Cell Membranes and Transport

Fred Rieke and Bertil Hille

Session Learning Objectives and Quick Synopses

1. Describe the structure and topology of cellular membranes.

Cell membranes surround the cell and surround each organelle in the cell. They are formed by bilayers of phospholipids.  The phospholipid tails form a hydrophobic (water-fearing) core between two hydrophilic (water-loving) layers formed by the phospholipid head-groups. Molecules that are lipid soluble dissolve in and pass readily through the bilayer. In addition, integral and peripheral membrane proteins are embedded in the lipid bilayer. They confer additional membrane properties through their functions as receptors, enzymes, or permeation pathways.

2. Contrast ion channels and ion transporters and the forces that drive them.

Ion channel proteins are gated pores in the membrane that allow selected ions to flow down their electrochemical gradients. In ion channels, the ions are driven only by their own concentration gradients and by the electric field acting on them. We call this flow passive. Other transport proteins act more like enzymes that couple the movement of one kind of ion or solute to energy derived either from the flow of another kind of ion or directly from the hydrolysis of ATP. Often these transporters can establish gradients of ion concentration. We call this active transport. It is primary active transport when the pump is driven by ATP, and secondary active transport when the energy comes from another ion gradient.

3. Know the normal balance of Na+, K+, Cl and Ca2+ with respect to the plasma membrane.

As a result of active transport, Na+, Ca2+, and Cl are more abundant outside of the cell in serum, whereas K+ is more abundant inside the cell in cytoplasm (Table 2). These non-equilibrium distributions are essential for many cellular responses including electrical excitability.

4. Describe the elements of ionic electricity: ions, charge, potential gradients, forces, current, and conductance.

Dissolved salts dissociate into small ions. These are charged particles with typical charges of -2, -1, +1, or +2. Ions are moved across membranes by two forces: concentration gradients and electric fields acting on the charge of the ion. Any net movement of an ion across the membrane is by definition an electric current, and electric currents flowing across the membrane will alter the membrane potential. Ion currents are primarily conducted through the membrane by ion channels.

Cell membranes

All cells are surrounded by a plasma membrane that forms the boundary between the living cyto­plasm and the extracellular space. The membrane retains the cytoplasmic contents and pre­vents intrusion by most molecules outside the cell. The mem­brane is flexible and semi-fluid, conforming dynam­ically to the changing forces of intracellular cytoskeletal proteins and the extra­cellular matrix and substrate. Red blood cells, for example, take their bicon­cave disk shape from their special­ized spring-like intra­cellular cyto­skeletal network. Nevertheless, they readily bend and squeeze unharmed in transient con­tor­tions as they rush through narrow capillaries. Inside nucle­ated cells, other mem­branes define organ­elles like the mitochondria, the nuc­leus, and the endo­plas­mic reticulum. The plasma membrane and the intra­cellular mem­branes share a common basic archi­tecture and a common origin. They are made of a molecular bilayer of lipids peppered with mem­brane proteins. We start by discussing the lipid component and then return to the proteins.

 

Learning Objective #1.  Describe structure and topology of cellular membranes.

Membranes form a hydrophobic lipid bilayer

Typical membrane lipids are phospho­lipids and chole­sterol. These molecules are primarily hydro­pho­bic (“water fearing”) but bear a charged or polar group at one end that is hydrophilic (“water loving”) (Figure 1). We call this dual nature, amphipathic (“both pre­fer­ences”). Soaps and detergents are also amphi­pathic. This allows them to bring greasy substances into solu­tion in water (the cleaning action of soaps, for example, relies on breaking grease up into small droplets in water).

Figure 1:  Structures of two membrane lipids.  Left: phosphatidylcholine. Right: cholesterol.

In the structure of phospho­lipids, we see two hydrophobic fatty acid chains attached to a glycerol scaffold at the glycerol 1- and 2-positions (Figure 1). The glycerol 3-position carries the hydrophilic phos­phate and head group. Common head groups include (Figure 2) serine, etha­nol­amine, choline, and inositol, each with its own special roles and forming phos­pho­lipids with names like phos­pha­tidyl serine, phospha­tidyl­inositol, and so forth. Amphipathic phos­pho­lipids spontan­eously form a lipid bilayer made of two lipid leaflets as a thin flexible sheet (Figure 3). This is a minimum energy state for phos­pho­lipids in water because it maxi­mizes the interactions of the hydrophobic fatty acid side chains with each other and away from water, and it maximizes the interaction of the hydro­philic head groups with water.

