Evidence for a rod-to-cone lactate shuttle in the mammalian retina

In his seminal 1920s studies, Otto Warburg found the retina to generate large amounts of lactate. However, it was unclear what retinal cells produced lactate and whether it was a metabolic waste product or used further. Here, we show that lactate produced by rod photoreceptors fuels the energy-intensive function and viability of cone photoreceptors. In an initial expression analysis, we found monocarboxylate transporter-1 (MCT1), lactate-producing lactate-dehydrogenase-A (LDHA), and pyruvate carboxykinase-1 (PCK1) localized to rod photoreceptors, while high-affinity MCT2, pyruvate-producing LDHB, and PCK2 were expressed in cones. We then exposed retina to defined media containing either glucose or lactate as caloric component, and applied specific MCT inhibitors. In glucose-containing medium, 1H-NMR metabolomics showed rod MCT1 inhibition to increase retinal lactate, suggesting rods as a major source of lactate. In lactate-only medium, functional recordings using micro-electroretinography showed decreased rod function, while cone function was maintained. In glucose-containing medium, blocking rod MCT1 abolished cone function. Long-term treatment with MCT inhibitors selectively decreased photoreceptor viability. Conversely, supplementing the defined medium with lactate preserved cone viability in the rd1 mouse model for Retinitis Pigmentosa. Together, our data suggest that lactate shuttling from rods is crucial for cone function and viability. This may explain cone degeneration seen in various retinal diseases and provides an entirely new avenue for metabolism-based treatment development. The discovery of a lactate-shuttle between two functionally similar, yet distinct types of neurons may have far-reaching implications for our understanding of the central nervous system in general.