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Although MCT-1 operates bi-directionally depending on the concentration gradient, the unidirectional movement of lactate is maintained by its higher affinity for lactate (Km = 36 mM) and an ever-increasing extracellular pool of lactate effluxed from glycolytic cells through MCT-4 (Km = 2530 mM) ( This effluxed lactate is converted to pyruvate in the presence of the enzyme LDHB to run the Krebs cycle for energy production, thereby sparing glucose for distal hypoxic areas [171] (Figure 7)

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