Quantitative electron microscopical studies on in vitro incubated rabbit gallbladder epithelium

Monolayer and three-dimensional cell culture and living tissue culture of gallbladder epithelium

Several models for preparing and isolating human and animal gallbladder epithelial cells, including low-grade gallbladder carcinoma cells, as well as proposed systems for culturing these isolated epithelial cells are reviewed here. Several reports concerning tissue culture of the gallbladder are also reviewed. The cell culture systems are divided into monolayer cell culture on collagen-coated or uncoated culture dishes or other culture substrate and three-dimensional cell culture in collagen gel. To prepare and isolate gallbladder epithelial cells, digestion of the gallbladder mucosa, abrasion of the mucosal epithelial cells, and excision of epithelial outgrowth of mucosal explants are applied. In monolayer cell culture, most of the specific biological features of isolated and cultured cells characteristic to the gallbladder are gradually lost after several passages, though quantitative and objective analyses of the pathophysiology of cultured cells and their secretory substances can be performed. Tissue culture using explants of the gallbladder has mainly been used for physiological studies of the gallbladder, such as investigating the transport of water and electrolytes. In this tissue culture system, quantitative assessment is difficult, though the original and specific biological and histological characteristics of the gallbladder are retained. Three-dimensional collagen gel culture could be an ideal model combining monolayer cell culture and tissue culture systems, and create controllable conditions or environments when several biologically active substances, such as growth factors, proinflammatory cytokines and adhesion molecules, are added to the culture medium. Advantages and shortcomings of individual cultivation models are discussed, and selecting the culture model most appropriate to the purpose of the study will facilitate investigations of the biology and pathogenetic mechanisms of gallbladder diseases such as cholelithiasis.

Ultrastructural aspects of human gallbladder epithelial cells in cholelithiasis: production of anionic mucus

The surface epithelium of 28 gallbladders removed during elective cholecystectomies and pathology collection was studied ultrastructurally. Focusing on 10 of the 28 cases that were diagnosed as cholecystitis, we found that the epithelium displayed numerous apical mucous granules and bulging apical apices. Mucous granule changes included 1) hyperproduction of secretory granules of neutral type containing an electron-dense proteinaceous spherule, similar to that described in other mucus-producing glands of the digestive system, and 2) production of anionic, osmiophilic secretory mucus. Other alterations of the surface epithelial cells included the production of bizarre surface appendages resembling primitive cilia without axoneme and epithelial excrescences.

Biochemical and morphological correlations in human gallbladder with reference to membrane permeability

There is good evidence that gallbladder epithelium is permeable to a diverse range of molecules which move into the epithelial cell from the lumen or the basement membrane. Morphological investigations have shown both secretory mucous droplets, components of the endocytosis pathway together with evidence of a system allowing passage of molecules across the basement membrane. This indicates that the gallbladder epithelium may be influenced by molecules presented via the apical and basal membranes, complicating our understanding of gallbladder function, particularly in disease. Gallbladder disease increases the proteoglycan content of the basement membrane, but the implication of this in terms of permeability remains to be defined. Indeed, it remains unknown whether this precedes disease or is a manifestation of the disease process. The removal of water from hepatic bile by gallbladder involves two counter ion transport systems. Autoradiography shows that ion transport occurs into the lateral intracellular spaces but it remains unclear whether this leads to a hypertonic solution in these spaces causing an osmotically driven water absorption or if the process involves an osmotically linked isotonic secretion. These ion pumps are reversible, for water is absorbed during the interdigestive phase but fluid is secreted into the lumen during digestion or in the presence of disease. Appropriate neural stimulation can increase or decrease fluid absorption from the lumen while vasoactive intestinal peptide or secretin promote fluid secretion, probably mediated by prostaglandins leading to raised cyclic AMP acting at the cellular level. Immediate control may depend on intracellular Ca2+ which activates a calmodulin-protein kinase, phosphorylating the counter ion transporters to downregulate their activity. Failure of this regulatory process may explain the initial increase in bile concentrating potential seen in the development of gallstones although the mechanism of such failure remains unknown. More concentrated bile increases movement of biliary compounds into gallbladder epithelial cells which alter gallbladder function in a complex manner. Secondary bile acids are raised in gallstone disease and increase permeability of the gallbladder epithelium to molecules including cholesterol. This cholesterol absorbed from the lumen may have paramount importance to gallbladder function. Raised biliary cholesterol reduces gallbladder motility, possibly by increasing the amount of cholesterol in gallbladder muscle membranes and reducing contraction in response to cholecystokinin. However, increased secondary bile acids are also associated with an alteration in phospholipid acyl groups which may alter ion transport activity and/or cholesterol solubility within the micelle/vesicle. As the acyl groups show increased arachidonate levels the production of prostaglandins could be raised, although currently it is not known if this phospholipid arachidonate enters the epithelial cells. In addition, gallbladder inflammation is associated with raised phospholipase A2 activity, leading to formation of fatty acids and lysophospholipid which causes membrane damage. The fatty acids are likely to displace cholesterol from the micelle but may also act directly on the epithelium, possibly increasing prostaglandin production and thus stimulating mucin secretion. Increased mucin secretion is seen early in gallstone disease but the evidence presently available cannot determine if this is a causative factor.

