Guanylin receptor guanylate cyclase (GC-C) peaks in neonatal intestine and is involved in either enterocyte proliferation or chloride secretion. The latter is more potent when GC-C activator guanylin, or its analog Escherichia coli heat-stable enterotoxin (ST), is added to the mucosal rather than serosal side of intestinal monolayers. By using Ussing chambers, we investigated transepithelial ion transport and enterocyte proliferation and their mechanisms in response to the addition of guanylin or ST to the mucosal or serosal side of Caco-2 monolayers and in ileal specimens from neonates. GC-C activation showed a polar pattern of the effects. GC-C mucosal activation resulted in a potent cGMP-chloride secretion activation and in a marginal enterocyte proliferation. Conversely, serosal GC-C activation induced a potent enterocyte proliferation, through MAP kinase ERK 1/2. Finally, the inhibition of ERK1/2 enhanced the Isc increase in response to serosal but not to mucosal ST stimulation, indicating that ERK1/2 also acts as a brake of chloride secretion. These data suggest that the guanylin/GC-C system plays a key role in early postnatal intestinal adaptation exploiting the polar structure of enterocyte. (Pediatr Res 69: 17-22, 2011) T he human intestinal epithelium is organized in crypt-villus units with stem cells in the crypt that proliferate and mature while migrating along the villus (1). The mature enterocyte is a polarized cell whose structure is functional to create a barrier between the intestinal environment and the bloodstream and to transport ions, solutes, and macromolecules between the apical and basal compartments (2). A number of autocrine and paracrine messengers act on either side of the enterocyte to modulate these functions (3). Human guanylin is one such modulator, and similar to its bacterial analog, Escherichia coli heat-stable enterotoxin (ST), it binds to intestinal guanylyl cyclase C (GC-C) and induces an increase in cGMP (4) that triggers active chloride secretion. GC-C receptors are located along the entire intestine of mammals including humans (5-7). However, GC-C is in a polar fashion distributed in the enterocyte, with a lower receptor density in the basolateral than in brush border membranes (8). We previously reported that the rate of chloride secretion is lower when guanylin is added to the basolateral side than to the apical side of intestinal epithelium mounted in Ussing chambers (9).In addition, guanylin receptor density is age dependent (7), and the number of GC-C receptors is highest in the small intestine and colon of newborn infants and decreases with age (10). Because GC-C peaks sharply at birth, we suggested that the abundance of GC-C receptors in neonates induces copious intestinal water secretion on guanylin stimulation that allows meconium expulsion in the very first days of life (9). Guanylin is the endogenous ligand of GC-C. It is produced in intestinal cells, is detected in both the intestinal lumen and the blood (11), and induces chloride secretion. E. coli ...