The bacterial toxin acts via ADP ribosylation of the Gs subunit.
Through ribosylation, the Gs subunit remains in a locked “on” position, resulting in the increase of cAMP within the cell. This continued elevation of cAMP results in excessive secretion of electrolytes and water into the gut lumen.
In cholera, the Cl- channel is persistently open due to a locked Gs subunit. This openness results in the accumulation of cAMP and subsequent Cl secretion into the lumen, contributing to the diarrhea.
The reabsorption of Na is a necessary piece of the gut's function. By inhibiting this function, cholera causes profuse diarrhea that can be fatal due to electrolyte imbalances.
The diarrhea is classically described as rice water diarrhea due to the high fluid and electrolyte content. It also signifies that there is a lack of inflammatory cells because this is secretory diarrhea as opposed to invasive diarrhea.
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