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The lactate and ketones exported by CAFs are transported via monocarboxylate transporters (MCTs)—particularly MCT4 in CAFs for export and MCT1 in cancer cells for import—forming a bidirectional shuttle system (134, 135)

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On the other hand, perhaps enhanced ER retention time and chaperone association of client proteins facilitates proper protein folding under stressful conditions, which would be consistent with the delayed secretion but diminished ER stress by ET that we observed