Cell adhesion is a crucial step in proliferation, differentiation, migration, apoptosis, and metastasis. In previous works we have shown that cell adhesion is modulated by ouabain, a highly specific inhibitor of Na ؉ ,K ؉ -ATPase, recently found to be a hormone. In the present work we pursue the investigation of the effect of ouabain on a special type of cell-cell interaction: the rescue of ouabainsensitive MDCK cells (W) by ouabain-resistant cells (R). In cultured monolayers of pure W cells, ouabain triggers the ''P3 A mechanism'' (from pump͞adhesion) consisting of a cascade of phosphorylations that retrieves adhesion-associated molecules occludin and -catenin and results in detachment of the cell. When W cells are instead cocultured with R cells, the P3 A reaction is blocked, and W cells are rescued. Furthermore, in these R͞W cocultures ouabain promotes cell-cell communication by means of gap junctions by specifically enhancing the expression of connexin 32 and addressing this molecule to the plasma membrane. Ouabain also promotes the internalization of the -subunit of the Na ؉ ,K ؉ -ATPase. These observations open the possibility that the crucial processes mentioned at the beginning would be under the control of the hormone ouabain.ardiotonic steroids started in the 18th century as unknown active principles when William Withering used foxglove tea (Digitalis purpurea) to treat dropsy (congestive heart failure). Once ouabain was isolated, the demonstration that it specifically inhibits the Na ϩ ,K ϩ pump (1) transformed ouabain into a crucial tool to identify the pump with the membrane enzyme Na ϩ ,K ϩ -ATPase (2) and unravel its intrinsic mechanisms. Ouabain was recently recognized to be a hormone (3) whose blood level increases in physiological (e.g., exercise) as well as pathological (e.g., arterial hypertension, chronic cardiac and renal failure, preeclampsia, etc.) conditions (4-7). Furthermore, we found that ouabain specifically decreases cell adhesion by triggering a P3A mechanism that involves the activation of protein tyrosine kinases and extracellular signal-regulated kinases, decreases the cell content of the small GTP-binding protein RhoA, and changes the degree of phosphorylation, internalization, and degradation of adhesion molecules such as occludin, E-cadherin, etc. (8, 9) (D. Flores-Benítez, personal communication). We have also shown that detachment may not be ascribed to the ensuing decrease of K content (8) and that a decrease of K content provoked by incubation of R or W cells in media with only 0.1 mM K ϩ (instead of the regular 4.0 mM) does not cause cell detachment (8). This finding is in keeping with the fact that changes in reduced͞oxidized glutathione modify the degree of ouabain resistance without reducing the cell K (10, 11).Because in the meanwhile ouabain was shown to be a hormone (3), in the present work we pursue the study of its effect on a special type of cell-cell interaction: metabolic cooperation (12). A typical example of cooperation is provided by R cells that have low...