Na+-K+-Cl- cotransporter (NKCC) maintains the chloride gradient to sustain pacemaker activity in interstitial cells of Cajal.

Interstitial cells of Cajal (ICC) generate electrical slow waves by coordinated openings of ANO1 channels, a Ca-activated Cl (CaCC) conductance. Efflux of Cl during slow waves must be significant, as there is high current density during slow-wave currents and slow waves are of sufficient magnitude to depolarize the syncytium of smooth muscle cells and PDGFRα cells to which they are electrically coupled. We investigated how the driving force for Cl current is maintained in ICC. We found robust expression of Slc12a2 (which encodes an Na-K-Cl cotransporter, NKCC1) and immunohistochemical confirmation that NKCC1 is expressed in ICC. With the use of the gramicidin permeabilized-patch technique, which is reported to not disturb [Cl], the reversal potential for spontaneous transient inward currents (E) was -10.5 mV. This value corresponds to the peak of slow waves when they are recorded directly from ICC in situ. Inhibition of NKCC1 with bumetanide shifted E to more negative potentials within a few minutes and reduced pacemaker activity. Bumetanide had no direct effects on ANO1 or Ca3.2 channels expressed in HEK293 cells or L-type Ca currents. Reducing extracellular Cl to 10 mM shifted E to positive potentials as predicted by the Nernst equation. The relatively rapid shift in E when NKCC1 was blocked suggests that significant changes in the transmembrane Cl gradient occur during the slow-wave cycle, possibly within microdomains formed between endoplasmic reticulum and the plasma membrane in ICC. Recovery of Cl via NKCC1 might have additional consequences on shaping the waveforms of slow waves via Na entry into microdomains.