Figure 2:  Structures of common membrane phospholipids.  The glycerol-like moiety is shown in bold to emphasize similarity in structure. The fatty acyl chains are just shown as yellow boxes but represent a mixture of chain lengths and unsaturation. The percentage indicates the relative abundance in the plasma membrane of a red blood cell.

At physio­logical tem­per­atures, the lipid side chains are free to undergo rapid spon­taneous thermal motion, waving around in a fluid-like state while still remaining anchored to the gly­cerol, which carries the head group. In addition, each phos­pho­lipid molecule experiences spontaneous thermal rotation, stocha­stically spinning around its long axis, as well as lateral diffusion by Brown­ian motion in the plane of the membrane. All these motions make the lipid bilayer an ultrathin flex­ible, oily fluid. The thickness is just twice that of the two opposing fatty acid leaflets, about 3 nm, far thinner than the wave­length of light and therefore resolv­able only by electron microscopy.

 

Figure 3:  A bilayer of phospholipids forms a membrane.

Passive permeability of the bilayer

Some molecules easily cross the lipid bilayer membrane and some do not (Figure 4). Permeability is a measure of how easily molecules cross the mem­brane. Key permeability properties of cell mem­branes are well under­stood if we remember that the lipid bilayer is like a thin sheet of oil. Hydro­phobic molecules presented in the aqueous phase, being lipid soluble, pass easily into the oily lipid bilayer and cross the membrane barrier. Illustra­tive examples would include aspirin, steroid hormones, O2, CO2, and NO (Box A). We say the mem­brane is permeable to these hydrophobic mole­cules, which is good in these cases since their physio­logical actions require them to enter cells from the outside. Thus, the steroid hormone estro­gen is made in the ovaries but has to act on receptors in the nucleus of cells throughout the body. In all respiring cells, O2 has to enter the cell con­tinuously, and CO2 has to leave. Similarly, O2 has to enter red blood cells in the lungs and be delivered to tissues in the capillaries during every circuit of the circu­lation, and the reverse for CO2. Each of these steps requires the hydro­pho­bic steroid or gas molecules to dissolve in the plasma mem­brane and to pass across it and emerge on the other side, a process that takes only a small fraction of a second. For the same reasons, some degree of hydrophobicity is essential in the design of new drugs that are intended to be taken orally so that they can be absorbed across cells of the intestinal wall and cross into target tissues.

On the other hand, molecules that are polar (sugars) or charged (ions) are hydrophilic and do not enter into oil. They are reluc­tant to leave water and do not enter or cross the lipid bilayer easily. Examples include Na+, ATP, and glucose (Box A). Cell membranes are relatively imper­meable to them, which allows the cell to develop ion gradients across mem­branes and to retain its high-energy molecules, meta­bolites, and genetic material inside. Many important physiological responses involve changes of membrane permeability to charged and polar molecules. In electrophysiology we will see that the ion-imper­meable lipid bilayer can be thought of as an electri­cal insulator. It allows a small charge imbalance across the mem­brane to generate an electrical potential difference across the membrane – the mem­brane potential. The electrical responses of cells involve changes of permeability to ions and ion movements through the carefully orchestrated opening and closing of ion channels in the plasma membrane. In this way, as we shall see later, the plasma membrane is the seat of all electrical signaling in nerve and muscle.

 

Figure 4:  Different types of molecule differ in membrane permeability.  Non-polar molecules can cross membranes without help.  Charged ions or polar molecules cannot.

Proteins add functions to cell membranes

A more complete view of biological mem­branes would show a thin lipid sea with many proteins inserted and floating in it (Figure 5). Some proteins, the integral mem­brane proteins, have one or more hydro­phobic trans­membrane segments and never leave the mem­brane (Box B). Others, the peripheral proteins, bind to other membrane proteins and lipid head groups but do not have any trans­mem­brane segments. They may associate and disso­ciate dyna­mically from the mem­brane compart­ment depending on the state of the cell.

Almost all integral membrane proteins are initially inserted into membranes of the endo­plasmic reticulum (ER) during protein synthesis as the nascent peptide chain is length­ened by protein translation. The ER membrane then buds off a membrane vesicle that passes to the Golgi with its new membrane proteins. Eventually, more budding from the Golgi sends a vesicle further to, e.g., the plasma mem­brane.