The nature of the neutral Na+-Cl(-)-coupled entry at the apical membrane of rabbit gallbladder epithelium: II. Na+-Cl- symport is independent of K+

In the epithelium of rabbit gallbladder, in the nominal absence of bicarbonate, intracellular Cl- activity is about 25 mM, about 4 times higher than intracellular Cl- activity at the electrochemical equilibrium. It is essentially not affected by 10(-4) M acetazolamide and 10(-4) M 4-acetamido-4'-isothiocyanostilbene-2,2'-disulfonate (SITS) even during prolonged exposures: it falls to the equilibrium value by removal of Na+ from the lumen without significant changes of the apical membrane potential difference. Both intracellular Cl- and Na+ activities are decreased by luminal treatment with 25 mM SCN-; the initial rates of change are not significantly different. In addition, the initial rates of change of intracellular Cl- activity are not significantly different upon Na+ or Cl- entry block by the appropriate reduction of the concentration of either ion in the luminal solution. Luminal K+ removal or 10(-5) M bumetanide do not affect intracellular Cl- and Na+ activities or Cl- influx through the apical membrane. It is concluded that in the absence of bicarbonate NaCl entry is entirely due to a Na+-Cl- symport on a single carrier which, at least under the conditions tested, does not cotransport K+.

Isolation of apical plasma membrane in rabbit gallbladder epithelium by Percoll density gradient centrifugation

The apical membranes of rabbit gallbladder epithelial cells were isolated by treating the homogenate with Ca2+ or Mg2+ and centrifuging the suspension in Percoll gradient. In this way brush-border membranes were obtained with enrichment factors ranging between 10 and 20 and yields of 15-30%. A second method is described with which membranes were isolated, without any preliminary treatment, first by differential centrifugation, then with Percoll gradient; the final membrane enrichment was over 15, however the yield was very low (3%). Many possible enzymatic markers of the apical plasma membrane were investigated: L-gamma-glutamyltransferase, alkaline phosphatase, leucine aminopeptidase, sucrase. The first appears to be that of choice. Apical membrane fraction could be also evidenced by autofluorescence or by labeling with Lotus tetragonolobus lectin. Preliminary experiments showed that apical plasma membranes isolated in this way form vesicles.

The roles of paracellular and transcellular pathways and submucosal space in isotonic water absorption by rabbit ileum

