The carbonic anhydrase-rich (CA) cell population of the turtle urinary bladder, which is responsible for the secretion of H+ and probably of HCO-3, was studied by freeze-fracture and thin-section electron microscopy. The apical membrane of the major CA cell type (alpha type) was characterized by microplicae and by a coat of studs on its cytoplasmic side; on freeze-fracture, it contained a dense population of rod-shaped intra-membrane particles. When fixed at low CO2 tension, the apical membrane area of the alpha cell was reduced; its surface displayed microplicae as well as microvilli, and the apical cytoplasm contained many vesicles with rod-shaped particles and studs. The apical membrane of the other (beta type) CA cell was characterized by numerous individual microvilli without microplicae and by a relative absence of rod-shaped particles and studs. Instead, the beta cell contained studs and rod-shaped particles in its basolateral membrane. The ultrastructure and frequency of the beta CA cell were not affected by changes in CO2 tension. We suggest that the alpha cell is responsible for H+ secretion. The reversal of the polarity of the membrane elements in the beta cell and failure to respond to CO2 with amplification of its apical membrane are consistent with a role in HCO-3 secretion.

The turtle bladder contains transport systems for active sodium absorption, electrogenic proton secretion, and bicarbonate secretion (coupled to chloride absorption) that are functionally separate and occur in specialized epithelial cells. Maneuvers that alter the intracellular acid-base state, such as changes in PCO2, cause marked changes in the apical membrane area of alpha-type carbonic anhydrase (CA) cells by addition or retrieval of membrane vesicles but have no effect on the granular cells that transport sodium. The apical cell membrane of alpha-CA cells contains characteristic rod-shaped intramembrane particles (RSP) by freeze fracture and is coated on its cytoplasmic side with studs. A subpopulation of CA cells (beta-type), which is characterized by apical microvilli, fails to exhibit an apical response to CO2 stimulation and does not reveal RSPs or studs at its apical membranes; instead, these elements can be demonstrated at the basolateral membrane. The reversal in the polarity of these elements as well as physiological evidence suggest that beta-type cells are responsible for bicarbonate secretion. Structure-function studies of CO2 stimulation of H+ secretion by alpha-CA cells indicate that the secretion rate (JH) correlates with apical membrane area and numbers of RSPs. The view that RSPs represent arrays of transmembrane channels and that studs represent catalytic units of H+ pumps is supported by quantitative considerations but remains to be proven. Urinary acidification is regulated not only by changes in the number of H+ pumps but also by the intrinsic properties of the H+ pump itself. For a given pump population, JH is closely controlled by the delta microH across the active transport pathway.

We measured bone mineral density (BMD), four markers of bone formation [bone alkaline phosphatase (bAP), osteocalcin (Oc), N- and C-terminal propeptide of type I procollagen (PINP and PICP respectively)] and five markers of bone resorption [serum C-terminal telopeptide of type I collagen (CTx), urinary CTx, N-terminal cross-linked telopeptide (NTx), free and total deoxypyridinoline (fDpd and tDpd respectively)] in 28 healthy premenopausal women (45.7 +/- 3.0 years), 15 early (< 7 years) healthy menopausal women (53.8 +/- 3.1 years) and 20 osteoporotic women (65.3 +/- 8.2 years). Bone markers and BMD were also measured in the osteoporotic women 4.1 +/- 0.2 and 12.6 +/- 1.2 months after the beginning of alendronate therapy (Fosamax, 10 mg/day) respectively (BMD in 16/20). We calculated the intra-individual coefficient of variation (iCV) and the least significant change (LSC) for each bone marker from a subset of 9 healthy premenopausal women (32 +/- 5 years) who had a first and a second morning void urine collection (FMV and SMV respectively) and a blood sample on 4 nonconsecutive days (mean interval 14 +/- 3 days). None of the bone markers was correlated with BMD (except p = 0.043 between serum Oc and hip BMD). All markers, except fDpd, were increased significantly in early menopausal women when compared with the premenopausal group. Serum CTx presented the highest increase at menopause (+67.8%) and identified the highest rate (11/15) of early menopausal women with bone turnover above the premenopausal range. The iCVs for bone formation markers (7.2-14.4%) were lower than those for bone resorption markers (14.6-22.3%). The iCVs obtained on FMV and SMV were not different. The decrease after 4 months of alendronate was significant for each bone marker but variable from one marker to another. Serum CTx showed the largest decrease (70.8%) and identified the highest number of biologically responding patients (change > LSC; n = 17/20). A significant change in serum CTx after 4 months of alendronate was the best predictor of a significant gain in spine BMD (i.e., > or = 27 mg/cm2) after 1 year of therapy, allowing 15 of 16 patients (94%) to be classified correctly (one false-positive). Urinary NTx/Cr was the second best predictor. Despite a moderately high iCV (20.6%), serum CTx appeared the most effective of the markers tested and could be of interest for the detection of high bone turnover and the longitudinal monitoring of alendronate therapy in the individual patient. It must be stressed that serum PINP and urinary NTx and tDpd compared very similarly with serum CTx for monitoring alendronate therapy.

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