 

Figure 5:  Membrane proteins in the lipid bilayer.  Integral membrane proteins (blue) with extracellular glycosylation and peripheral membrane proteins (gray).

Details of mem­brane origin and traffic will be discussed in a separate session empha­sizing cell biology of mem­brane budding and endo- and exo­cytosis. They explain how all membranes have a similar archi­tecture since they derive from the same source. Mem­brane proteins contri­bute many biological functions to the mem­brane including transport and enzy­matic cata­lysis (Box B). Although the basic architecture of the membrane is conserved, the different mem­branes of a cell are special­ized by having different sets of functional proteins to allow them to perform different functions, so both at the level of gene expres­sion and in the events of mem­brane traffic, decisions are made as to which protein belongs where.

 

Learning Objective #2.  Contrast ion channels and ion transporters and the forces that drive them.

 

Figure 6:  Three classes of ion transport.  These cartoons are drawn in a conventional shorthand that indicates the net function but not the true structure of these proteins. Each diagram represents families of related proteins. Solute cotransporters exist for a variety of possible organic molecules including various sugars and amino acids. ATPase cation pumps exist for Na+/K+, H+/K+, and Ca2+ ions.

Now we will emphasize certain transmembrane proteins that facilitate movement of ions across the membrane, sometimes coup­ling with transport of other small mole­cules. One can consider them catalysts that enable regu­lated trans­mem­brane move­ments of a small select number of molecules. They include ion channels, coupled trans­porters, and ion ATPase pumps (Figure 6). We introduce them superficially first.

(A) The ion channels are the sim­plest. When they are open, they act like a pore that allows ions to flow. They have ion selec­tivity – a prefer­ence for certain ions. The direction of ion flow is set entirely by two thermo­dy­namic forces on the ions: (i) the ion concen­tration gradient across the membrane, and (ii) an electrical force if there is a difference in electrical poten­tial across the membrane. We can say that the direction of ion flux is thermo­dyna­mically downhill, and, more tech­nically, we say it is down the electro­chemical gradient. The ion channels in Figure 6 are selec­tive for K+, Na+, or Cl and would be called K+ chan­nels, Na+ channels, or Cl channels. Some ion channels are less selective, passing a range of small cations or a range of small anions. Ion channels have an addi­tional feature: most of them open and close their pore in response to stimuli such as a neuro­trans­mitter, a voltage change, heat, or an intracellular second mes­senger. We say they are gated. This gating allows them to react dynamically to other stimuli.  The figure also shows a water channel, a pore that allows osmotic flow of water across the membrane, e.g. in the kid­ney. As a peek forward to the next few weeks, Table 1 lists the proper­ties of ion channels you will be encoun­tering soon.

(B) The next category in Figure 6, the coupled trans­porters, couples the movement of one molecule (here an organic solute or bicarbonate or Ca2+) to the downhill flow of another (Na+ or Cl). The action is like that of an enzyme that in this case has two substrates. Nothing happens until both substrates are present. They bind and induce con­for­mational changes of the protein that exposes each of them to the opposite side of the mem­brane. Such transporters are sometimes called “carriers.” The first example shown is a Na+-coupled solute trans­porter, of which there are many types (for sugars, amino acids, neuro­transmitters, etc.). Here Na+ and the coupled solute move in the same direc­tion into the cell, so it is called a co-transporter. These cotransporters use the free ener­gy of Na+ allowed to flow down­hill (down its electro­chemi­cal gradient) into the cell, to drive the cotransport of the other sub­strate. They can drive uphill trans­port of solutes, cre­ating a concen­tration gradient. Such a process is called secon­dary active transport, an active trans­port that does not use ATP as its direct source of energy. It is analo­gous to using the cascading of water over a waterfall (Na+ entry) to do some work (solute transport).

The second group of coupled transporters exchanges ions from opposite sides of the membrane. Shown are examples of Cl/­bicarbonate exchangers and Na+/Ca2+ exchangers. All these coupled trans­porters are fully reversible, operating in whichever direction thermodynamics dictates, and are capable of secondary active transport. For completeness, we also mention a type of transporter that has only one substrate and no coupled ion flow (Figure 6). This transport process, called facili­tated diffusion, is by necessity thermodynamically downhill for the single substrate. A notable exam­ple is the Glut4 glucose transporter inserted into the plasma membrane by the action of insulin to allow passage of glucose in either direction.

