Notably, D-lactate produced by gut microbes can polarize TAMs from the M2 to the M1 phenotype by inhibiting the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway and activating the NF-κB pathway, thereby inhibiting HCC growth and prolonging the survival of mice (28). This evidence concerns the gene AKT1 and hepatocellular carcinoma.