Lactate Decreases Bortezomib Sensitivity and Predicts Poor Clinical Outcomes of Multiple Myeloma

Curr Med Sci. 2023 Aug;43(4):679-688. doi: 10.1007/s11596-023-2747-0. Epub 2023 Jun 16.


Objective: Metabolic disorders are regarded as hallmarks of multiple myeloma (MM) and are responsible for rapid cancer cell proliferation and tumor growth. However, the exact biological roles of metabolites in MM cells have not been fully explored. This study aimed to explore the feasibility and clinical significance of lactate for MM and investigate the molecular mechanism of lactic acid (Lac) in the proliferation of myeloma cells and cell sensitivity to bortezomib (BTZ).

Methods: Metabolomic analysis of the serum was carried out to obtain metabolites expression and clinical characteristics in MM patients. The CCK8 assay and flow cytometry were used to detect cell proliferation, apoptosis, and cell cycle changes. Western blotting was used to detect the potential mechanism and apoptosis- and cycle-related protein changes.

Results: Lactate was highly expressed in both the peripheral blood and bone marrow of MM patients. It was significantly correlated with Durie-Salmon Staging (DS Staging) and the International Staging System (ISS Staging) and the serum and urinary involved/uninvolved free light chain ratios. Patients with relatively high lactate levels had a poor treatment response. Moreover, in vitro experiments showed that Lac could promote the proliferation of tumor cells and decrease the proportion of G0/G1-phase cells, which was accompanied by an increased proportion of S-phase cells. In addition, Lac could decrease tumor sensitivity to BTZ by disrupting the expression of nuclear factor kappa B subunit 2 (NFkB2) and RelB.

Conclusion: Metabolic changes are important in MM cell proliferation and treatment response; lactate could be used as a biomarker in MM and as a therapeutic target to overcome cell resistance to BTZ.

Keywords: NF-kappa B pathway; biomarker; bortezomib; lactate; multiple myeloma.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents* / metabolism
  • Antineoplastic Agents* / pharmacology
  • Apoptosis / drug effects
  • Bortezomib* / pharmacology
  • Bortezomib* / therapeutic use
  • Cell Cycle Proteins / metabolism
  • Cell Line, Tumor / drug effects
  • Cell Line, Tumor / metabolism
  • Cell Proliferation / drug effects
  • Drug Resistance, Neoplasm* / drug effects
  • Drug Resistance, Neoplasm* / physiology
  • Female
  • Humans
  • Lactic Acid* / blood
  • Lactic Acid* / metabolism
  • Lactic Acid* / pharmacology
  • Male
  • Metabolome
  • Middle Aged
  • Multiple Myeloma* / blood
  • Multiple Myeloma* / drug therapy
  • Multiple Myeloma* / metabolism
  • Prognosis


  • Antineoplastic Agents
  • Bortezomib
  • Cell Cycle Proteins
  • Lactic Acid