(C) The final example in Figure 6 is an ion pump that couples transport of Na+ and K+ to the free energy of hydrolysis of ATP, the metabolic dollar bill. Now both ions are moved uphill (in opposite directions) at the direct expense of metabolic energy. Such pumps that consume ATP directly are said to perform primary active trans­port. They generate the ion gradients across the membrane that are important for ion movements in coupled transporters and in ion channels. Before considering how the pumps work, we will discuss the ion imbalances that these pumps set up.

 

Learning Objective #3.  Know the normal balance of Na+, K+, Cl and Ca2+ with respect to the plasma membrane.

Four ion gradients

Gradients of ions across the plas­ma membrane are key for physio­logy and medi­cine–indeed for life. The word gradient means a differ­ence in concentration on the two sides of the mem­brane. Recall that salts like NaCl disso­ciate in water into the free cations and anions – Na+ (“sodium ion”) and Cl (“chloride ion”) in the case of NaCl.  This makes an electro­lyte solu­tion. With respect to ions, our plas­ma (the extra­cellular medi­um for cells) is like a dilute ver­sion of seawater, reflect­ing the origins of animals in early oceans. As in seawater, the con­cen­trations of Na+ and Cl are high and K+ is low (Table 2). In contrast, inside the cell, the Na+ is low, Cl is often low, and K+ is high. Resting cellular free Ca2+ is extra­ordi­narily low, making Ca2+ a good ion for intra­cellu­lar signaling as we will see later. Note that the table has a footnote explaining two conven­tions for the units of extra­cellular con­cen­tration that will be important for you as a clinician. Here we will use inter­national scientific units, but in the clinic you will use the other. Shortly we shall see that ion gradients allow cells to make electrical signals. Later curriculum blocks show how ion gradients help to regulate cellular and body volume and to transport essential meta­bo­lites into cells by Na+-coupled trans­porters. Right now, it would be important to com­mit to memory the direction of these four important cellular ion gradi­ents, remem­bering which ions are high outside, and which are high inside. These gradients are an essential concept for under­standing electrical excitability and cell physiology.

Ion pumps make ion gradients

The existence of ion gradients tells us that the cell is not at equilibrium and that some work has been done to make such an imbalance. As is always the case, doing work requires expenditure of energy; this is the job of the ATPase ion pumps. In cell membranes, there are several pumps in this protein/gene family specialized for active trans­port of Na+, K+, Ca2+, and protons. We start with the Na+/K+-ATPase, some­times just known as the Na+-pump for short.

Pumps are integral membrane proteins; more specifically, they are enzymes. Like other enzymes, they have a reac­tion velocity that increases with substrate concentration and that saturates when the sub­strates are abundant. Also, their reaction is cyclic with substrates binding and products unbinding in a fixed and cyclic stoichiometry. The unusual feature com­pared with most enzymes is that the substrate is picked up in one compartment and through a conformational change the product is released in a different compart­ment. They operate across membranes. The reaction for the Na+/K+-ATPase in the plasma mem­brane, already diagrammed in Figure 6, can be written as a chemical formula:

E + 3 Na+i + 2 K+o + ATP    ->    E + 3 Na+o + 2 K+i + ADP + P

where E stands for the enzyme, the numbers indicate the stoichio­metry of the reaction, subscript “o” means outside the cell, and subscript “i” means inside the cell, except that Pi is the conven­tional abbreviation for “inorganic phosphate.” Let’s turn this into words: 3 Na+ ions are moved from the inside to the outside, 2 K+ ions are moved from the outside to the inside, and 1 ATP is broken down to ADP plus inorganic phos­phate in the cyto­plasm. Some known substeps of the pump cycle can be repre­sented by a cyclic cartoon (Figure 7). Because this pump operates all the time in all our cells, the cytoplasmic Na+ is removed and replaced by K+, creating and maintaining the Na+/K+ gradients of Table 2. Some cells, like kidney cells and most excitable cells, must move ions rapidly to accomplish their transport and excitability functions. They have many copies of the Na+-pump in their plasma membrane. Others, like red blood cells, have very few ion channels and can get by with a low density of Na+-pumps. Red blood cells therefore do not need to consume glucose and produce ATP as rapidly as a kidney cell would.

