ϩ -K ϩ -ATPase (NKA) pump is the receptor for the potent marine toxin palytoxin (PTX). PTX binds to the NKA and converts the pump into a monovalent cation channel that exhibits a slight permeability to Ca 2ϩ . However, the ability of PTX to directly increase cytosolic free Ca 2ϩ concentration ([Ca 2ϩ ]i) via Na ϩ pump channels and to initiate Ca 2ϩ overload-induced oncotic cell death has not been examined. Thus the purpose of this study was to determine the effect of PTX on [Ca 2ϩ ]i and the downstream events associated with cell death in bovine aortic endothelial cells. PTX (3-100 nM) produced a graded increase in [Ca 2ϩ ]i that was dependent on extracellular Ca 2ϩ . The increase in [Ca 2ϩ ]i initiated by 100 nM PTX was blocked by pretreatment with ouabain with an IC50 Ͻ 1 M. The elevation in [Ca 2ϩ ]i could be reversed by addition of ouabain at various times after PTX, but this required much higher concentrations of ouabain (0.5 mM). These results suggest that the PTX-induced rise in [Ca 2ϩ ]i occurs via the Na ϩ pump. Subsequent to the rise in [Ca 2ϩ ]i, PTX also caused a concentration-dependent increase in uptake of the vital dye ethidium bromide (EB) but not YO-PRO-1. EB uptake was also blocked by ouabain added either before or after PTX. Time-lapse video microscopy showed that PTX ultimately caused cell lysis as indicated by release of transiently expressed green fluorescent protein (molecular mass 27 kDa) and rapid uptake of propidium iodide. Cell lysis was 1) greatly delayed by removing extracellular Ca 2ϩ or by adding ouabain after PTX, 2) blocked by the cytoprotective amino acid glycine, and 3) accompanied by dramatic membrane blebbing. These results demonstrate that PTX initiates a cell death cascade characteristic of Ca 2ϩ overload.necrosis; vital dyes; membrane blebs; time-lapse video microscopy; fura-2 NATURAL TOXINS AND POISONS (e.g., cholera toxin, pertussis toxin, tetrodotoxin, conotoxin, digitalis, ryanodine, and thapsigargin) have proved useful in the identification and functional characterization of specific proteins in biochemical pathways critical for cell homeostasis and signaling. Palytoxin (PTX), originally isolated from sea corals of the genera Palythoa (24), is one of the most potent toxins known. PTX causes membrane depolarization, loss of cellular K ϩ , and a dramatic increase in cytosolic Na ϩ . PTX causes contractions of all muscles, release of neurotransmitters, hemolysis of red blood cells, and, ultimately, oncotic cell death (for review, see Ref. 38). It is now clear that the molecular receptor for PTX is the plasmalemmal Na ϩ -K ϩ -ATPase (NKA) pump. Early studies showed that the cardiac glycoside ouabain could effectively antagonize the actions of PTX, and it was suggested that PTX might convert the NKA into a channel (14, 15). Indeed, a variety of investigators showed that PTX activates a relatively nonselective cation channel with conductance in the range of 8 -14 pS (16,17,20,25,27, 28,39,43). PTX-induced cation fluxes were activated when the NKA was heterolog...