Over the past decade, studies of Neisseria gonorrhoeae have shown that in media containing glucose, lactate stimulates metabolism, and this could affect pathogenicity (7,19). Recently, the probable mechanism of this stimulation has been identified as one that could apply to other pathogens (68). Earlier studies implicated lactate metabolism in the serum resistance of Haemophilus influenzae (30), and during the past year, the use of signature-tagged mutagenesis and an infant rat model identified a putative (i.e., homologous with the gene in Escherichia coli) lactate permease-deficient mutant of Neisseria meningitidis with diminished virulence (62; C. M. Tang, personal communication). There may be a common role for lactate in the pathogenicity of these and other pathogens. Lactate and glucose are present together in most sites where infection occurs in vivo. This review summarizes the present position on gonococci and its implications regarding other pathogens. Throughout, the phrase "stimulation of metabolism by lactate" refers to this event occurring in a medium containing glucose.
ENERGY SOURCES OF GONOCOCCIThe nutritional requirements for growth of gonococci include amino acids, purines, pyrimidines, vitamins, and an energy source (8). The last is restricted; only glucose, pyruvate, and lactate are used efficiently (39). The mechanism for lactate stimulation of gonococcal metabolism depends on interaction between it and glucose. The literature records information on the metabolism of one or the other alone but not in combination; it is summarized below.Glucose is metabolized at pH 7.2 and 8.0 primarily (ca. 80%) via the Entner-Doudoroff pathway, with some contribution (ca. 20%) from the pentose phosphate pathway (40). At a pH above 7, most of the pyruvate and acetyl coenzyme A (CoA) generated from glucose accumulates as acetate, with only small amounts being oxidized by the tricarboxylic acid (TCA) cycle (40). However, at pH 6, the contribution of the pentose pathway increases to about 50% and more acetyl-CoA is metabolized via the TCA cycle (40).Lactate provides energy for growth by being a substrate for electron transport when it is oxidized to pyruvate (3, 4). Gonococci contain at least three lactic dehydrogenase (LDH) enzymes. The most important are two electron transport-linked LDHs that are associated with the cytoplasmic membrane and independent of NAD ϩ (13, 67). Isoenzyme LDH-I utilizes lactate exclusively as its substrate and with a preference for the D-isomer, while isoenzyme LDH-II has broad substrate specificity (lactate, phenyl-lactate, and 4-hydroxy-phenyl-lactate), but it is steriospecific for L-isomers. The third LDH is a cytoplasmic, soluble NAD ϩ -dependent LDH (25). Pyruvate produced from lactate is catabolized by the TCA cycle (24).
STIMULATION OF METABOLISM BY LACTATEEvidence for the stimulation of metabolism by lactate comes from several sources.Interaction of gonococci with neutrophils. Cohen and his colleagues showed that when gonococci were phagocytosed by neutrophils, their metabolic...