IntroductionThe KCl cotransporter (KCC) is a member of the cation-chloride cotransporter family of proteins that mediate electroneutral net transport of salt to effect cell volume regulation, epithelial solute secretion and absorption, and control of intracellular ion concentrations. 1 In red blood cells (RBCs), KCC functions during reticulocyte maturation to establish the steady-state volume and mean corpuscular hemoglobin concentration (MCHC) of the mature RBC. 2,3 RBC KCC activity is stimulated in vitro by cell swelling (low MCHC), 4,5 acid pH, 6,7 and urea, 8 but the physiologic stimuli that effect reticulocyte volume reduction in vivo are not clear.KCC activation is controlled by phosphatase/kinase equilibria. Activation involves dephosphorylation of a serine (threonine) residue, probably by protein phosphatase 1 (PP1) 9,10 or PP2A. 11 There is also evidence for control by tyrosine phosphorylation; in fact, certain tyrosine kinase inhibitors activate KCC, 12,13 whereas others inhibit, 14,15 suggesting multiple control points, including PP1 itself. 16,17 Activation by cell swelling appears to involve inhibition of a putative volume-sensitive serine/threonine kinase, which maintains the system in a phosphorylated, quiescent state. 18 It is unknown whether control is mediated through phosphorylation of the transporter itself or other regulatory protein(s).KCC is also activated by sulfhydryl alkylation with Nethylmaleimide (NEM) 5,[19][20][21] and oxidation by diamide 22 or hydrogen peroxide. 23 CDNB (chloro-dinitrobenzine) stimulates KCC without a direct oxidant effect by enzymatic coupling to reduced glutathione (GSH). [24][25][26][27] Although the target of these agents is not known, it is clear that KCC activity and regulation are modulated by the oxidation state of RBC sulfhydryls.KCC activity in sickle (SS) RBCs is greatly elevated compared with normal (AA) RBCs, regardless of the activating stimulus. Some of this elevated activity is a consequence of the high percentage of reticulocytes in SS blood. 2,28 Nevertheless, there is evidence that the presence of sickle hemoglobin (Hb S,  6glu3val ) or hemoglobin C (Hb C,  6glu3lys ) directly affects the activity and properties of KCC in RBCs and RBC ghosts. [29][30][31]7 demonstrated acid stimulation of KCC in SS RBCs and showed that acidification of SS RBCs produced an increase in cell density. 6,7 Bookchin et al 32 showed that SS reticulocytes were susceptible to acid-induced dehydration and suggested that most of the dense cells in sickle blood arose from a subpopulation of SS reticulocytes with high sensitivity to KCC-mediated dehydration. Franco et al 33 found that SS reticulocytes that were dense in vivo were more susceptible to acid-induced dehydration via KCC than reticulocytes that were normally hydrated in vivo. These studies demonstrated the capacity of KCC to mediate SS RBC dehydration in vitro, but since direct comparisons with AA reticulocytes have not been made, the abnormal volume regulatory response of KCC in SS reticulocytes has not been f...