Apoptosis is a major form of cell death that occurs in response to a variety of signals in both physiological and pathological situations. A hallmark of apoptosis is normotonic cell shrinkage, called apoptotic volume decrease (AVD), the process of which involves fluxes of K + , Cl − , and Na + . Na + influx was suggested to be required in Fas-induced apoptosis in human Jurkat T cells, whereas Na + efflux was found to be associated with AVD and apoptosis in human HL-60 cells. Here we examined the effects of extracellular Na + deprivation on cell volume and viability in human epithelial HeLa cells. The incubation of HeLa cells in normotonic Na + -free Ringer solution resulted in persistent cell shrinkage after ≥30 min and reduction in cell viability after ≥1 h. After exposure to Na + -free solution for 5 h, a marked reduction in cell viability was found to be associated with an activation of caspase-3 without showing significant LDH release, indicating that the cells underwent apoptosis but not necrosis. Na + deprivation-induced cell shrinkage and apoptotic cell death were significantly inhibited by a blocker of Na + -K + -2Cl − cotransporter (NKCC) or of the reverse-mode operation of Na + /Ca 2+ exchanger (NCX), but not by a blocker of Na + /H + exchanger (NHE). Therefore it is concluded that Na + deprivation causes persistent cell shrinkage resulting from Na + efflux mainly via NKCC and NCX and thereafter leads to apoptotic death of HeLa cells. It is also suggested that normotonic cell shrinkage per se, if persistent, provides a sufficient condition for apoptosis induction.Key words: apoptosis, Na + efflux, apoptotic volume decrease, normotonic cell shrinkage.Apoptosis is an essential process involved in normal somatic cell turnover, embryonic development, and metamorphosis, and inappropriate apoptosis is implicated in the pathogenesis of degenerative diseases, ischemic damage, autoimmune disorders, and cancer. A major hallmark of the early-phase process of apoptosis is normotonic whole cell shrinkage [1]. The apoptotic volume decrease (AVD) is attained by water exit driven by an efflux of osmolytes, including K + and Cl − , and is an essential event leading to apoptotic cell death under stimulation with a variety of apoptosis inducers [2][3][4].Recently, we have demonstrated that exposure to normotonic low Cl − solution induces persistent cell shrinkage and thereafter apoptotic death in U937 and HeLa cells even without the application of any apoptosis inducer [5]. These results suggest that ion efflux mediated by an outward-directed operation of Cl − transporters results in normotonic cell shrinkage leading to apoptosis. Thus it is possible that exposure to Na + -free solution also gives rise to persistent normotonic cell shrinkage resulting in apoptosis. The first purpose of the present study was to test this possibility. An imposition of an electrochemical driving force for passive Na + efflux may facilitate the outward operations of Na + -K + -2Cl − cotransporter (NKCC) and Na + / H + exchanger (NH...