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Lactate is then efficiently extruded via monocarboxylate transporters (primarily MCT4), a proton-coupled symporter that co-exports H + with lactate ( + extrusion by tumor cell H + -ATPases and Na + /H + exchangers (NHEs), directly acidifies the TME (extracellular pH [pHe] ≈6.5–7.0 vs
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