Water movements have been studied in sheets of isolated rabbit ileum using a method which measures net volume flows across the mucosal and serosal surfaces of the tissue continuously with high resolution. At 35 degrees C, with the tissues incubated in isotonic Ringer solution containing D-glucose (25 mM) on both sides, there is a steady net inflow of fluid at the rate of 24 +/- 2 microliter cm-2 h-1 across the mucosal surface (Jm) and an outflow of 8 +/- 1 microliter cm-2 h-1 across the serosal surface (Js) (n = 16). The stable transepithelial p.d. across these tissues is 2.7 +/- 0.2 mV, serosa positive. Jm can be reversibly inhibited by anoxia. Ouabain (0.1 mM) added to the serosal solution inhibits inflow across the mucosal and serosal surfaces by 75% (n = 7) within 30 min. If phlorizin (0.1 mM) is added to the mucosal Ringer solution containing glucose (20 mM) within 30 min of the commencement of in vitro absorption, Jm is reduced from 37 +/- 3 to 28 +/- 2 microliter cm-2 h-1 (n = 3). Dilution of the mucosal Ringer solution by 50 mosmol kg-1 (with the serosal solution kept isosmolar) results in a rapid transient increase in mucosal inflow. An increase of 50 mosmol kg-1 in the mucosal Ringer solution with NaCl, sucrose or mannitol causes a transient reversal of mucosal flow, followed by a return of inflow at a reduced level. Rabbit ileum can transport water against gradients of approximately 75 mosmol kg-1 of sucrose, NaCl, or mannitol. Addition of polyethylene glycol (mol. wt. 20000; 3 mosmol kg-1) causes a sustained reversal of mucosal inflow; inflow can be restored only by removing polyethylene glycol from the mucosal Ringer solution. The tissue can absorb water against an osmotic gradient of 200 mM-glycerol. The above data have been incorporated into a new model to explain isotonic flow of fluid by this epithelium. The main features are that the hydraulic conductivity (Lp) of the mucosal boundary of the lateral intercellular space is approximately 1 X 10(-8) cm s-1 cmH2O-1. This Lp is too low to sustain isotonicity of the flow emerging from the lateral intercellular space at the observed rates. Hypertonic fluid emerging from the lateral intercellular space is diluted by transcellular water flow generated by the hypertonicity of the submucosa and back-diffusion of solute via mucosal shunt channels.(ABSTRACT TRUNCATED AT 400 WORDS)

Structural changes associated with fluid absorption by dog tracheal epithelium

During fluid absorption induced by amphotericin B, the lateral intercellular spaces (LIS) of the dog tracheal epithelium were widely dilated as compared to untreated time controls. When fluid absorption was inhibited by ouabain, or by replacement of luminal Na by choline, amphotericin B failed to cause dilation of the LIS. These data suggest that, as in other epithelia, a significant amount of transepithelial fluid flow passes down the LIS, and that these spaces may provide the local osmotic compartment which is responsible for linking transepithelial fluid movement to active ion transport.

Sodium-pump density of cells from dog tracheal mucosa

Uptake of tritiated ouabain by cells isolated from dog tracheal epithelium showed two components: a saturable component with a Km of 5.1 X 10(-8) M and a maximal uptake of 8.3 X 10(5) molecules/cell and a nonsaturating component of uptake that was linear with concentration. Several criteria indicated that the saturable uptake component represented binding to the Na+-K+-ATPase. To estimate the average surface area per cell, a known number of cells were pelleted and weighed, and the average surface area was calculated, assuming the cells to be perfectly spherical. The validity of this assumption was confirmed by comparing the calculated surface areas of cells in isotonic and hypotonic media. From the values for maximal saturable uptake and average surface area, a pump density of approximately 2,400 sites/micron2 was calculated. Given that the apical membrane lacks Na pumps and accounts for only approximately 5% of the total surface area, this value corresponds to the pump density of the basolateral cell membrane. The pump densities of ciliated, goblet, and basal cells were compared by autoradiography. The three cell types had approximately the same density of pump sites.

Structure of Necturus gallbladder epithelium during transport at low external osmolarities

Gallbladders transport isotonically over a wide range of osmolarities. This ability has been assumed to depend on the geometry of the lateral intercellular spaces. We report that this geometry in the Necturus gallbladder varies extensively with the external osmolarity and depends in vitro on the integrity of the subepithelial tissues. The structure of the living epithelium was studied by Nomarski light microscopy while ultrastructural effects were revealed by electron microscopy. The short-term effects (less than 60 min) of low external osmolarities were: 1) the cells became bell-shaped with an increased cell height measured centrally, 2) lateral intercellular spaces lost their convoluted character; and 3) numerous membrane-bound cavities appeared in the cells. Furthermore, long-term exposure to the low external osmolarities caused an uneven density of epithelial cells. With subepithelial tissues intact, blistering of the epithelium cell layer was evident. Qualitative electron-microscopic data indicate that the membrane of the cavities was recruited from the basolateral cell membrane. This agrees well with light-microscopic observation that the cavities were initiated as invaginations of this cell membrane.

