Mode
Text Size
Log in / Sign up

Metabolic checkpoints like lactate and adenosine drive immune escape and resistance to checkpoint blockadeMetabolic Checkpoints May Impact Immune Therapy for Cancer

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway
Note that targeting metabolic checkpoints may overcome resistance to immune checkpoint blockade in cancer.

This mini review explores the mechanisms by which metabolic immune checkpoints contribute to tumor progression and resistance to current therapies. The scope includes four primary metabolic axes: lactate, the CD73-adenosine axis, tryptophan-derived metabolites (including the IDO1-kynurenine-AhR pathway), and nucleotide-derived UDP signaling.

The review synthesizes evidence that these pathways actively promote immune escape. Specifically, tumor glycolysis linked to lactate is associated with Treg recruitment and impaired T-cell function. The CD73-adenosine axis suppresses CD8+ T cells and natural killer cells while reinforcing myeloid immune programs. Furthermore, tryptophan-derived metabolites involve non-classical checkpoints like Siglec-15, and nucleotide-derived UDP signaling drives macrophage-mediated immunosuppression.

While these mechanisms suggest that targeting metabolic checkpoints in combination with immune checkpoint blockade may improve therapeutic responses, the review notes that this is based on mechanistic descriptions rather than clinical trial data. The evidence remains focused on the biological pathways of resistance. Clinical application is currently limited by a lack of reported trial data and specific safety profiles for these combinations.

How this fits prior evidence

This review addresses a gap in understanding how metabolic factors contribute to immune escape. While previous coverage noted that FTO-targeted strategies currently lack clinical evaluation and rely on preclinical evidence, this review focuses specifically on the role of metabolic checkpoints like lactate and adenosine in driving resistance to immune checkpoint blockade.

Researchers are looking at how the body's metabolism affects cancer treatment. This review looked at several metabolic checkpoints, including substances like lactate, adenosine, and tryptophan-derived metabolites. These factors can influence the way the immune system responds to certain therapies.

The review found that these metabolic signals can create a protective environment for tumors. For example, lactate is linked to impaired T-cell function, while the CD73-adenosine axis can suppress important immune cells like natural killer cells. These processes may contribute to why some patients develop resistance to standard immune checkpoint treatments.

Because this is a review of experimental evidence and not a clinical trial, these findings are still in the early stages of research. The results do not provide specific medical advice or guaranteed outcomes for patients. However, targeting these metabolic pathways alongside current therapies could potentially improve how well treatments work for some people.

What this means for you:
Metabolic factors like lactate and adenosine may influence immune system responses to cancer treatment.

Common questions

What are metabolic checkpoints in cancer?

Metabolic checkpoints are chemical signals, such as lactate, adenosine, and tryptophan-derived metabolites, that influence the immune system. These substances can create an environment where tumors hide from the body's natural defenses. This review suggests that these factors may contribute to why some patients develop resistance to certain cancer treatments.

How do these findings affect current cancer treatments?

The review indicates that targeting metabolic checkpoints in combination with immune checkpoint blockade might improve how well a patient responds to treatment. However, this is based on experimental evidence and not clinical trial data. You should talk to your doctor about how these mechanisms relate to specific treatment plans.

What role does lactate play in cancer?

Lactate is linked to the recruitment of regulatory T cells and impaired T-cell function. The review suggests that lactylation can be associated with therapeutic resistance, meaning it may help a tumor avoid being attacked by the immune system.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
Immune checkpoint blockade has transformed cancer therapy, yet many tumors remain intrinsically resistant or acquire resistance after initial response. Increasing evidence indicates that this failure is not determined solely by PD-1, PD-L1, CTLA-4, or T-cell exhaustion, but also by metabolically suppressive states within the tumor microenvironment. Tumor-derived metabolites can function as metabolic immune checkpoints by limiting effector immune activity, promoting regulatory or myeloid suppressive compartments, and weakening immunotherapy efficacy. This mini review summarizes recent experimental evidence showing how lactate, adenosine, tryptophan-derived metabolites, and nucleotide-derived metabolites shape immune escape and resistance to immune checkpoint blockade. Lactate links tumor glycolysis to Treg recruitment, impaired T-cell function, and lactylation-associated therapeutic resistance. The CD73-adenosine axis suppresses CD8+ T cells and natural killer cells while reinforcing regulatory and myeloid immune programs. Tryptophan-derived metabolites extend beyond the classical IDO1–kynurenine–AhR pathway to involve non-classical checkpoints such as Siglec-15 and broader kynurenine/indole/serotonin networks. Emerging evidence further identifies nucleotide-derived UDP signaling as a driver of macrophage-mediated immunosuppression. Finally, we discuss how targeting metabolic checkpoints in combination with immune checkpoint blockade may improve therapeutic responses. Defining the spatial and cellular contexts of metabolite-mediated immune suppression may enable more precise strategies to overcome immunotherapy resistance.
Free Newsletter

Clinical research that matters. Delivered to your inbox.

Join thousands of clinicians and researchers. No spam, unsubscribe anytime.