Figure 6: Cartoon of the Na+/K+ ATPase cycle. Starting from upper left and going clockwise around in one pump cycle, 3 Na+ load, ATP is cleaved, Na+ is unloaded, 2 K+ are bound, and K+ is unloaded. The pump itself alternately opens a gate to the outside and a gate to the inside driven by ATP so the ions are transported to the opposite side of the membrane setting up a gradient.

This pump can be blocked by cardiac glyco­sides like digitalis (related to Digoxin used clinically) and ouabain. When this is done experi­mentally, the ion gradients of the cell gradually run down over hours. Such experiments also show that as much as 25-40% of the energy meta­bolism of a kidney cell is devoted to providing the ATP for the Na+/K+-ATPase. Clinically, digitalis analogs are used at very low concentration to reduce the Na+ gradient just a little in the heart. As you will learn later in the Cardio­vascular Block, a decreased Na+ gradient reduces the activity of the Na+/Ca2+ exchan­ger (see Figure 6), which is powered by the Na+ gradient. Therefore, some additional cyto­plasmic Ca2+ accu­mulates inside the cardiac cells, boosting muscle contraction and helping to ameliorate congestive heart failure.

Learning Objective #4.  Describe the elements of ionic electricity: ions, charge, potential gradients, forces, current, and conductance.

The movement of ions through channels is the foundation of electrical signaling.  The properties of membranes and proteins contained within them described thus far lay much of the foundation for studying electrical signaling. We focus on ion channels. We introduce some of the essential components of electrical signaling here, and return to this in the chapters on membrane potentials and action potentials.

Diffusion and voltage

The movement of ions through an open ion channel is dictated by two forces.  The first is the chemical or diffusive force created by differences in the concentration of the ions on the two sides of the membrane.  In the example of Figure 7, K+ and Cl- are initially at higher concentration on the left side of the beaker.  If the membrane dividing the beaker permits both K+ and Cl to cross, both will move from left to right, down their concentration gradient.  Equilibrium in this case is achieved when the concentrations of K+ and Cl are the same on both sides of the membrane,

Figure 7:  Diffusion.  Diffusion causes ions or other molecules to move from a region of high concentration to low concentration (here from the left to right of the beaker), provided there is a route that the molecules can take (here provided by membrane channels that permit K+ and Cl- to traverse the membrane). 

The second force influencing the flow of ions through a channel is the electrical force created by voltage differences.  In Figure 8, as soon as the battery is turned on, the negative electrode (on the right) will attract positively-charged cations (Na+) and the positive electrode will attract negatively-charged anions.

Figure 8:  Charges ions and voltage  DSalts (e.g. NaCl) dissociate in water into positively charged cations (e.g. Na+) and negatively charged anions (e.g. Cl-). If we place two electrodes in a beaker and impose a voltage difference between the electrodes with a battery, the cations will move to the negative electrode and the anions to the positive electrode.  The resulting movement of charged ions creates an electrical current.

Membrane conductance  (Figure 9A)

A beaker with electrolyte solutions is divided into two com­part­ments called IN and OUT by a mem­brane contain­ing only K+ channels (in Figure 7, the membrane was permeable to both K+ and Cl). The IN and OUT com­part­ments contain equal concentrations of dissol­ved KCl and each has an immersed electrode (e.g. a wire, green) connected to a voltage-pulse gen­er­ator. The pulse generator chan­ges the potential on the wire for brief periods and can make the IN side briefly negative, pos­itive, or unchanged. Figure 2B plots the results as blue triangles. These triangles show the measured current IK carried by K+ ions versus the applied voltage. (i) When the trans­mem­brane voltage is kept at 0 mV, no net K+ current flows (sym­bols at the origin). There is no force on the K+ ions. (ii) When the IN voltage is made nega­tive, there is an inward K+ current, the negative electrical potential pulls K+ ions towards the IN com­part­ment. (iii) when the IN voltage is made positive, there is out­ward K+ current.

Figure 9:  Measuring the electrical conductance GK of a membrane containing K+-selective ion channels.  A. A voltage pulse generator changes the voltage across the membrane.  B. The resulting K+ currents are plotted against the applied voltage. By physiological convention, outward currents are called positive and inward currents are called negative as the plot shows. In this example there are no ion gradients across the membrane.

The blue triangles in Figure 9B describe a straight line through the origin. The conductance is the slope of this line. This illustrates Ohm’s law

IK = GK E

which says that K+ current IK is linearly pro­por­tional to GK (the conductance to K+) and the electrical driving force E. Remember that the conductance is the inverse of the resistance (G = 1/R), which connects the equation above to the more familiar form of Ohm’s law (E = I R).  Ohm’s law tells us that more force (more E) means more current.

