reported a time delay of 2 min for peak [LA]RBC compared to [LA]plasma (Juel et al., 1990). When [LA]RBC reached the peak, the ratio [LA]RBC/[LA]plasma roughly recovered to its beginning value. After [LA]RBC reached the peak, it decreased, representing an outflow of lactate from red blood cells, in spite of the fact that [LA]plasma was still much higher than [LA]RBC. It seems that the system reached its equilibrium, dependent on the distribution of [LA]RBC and [LA]plasma (1 RBC : 2 plasma) and dependent on the fact that [LA]plasma now changed only slowly. WU affected the increase of [LA]RBC directly after the all-out exercise, which was shown by the different percental increments of [LA]RBC and [LA]plasma. Later during recovery no differences for [LA]plasma, [LA]RBC and the increments of both were found. Some possible mechanisms for a decreased influx have previously been suggested in the literature, e.g. Donnan equilibrium (Johnson et al., 1945), barrier provided by the membranes of RBCs (Buono and Yeager, 1986) and the saturation of transporters (MCT) (Böning et al., 2007; Buono and Yeager, 1986; Gladden et al., 1994; Harris and Dudley, 1989; Hildebrand et al., 2000). In this context it has to be considered, that the lactate transport by MCTs is a facilitated but passive transport mainly driven by the concentration gradient. Therefore the velocity of reaching the equilibrium depends on the initial difference and on the permeability. However, the exact mechanisms remain unclear. The increase in [LA]plasma was significantly lower in the first time interval (pre-0') for IWU. Therefore one would expect a similar or even higher increase in [LA]RBC (and not a lower) because of a less saturated transport system (MCT). But the lower increment of [LA]RBC after IWU might be due to a “higher preloading” with lactate before exercise, causing a smaller [LA] gradient (initial difference) between plasma and RBCs. It seems that the influx decreases with increasing intracellular [LA]. It can be speculated, that RBCs may have a maximal uptake capacity for lactate, although this has never been proven. As the [LA] increases inside of RBCs, the resistance against an influx increases as well. But the negative electric charge inside RBCs, which is caused by various anions, particularly the non-diffusible anions of hemoglobin Hb- may also involve. The negative electric charge is ~ -10 mV at the inside of the red cell membrane forcing diffusible anions out. This negative charge resists the inward diffusion of LA- even for the resting state. However, the couple {LA-, H+}, transported through MCT-1, as a whole, is electrically neutral. Therefore, there is no net electric force acting on the couple. Another possibility for the forces acting on the distribution could be a preferred direction for transport of MCT-1. Indeed, the different Km values (Michaelis Menten constant) for efflux and influx in RBCs may suggest asymmetric behaviors of MCT-1 (Deuticke, 1982). Another possibility one could speculate about is, that the extracellular increase in [LA] inhibits the export of lactate (produced by the RBC itself, as they rely exclusively on glycolysis to produce energy) from RBCs (Siems et al., 2000). This inhibited export of lactate from RBCs may lead to an intracellular lactate accumulation, but not due to an uptake. But the relatively fast increase of [LA]RBC partly contradicts the second possibility, as the lactate production in RBCs is only 2.3-2.5 mmol·L-1 of cells per hour (Siems et al., 2000). Furthermore studies showed that, differently trained subjects reveal different influx rates into RBCs (Skelton et al., 1998). Higher total, as well as MCT-1 mediated lactate influx was also reported for persons with sickle cell trait and sickle cell disease (Patillo et al., 2005; Sara et al., 2006). The question remains, why RBCs should take up lactate, as they cannot use it for oxidative energy production as other tissues. However RBCs might be involved in the spreading of the oxidative substrate “lactate” between tissues. A key aspect of this cell-to-cell lactate shuttle concept is the exchange of lactate between tissues of net lactate release and gluconeogenesis/oxdative tissues. RBCs may act as a “shuttle” between these tissues. Lindinger et al., 1992 showed that large and rapid increases in [LA]plasma result in the transport into RBCs. They suggested that the uptake of lactate by RBCs plays an important role in regulating ion homeostasis within plasma and the interstitial and intracellular compartments of contracting muscle (Lindinger et al., 1992). RBCs function to transport lactate from the working muscle and help to maintain a concentration difference between plasma and muscle facilitating diffusion of lactate from the interstitial space into plasma (McKelvie et al., 1991). This regulatory process may help to maintain the function of active muscles by delaying the onset of fatigue (Lindinger et al., 1992 & 1995), but it may also help to improve the cell-to-cell lactate shuttle as more lactate can by transported out of the working muscle |