Epithelial cell volume modulation and regulation

Epithelial cell volume is a sensitive indicator of the balance between solute entry into the cell and solute exit. Solute accumulation in the cell leads to cell swelling because the water permeability of the cell membranes is high. Similarly, solute depletion leads to cell shrinkage. The rate of volume change under a variety of experimental conditions may be utilized to study the rate and direction of solute transport by an epithelial cell. The pathways of water movement across an epithelium may also be deduced from the changes in cellular volume. A technique for the measurement of the volume of living epithelial cells is described, and a number of experiments are discussed in which cell volume determination provided significant new information about the dynamic behavior of epithelia. The mechanism of volume regulation of epithelial cells exposed to anisotonic bathing solution is discussed and shown to involve the transient stimulation of normally dormant ion exchangers in the cell membrane.

Salt and water transport by epithelial cells

Epithelial cell volume is a sensitive indicator of the balance between solute entry into the cell and solute exit. Solute accumulation in the cell leads to cellular swelling because the water permeability of the cell membranes is high. Similarly, solute depletion leads to cellular shrinkage. The rate of volume change under a variety of experimental conditions may be utilized to study the rate and direction of solute transport by an epithelial cell. The pathways of water movement across an epithelium may also be deduced from the changes in cellular volume. A technique for the measurement of the volume of living epithelial cells is described and a number of experiments are discussed in which cellular volume determinations provided significant new information about the dynamic behavior of epithelia.

Paracellular non-electrolyte permeation during fluid transport across rabbit gall-bladder epithelium

1. Mucosa-to-serosa fluxes of seven polar non-electrolytes were determined during isotonic fluid transport across the unilateral rabbit gall-bladder preparation in an attempt to estimate the contribution of the paracellular pathway to the total transepithelial water flow.2. (3)H- and (14)C-labelled non-electrolyte tracers appeared in the transported fluid at fractions (f(n)) of their mucosal concentration which were inversely related to molecular size: ethanediol, 0.80; thiourea, 0.55; glycerol, 0.16; erythritol, 0.11; mannitol, 0.05; sucrose, 0.05; inulin, 0.02. The mean volume flow rate was 78 mul. cm(-2) hr(-1).3. While the fluxes of the larger molecules were probably due to diffusion through a small but unrestricted paracellular ;shunt' permeability, the high f(n) values obtained for the smaller molecules indicate the existence of a substantial paracellular permeability restricted to molecules smaller than erythritol.4. Upper limits to the transcellular ethanediol and thiourea permeabilities, estimated from the time constants of tracer efflux from preloaded epithelial cells, were too low to account for more than a very small fraction of the transepithelial fluxes observed in the unilateral preparation.5. Comparison of the f(n) values with the predictions of a hydrodynamic model of paracellular permeation suggests that in order to account for the large fluxes of ethanediol and thiourea, considerably more than one half of the transepithelial water flow must follow the paracellular pathway.6. Following a reduction of the mucosal osmolality to 110 m-osmole kg(-1), the apparent non-electrolyte permeability of the epithelium increased steadily over a period of 4 hr. This seems to reflect an increase in the shunt permeability rather than a change in the selectivity of the restricted permeability.7. It is concluded that during isotonic fluid transport the bulk of the transepithelial water flow crossing the epithelium passes through paracellular channels of approximately 3 A radius which are probably located in the intercellular junction.

Analysis of the ouabain-induced increase in transepithelial electrical resistance in the goldfish intestinal mucosa

1. The ouabain-induced increase in transmural resistance of goldfish intestinal mucosa stripped free from underlying muscular layers is analysed by comparing the resistance increase in normal and in low chloride saline, the resistance increased induced by anaerobic conditions and the resistance increase provoked by hypotonicity. 2. It is concluded that the collapse of the lateral intercellular space is the prime reason for the resistance increase and that the lateral intercellular space is maintained dilated by a ouabain-sensitive solute transport mechanism. 3. This mechanism can be either a rheogenic or a neutral Na/K-pump. In the latter case additional conditions have to be specified concerning values for ion concentrations in the lateral intercellular space and in the unstirred layer adjacent to the luminal membrane. 4. There are no indications for a chloride dependent mechanism involved in the maintenance of the width of the lateral intercellular spaces in the goldfish intestinal mucosa.

