Abstract-The sympathetic nervous system, via norepinephrine, regulates renal sodium transport, and chronic sympathetic activation causes sustained increases in blood pressure by reducing sodium excretion. Our previous studies show that chronic norepinephrine infusion increases the abundance of the bumetanide-sensitive cotransporter type 1, the apical sodium transporter of the thick ascending limb of Henle's loop. The present study was initiated to elucidate the mechanisms by which norepinephrine regulates the protein levels of this transporter in an immortalized thick ascending limb epithelial cell line. Treatment with norepinephrine, either alone or in the presence of actinomycin D or cycloheximide, had no effect on cotransporter mRNA levels. Treatment with norepinephrine, however, increased bumetanide-sensitive cotransporter type 1 protein levels (70% increase versus control; Pϭ0.012), and pretreatment with cycloheximide blocked the effect of norepinephrine on bumetanide-sensitive cotransporter type 1 protein levels. To further elucidate the mechanism, thick ascending limb cells were treated with norepinephrine in the presence of phentolamine (␣-adrenoceptor blocker), propranolol (-adrenoceptor blocker), SQ22536 (adenylyl cyclase inhibitor), PD098059 (mitogen-activated protein kinase pathway inhibitor), H-89 (protein kinase A inhibitor), or staurosporine (protein kinase C inhibitor). Treatment with propranolol, SQ22536, and H-89 abolished the effects of norepinephrine on bumetanide-sensitive cotransporter type 1 protein levels, whereas staurosporine had no effect. Treatment with PD098059 partially inhibited the effects of norepinephrine (40% decrease versus norepinephrine; Pϭ0.03), and treatment with phentolamine potentiated the effects of norepinephrine (30% increase versus norepinephrine; Pϭ0.02) on bumetanide-sensitive cotransporter type 1 protein levels. We conclude that regulation of bumetanide-sensitive cotransporter type 1 by norepinephrine proceeds via the -adrenoceptor receptor-cAMP-protein kinase A pathway that involves in part mitogen-activated protein kinases and that ␣-adrenoceptor activation negatively regulates bumetanidesensitive cotransporter type 1 protein levels. Key Words: BSC-1/NKCC2 Ⅲ thick ascending limb Ⅲ norepinephrine Ⅲ ␣-adrenoceptor Ⅲ -adrenoceptor Ⅲ cAMP Ⅲ protein kinase A Ⅲ cAMP T he bumetanide-sensitive cotransporter type 1 (BSC-1) Na-K-2Cl cotransporter is the principal apical Na ϩ entry pathway in the thick ascending limb (TAL). 1,2 Therefore long-term dysregulation of BSC-1 may contribute to longterm dysregulation of arterial blood pressure. In support of this concept, recent studies demonstrate that enhanced expression of BSC-1 in the TAL causes sodium retention in rats with congestive heart failure. 3 Moreover, BSC-1 is upregulated in rats with small-to-moderate myocardial infarctions, 4 dehydration, and cardiac failure 5 and in an animal model of liver cirrhosis. 6 Moreover, our results in the spontaneously hypertensive rat (SHR) show that expression of BSC-1 is also ele...