In the renal proximal tubule (PT), Na+/K+-ATPase (NKA) is exclusively located in the basolateral domain. Through its classic ATP-dependent ion-pumping function, NKA generates the Na+ gradient that drives apical Na+ reabsorption, mostly through Na+/H+ exchanger (NHE3). Accordingly, activation of NKA-mediated ion transport decreases natriuresis through activation of basolateral (NKA) and apical Na+ reabsorption (NHE3). In contrast, pharmacological evidence suggests that activation of the more recently discovered NKA signaling function triggers a cellular redistribution of NKA and NHE3 that decreases transcellular Na+ flux in cultured PT cells. To obtain genetic evidence of this NKA/Src mechanism in the PT and asses its physiological importance, we used a knockdown and rescue approach in pig renal epithelial cells (LLC-PK1). Additionally, we genetically targeted NKA α1 in the mouse PT by crossing mice expressing a sodium glucose co-transporter 2 promoter driven Cre transgene with Floxed NKA α1 mice (PTα1-/-). Knockdown of 90% of NKA α1 in PT LLC-PK1 cells increased transepithelial 22Na flux by 2-fold, activated NHE3 (50% decrease in inhibitory phosphorylation), and increased basolateral Na+/HCO3- cotransporter (NBCe1A) protein content. In the PTα1-/- mouse (4-month males and females in a 1:1 ratio), 70% decrease in PT NKA α1 expression decreased urine output (0.51±0.14 vs 1.57±0.21 mL/24h in PTα1+/+, p<0.001, n=16) and absolute Na+ excretion (0.14±0.05 vs 0.36±0.05 mmol/24h in PTα1+/+, p<0.05, n=8) by 65%, without histological or functional evidence of renal injury. Those changes were driven by increased PT Na+ reabsorption, as indicated by a 65% decrease in lithium clearance (4-month males, 1344±220 vs 3932±697 mL/24h in PTα1+/+, p<0.001, n=12) with unchanged GFR. This hyper-reabsorptive phenotype of PTα1-/- mice was coupled to increased membrane abundance of NHE3 and NBCe1A, and rescued upon crossing with floxed NHE3 mice, consistent a NKA/NHE3-dependent mechanism. A dismantlement of caveolar NKA/Src receptor complex and intracellular redistribution of pY418Src occurred in knockdown NKA α1 PT cells, and was also observed in the PTα1-/- hypomorphic mouse. Rescue of PT cells with wild-type but not Src signaling-null NKA α1 restored NHE3 and NBCe1A to basal levels, indicative of a role for NKA/Src receptor function in the tonic inhibition of Na+ transporters in the PT. Hence, NKA signaling exerts a tonic inhibition on Na+ reabsorption by regulating key apical and basolateral Na+ transporters. This action, which is lifted upon NKA genetic suppression in cells and in vivo, tonically counteracts NKA's ATP-driven function of basolateral Na+ reabsorption. Strikingly, NKA/Src signaling is not only physiologically relevant, it is functionally dominant over NKA ion-pumping in the control of PT reabsorption. NKA signaling therefore provides a long sought-after mechanism for the natriuretic action of endogenous NKA ligands such as cardiotonic steroids.
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