Coupled water transport in standing gradient models of the lateral intercellular space

A standing gradient model of the lateral intercellular space is presented which includes a basement membrane of finite solute permeability. The solution to the model equations is estimated analytically using the "isotonic convection approximation" of Segel. In the case of solute pumps uniformly distributed along the length of the channel, the achievement of isotonic transport depends only on the water permeability of the cell membranes. The ability of the model to transport water against an adverse osmotic gradient is the sum of two terms: The first term is simply that for a well-stirred compartment model and reflects basement membrane solute permeability. The second term measures the added strength due to diffusion limitation within the interspace. It is observed, however, that the ability for uphill water transport due to diffusion limitation is diminished by high cell membrane water permeability. For physiologically relevant parameters, it appears that the high water permeability required for isotonic transport renders the contribution of the standing gradient relatively ineffective in transport against an osmotic gradient. Finally, when the model transports both isotonically and against a gradient, it is shown that substantial intraepithelial solute polarization effects are unavoidable. Thus, the measured epithelial water permeability will grossly underestimate the water permeability of the cell membranes. The accuracy of the analytic approximation is demonstrated by numerical solution of the complete model equations.

Stereological studies on the small intestinal epithelium of the rat. 1. The absorptive cells of the normal duodenum and jejunum

Quantitative macroscopic, light-microscopic and electron-microscopic studies were performed on the small intestine of fasted and non-fasted adult, male Sprague-Dawley rats. In non-fasted rats the small intestine was longer than in fasted rats. Due to the presence of villi the surface area in the duodenum and the jejunum was enlarged about six times. The microvilli on the villous crests caused a surface enlargement by 13 times in the duodenum (value corrected for overestimation due to section thickness), and 19 times in the jejunum of the fasted rats. At the base of the villi these values were about 50% lower. It was calculated that, in the fasted rats, the total enlargement of the luminal surface area--due to villi and microvilli--was 63 times in the duodenum and 81 times in the jejunum (corrected for section thickness). Differences between the villous crest epithelium and the villous base epithelium were also found with regard to the mean cell height, and the volume densities of the absorptive cell nuclei, the mitochondria, and the paracellular channels.

Salt-water coupling in leaky epithelia

The theory of quasi-isotonic transport by cellular osmosis (the standing-gradient theory) has been challenged on the grounds that the osmotic permeabilities of the mucosal and interspace membranes are too low; if they were as high as the theory requires then the osmotic permeability of the whole epithelium would be 2-3 orders of magnitude higher than observed. This objection has basically been accepted for it is now claimed that these enormous permeabilities do exist, but are masked by unstirred-layer effects; I show that this is incorrect because unstirred-layer corrections are small and that the situation has not changed since 1975. The view that the route of fluid transport is junctional is replacing the cellular theory, and trans-junctional water flows seem to account for major fractions of the flow in various epithelia. I argue on grounds of general theory that these are unlikely to be osmotic flows because the junctional pores cannot satisfy both the osmotic and diffusive properties required of them, but the basic osmotic theory is also rather vague here. Non-osmotic theories, if junctional flow is accepted, must be either electro-kinetic or peristaltic.

The effects of inhibition of the strial Na+-K+-activated ATPase by perilymphatic ouabain in the guinea pig

The endolymphatic effects of perilymphatic ouabain (2 X 10(-3) M) were followed in 3 guinea pigs using ion-sensitive micro-electrodes, enabling a Na+-related permeability increase to be identified. Investigation of the strial ultrastructural changes in 11 more animals revealed early swelling of the marginal cells, while the intermediate and basal cells became shrunken with characteristically dark-staining cytoplasm. The subsequent cellular alterations were complex. The findings suggest that a major function of the Na+-K+-activated ATPase is preservation of the normal intracellular environment, inhibition resulting in widespread indirect effects. General measures of strial function, consequently, do not document just ATPase inhibition.

Hydrostatic pressure changes related to paracellular shunt ultrastructure in proximal tubule

We examined the effets of changes in hydrostatic pressures on the ultrastructural geometry of the lateral intercellular space and tight junctions in proximal tubules of contrtol (C) and volume-expanded (VE) Necturus kidney. The following groups of tubules were studied: (1) C, free-flow pressure, (2) C, stopped-flow, high-luminal pressure, (3) C, stopped-flow, low-luminal pressure, (4) VE, free-flow pressure, and (5) VE, stopped-flow, high-luminal pressure. Intratubular and peritubular capillary pressures were monitored before and during standardized perfusion-fixation for electron microscopy, and complete cross-sections of all sampled tubules were subjected to morphometric analysis. Average lateral intercellular space widths decreased significantly in C and VE stopped-flow tubules with high-luminal pressures but widened greatly in C stopped-flow tubules with low-luminal pressures. The length or width of the tight junctions did not change between the five experimental conditions. The ultrastructural changes correlate with the applied transepithelial pressure gradients rather than with transepithelial volume fluxes. The narrowing of lateral intercellular spaces in high pressure tubules correlate with the previously described increase in electrical resistance expressed per unit length tubule indicating that in these conditions part of the paracellular resistance is located in the free interspaces. The geometry of the lateral intercellular space in the proximal tubule of Necturus favors models of near-isotonic transport that do not depend on long and narrow interspaces.

