Mutations comprising either deletion of 32 amino acids from the NH 2 terminus (␣1M32) or a Glu 233 3 Lys substitution in the first M2-M3 cytoplasmic loop (E233K) of the ␣1-subunit of the Na,K-ATPase result in a shift in the steady-state E 1 7 E 2 conformational equilibrium toward E 1 form(s). In the present study, the functional consequences of both NH 2 -terminal deletion and Glu 233 substitution provide evidence for mutual interactions of these cytoplasmic regions. Following transfection and selection of HeLa cells expressing the ouabain-resistant ␣1M32E233K double mutant, growth was markedly reduced unless the K ؉ concentration in the culture medium was increased to at least 10 mM. Marked changes effected by this double mutation included 1) a 15-fold reduction in catalytic turnover (V max /EP max ), 2) a 70-fold increase in apparent affinity for ATP, 3) a marked decrease in vanadate sensitivity, and 4) marked (Ϸ10-fold) K ؉ activation of the Na-ATPase activity measured at micromolar ATP under which condition the E 2 (K) 3 3 E 1 pathway is normally (␣1) rate-limiting and K ؉ is inhibitory. The decrease in catalytic turnover was associated with a 5-fold decrease in V max and a compensatory Ϸ3-fold increase in expressed ␣1M32E233K protein. In contrast to the behavior of either ␣1M32 or E233K, ␣1M32E233K also showed alterations in apparent cation affinities. K Na was decreased Ϸ2-fold and K K was increased Ϸ2-fold. The importance of the charge at residue 233 is underscored by the consequences of single and double mutations comprising either a conservative change (E233D) or neutral substitution (E233Q). Thus, whereas mutation to a positively charged residue (E233K) causes a drastic change in enzymatic behavior, a conservative change causes only a minor change and the neutral substitution, an intermediate effect. Overall, the combined effects of the NH 2 -terminal deletion and the Glu 233 substitutions are synergistic rather than additive, consistent with an interaction between the NH 2 -terminal region, the first cytoplasmic loop, and possibly the large M4-M5 cytoplasmic loop bearing the nucleotide binding and phosphorylation sites.The Na,K-ATPase couples the hydrolysis of one ATP molecule to the translocation of 3 Na ϩ and 2 K ϩ ions against their electrochemical gradients, thus maintaining the normally high K ϩ and low Na ϩ concentrations inside animal cells. This enzyme complex comprises a large subunit, ␣ (molecular mass, 112 kDa) and a small subunit,  (molecular mass, 35 kDa). ␣ and  have been cloned and sequenced from a variety of tissues (see Ref. 1). The functional unit may be a heterodimer (␣) 2 , although a monomeric ␣ unit can occlude both Na ϩ and (K ϩ )Rb ϩ , consistent with its being the minimal unit required for transport (2). ␣ is the catalytic subunit, which spans the membrane probably 10 times and includes the cytoplasmic catalytic domain and the extracellular cardiac glycoside binding site(s) (3). Although this enzyme complex has eluded efforts to obtain ordered three-dimensional crystals o...