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Robert J. Lee, J. Kevin Foskett
Published in Volume 120, Issue 9
J Clin Invest. 2010; 120(9):3137–3148 doi:10.1172/JCI42992
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Figure 8
Model of VIP/cAMP evoked fluid secretion in porcine and human airway gland serous acinar cells.

Binding of VIP to VPAC receptors (i) activates adenylyl cyclase–mediated (AC-mediated) elevation of [cAMP]i, causing PKA-stimulated elevation of [Ca2+]i required for activation of basolateral K+ channels (ii). This [Ca2+]i response is insufficient to activate CaCCs (iii). Thus, Cl secretion requires PKA-dependent activation of CFTR (iv). As during cholinergic stimulation, transepithelial Cl secretion is sustained by NKCC1 (v) and NHE/AE (vi), expressed on the basolateral membrane (4) and driven by Na+ gradient established by the Na+/K+ ATPase (vii). While AE function was not elucidated directly in this study, canonical models of epithelial Cl secretion (reviewed in ref. 44) dictate that NHE-mediated alkalinization drives Cl/HCO3 exchange resulting in Cl uptake to sustain secretion. Secretion of Cl drives movement of Na+ through a paracellular (tight junction; T.J.) pathway (viii) drawing osmotically obliged water into the gland lumen (ix) paracellularly or transcellularly through aquaporins (AQP; localization based on ref. 45). Our data suggest that activation of CaCC(s), either directly or indirectly through agents that enhance cAMP-activated [Ca2+]i signals, could restore fluid secretion in serous cells lacking functional CFTR.