Cholecystitis: a fine structural analysis

The epithelial cells from 40 gallbladders showing chronic cholecystitis and five with cholesterolosis were examined by electron microscopy. A number of features of non-specific cytological injury were noted some of which may have been related to the disease and others to anoxia. The basement membrane showed reduplication. Intraepithelial cells were identified as lymphocytes, polymorphonuclear leukocytes, macrophages and mast cells. Lipid droplets in the epithelial cells were found in 60 per cent. of the specimens.

Effects of glucose and ouabain on transepithelial electrical resistance and cell volume in stripped and unstripped goldfish intestine

1. In goldfish intestine (perfused unstripped segments and mucosal strips) the serosal addition of ouabain (10(-4) M) resulted in a vanishment of the transepithelial potential difference and in a continuous increase in transepithelial resistance. 2. Incubation of mucosal strips with ouabain resulted in an increase in sodium content which was greater than the decrease in potassium content. The resulting increase in cation content was accompanied by an increase in chloride content and an increase in water content. 3. Histological examination showed that exposure to ouabain resulted in a swelling of the epithelial layer as compared to the control situation. 4. The ouabain induced resistance increase is greater in the presence of glucose, 3-OMG or fructose than in the presence of mannitol. Phlorizin (10(-4) M) inhibits the extra resistance increase induced by mucosal glucose but is without effect on the fructose induced extra resistance increase. The initial velocity and the magnitude of the glucose induced extra resistance increase depends on the glucose concentration. 5. The results suggest that in goldfish intestine ouabain induces cellular swelling with a concomitant collapse of the lateral intercellular spaces, which is the cause of the increased transepithelial resistance. The additional changes in resistance induced by sugars suggest that the cell membrane is more permeable to glucose, 3-OMG and fructose than to mannitol. The resulting changes in osmotically active material within the epithelial cell influence the cross-sectional area and consequently the conductivity of the paracellular shunt pathway. The hypothesis that these sugars do not induce a resistance change in the absence of ouabain is discussed.

Distribution of osmotic flow in stomach and gallbladder

Stomach and gallbladder actively transport fluids which are nearly isotonic to plasma. Consideration of the measured areas of the appropriate transporting surfaces gives a more realistic view of the osmotic gradient required to account for the observed net flow of water. Simple osmosis may be adequate if the transporting membrane has an osmotic permeability in the range observed for synthetic lecithin-cholesterol bilayer membranes.

Intracellular chloride activities in rabbit gallbladder: direct evidence for the role of the sodium-gradient in energizing "uphill" chloride transport

Intracellular chloride activities, (Cl)c, in rabbit gallbladder were determined by using conventional (Kcl-filled) microelectrodes and Cl-selective, liquid ion-exchanger, microelectrodes. The results indicated that in the presence of a normal Ringer's solution, (Cl)c averages 35mM; this value is 2.3 times that predicted for an equilibrium distribution across the mucosal and baso-lateral membranes. On the other hand, when the tissue is bathed by Na-free solutions, (Cl)c declines to a value that does not differ significantly from that predicted for an equilibrium distribution. These results, together with those of Frizzell et al. (J. Gen. Physiol. 65:769, 1975) provide, for the first time, compelling evidence that (i) the movement of Cl from the mucosal solution into the cell is directed against an electrochemical potential difference (23mV); and (ii) this movement is energized by coupling to the entry of Na down a steep electrochemical potential difference. Finally, our data suggest that (i) Cl exit from the cell across the basolateral membrane may be coupled to the co-transport of a cation or the countertransport of an anion; and (ii) the mechanism responsible for active Na extrusion from the cell across the baso-lateral membrane is rheogenic (electrogenic), and is not the result of a neutral Na-K exchange.