The blue line and blue symbols in Figure 9B des­cribe the current when all the K+ channels are open. If we close half of them, we get the red line. As you might expect, the flow of K+ is reduced to half, the slope is only half, and the con­duc­tance of the mem­brane is half. Electri­cal conduc­tance is easy for electro­physi­ologists to mea­sure and con­ven­iently tells us how many ion channels are open. This con­cept is used repea­tedly when we start with electro­physio­logy.

Key terms and definitions (refer to these often!):

  1. Charge:  Ions have a charge given in multiples of one elementary electron charge. Cations (Na+, K+, Ca2+) are positively charged and anions (Cl) are negatively charged.
  2. Two forces that move ions:  (i) Charges are moved by the force of electric fields: Opposites attract, so cations (positively charged) move towards a negative pole, and anions towards a positive pole. (ii) In addition, ions are moved by diffusion (thermal agitation) down their concen­tration gradients–even in the absence of electric fields.
  3. Current:  A net movement of charge (flow of ions) is an electric current (an ion current) meas­ured in amperes (A) and symbolized by I. The direction of current is defined by con­vention as the direction of positive charge movement. Hence, if only positive K+ ions are moving OUT of a cell, then electric current is also moving OUT of the cell; however, if only negative Cl ions are moving OUT of the cell, we use this convention to say that electric current is flowing INTO the cell.
  4. Voltage:  If cations are removed from a compartment (the cell), the compartment becomes more negative, i.e, a negative electrical potential or negative voltage will be set up inside the cell. The voltage arises because there is a charge imbalance. In electro­physiology, the words voltage and electrical potential will mean the same thing. A voltage is measured in units of volts (V) and symbolized by V. It is defined as the amount of electrical work it would take to remove one more cation. [Aside: When you buy a flash­light battery, it is typically a 1.5 volt battery. We could write Vbattery = 1.5 V. The bigger the battery (AAA,AA,A,B,C,D, etc.), the more current and charge it can provide, but the alkaline battery chemistry always makes a 1.5 V potential. In biology, the mem­brane potentials are much smaller, within the range from -100 mV to +50 mV. All our electrical signaling occurs within this small voltage range as in Figure 1.]
  5. Conductance:  Conductance is a measure of how easily ions can cross the membrane (it is the inverse of the resistance). A membrane with many open ion channels has a high conductance (low resistance), and one with no open ion channels has a conductance that is almost too low to measure since the lipid bilayer is very impermeable to charged ions. Thus conductance, symbol­ized G, is proportional to the number of ion channels open. We now show how to measure it.

 

 Practice questions and review topics:

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Optional digoxin practice case

Patient Bob Jones is a 68-year-old man who suffered a heart attack 6 months ago, and as a consequence now has severe systolic heart failure (weakened pumping function of the heart muscle). Initial medications prescribed for this have resulted in only slight improvement of the heart failure symptoms, so Bob’s physician decides to add digoxin to the medication regimen.

Digoxin is a drug in the class called cardiac glycosides, which are derived from the foxglove plant and have great historic importance in medicine as they have been used for hundreds of years to treat heart failure. Newer drugs developed in recent decades have now become the mainstay of treatment for heart failure, but digoxin is still used in certain circumstances.

Among other effects, digoxin at optimal doses increases the force of contraction of heart muscle. The following questions will help you understand the physiology behind this therapeutic effect. Note: In a few weeks, you will be learning that intracellular Ca2+ triggers contraction of cardiac and skeletal muscle.

  • Review the function of the Na+-K+ ATPase pump.
  • How would inhibiting this Na+-K+ pump influence ion distribution?
  • How would inhibition of the Na+/K+ ATPase influence forces contributing to ion movement across the plasma membrane?
  • How might this decreased Na+ gradient influence function of a secondary active transport system?
  • Review the mechanism of action of the Na+-Ca2+ exchanger.
  • What would be the result on intracellular Ca2+ concentrations if activity of the Na+/K+ ATPase pump is slowed?
  • Predict how this change could be useful in the treatment of cardiac failure.
  • Now put together the physiologic processes discussed in this case, to explain the mechanism by which digoxin augments the force of myocardial contraction.

 

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