The Na/K pump is a P-type ATPase that exchanges three intracellular Na + ions for two extracellular K + ions through the plasmalemma of nearly all animal cells. The mechanisms involved in cation selection by the pump's ion-binding sites (site I and site II bind either Na + or K + ; site III binds only Na + ) are poorly understood. We studied cation selectivity by outward-facing sites (high K + affinity) of Na/K pumps expressed in like organic cation transport challenges the concept of rigid structural models in which ion specificity at site I and site II arises from a precise and unique arrangement of coordinating ligands. Furthermore, actions by guanidinium + derivatives suggest that Na + binds to site III in a hydrated form and that the inward current observed without external Na + and K + represents cation transport when normal occlusion at sites I and II is impaired. These results provide insights on external ion selectivity at the three binding sites.he Na/K pump uses the free energy from ATP hydrolysis to export three Na + ions against a steep electrochemical gradient in exchange for the import of two K + ions. The pump alternates between two major conformational states, E1 and E2 (1), and its function is explained via a ping-pong (2) alternate-access mechanism (Fig. S1). Under physiological conditions, the E2P (phosphorylated) state, with extracellular-facing ion-binding sites, must select K + in the presence of more than 10-fold greater external Na + concentration. On the other hand, the E1 state, with cytoplasmic-facing ion-binding sites, selects Na + over K + , which is present at a 10-fold higher concentration.Of the three ion-binding sites, sites I and II, or shared sites, can bind either Na + or K + , but site III exclusively binds Na + . External release of Na + ions from these three sites occurs sequentially (3, 4). In the outward-facing conformation, Na + release is followed by binding of K + in the normal forward operation of the Na/K pump, inducing an outwardly directed pump current that can be studied under voltage clamp. Rebinding of Na Most of the cycle's voltage dependence is believed to arise from the release (rebinding in the backward reaction) of the first Na + ion through a high-field access channel when leaving its binding site (3, 4, 7). There are indications that the Na + -exclusive site III releases Na + before the shared sites (6,8,9) and that the voltagedependent rebinding of this first externally released Na + blocks release of the other two Na + ions from the shared sites. Concordantly, at saturating [K + o ], where Na + competition for the shared sites should be negligible, the Na/K pump current still presents significant VDI in the presence of external Na + (10) (Fig. S2). In addition, several studies have proposed a noncanonical mode of transport in which protons move in the inward direction down their electrochemical gradient at very negative voltages (11) through a pathway that passes through site III (9, 10, 12, 13).These observations raise a number of critical questions ...