Vibrio cholerae colonises the small intestine and produces a potent protein exotoxin (1) which binds the GMI-ganglioside receptor on the cell membrane via binding units. The active subunits of the endotoxin enters the cell and activates the adenyl cyclase. This results in accumulation of cyclic AMP, which stimulates active secretion of ionic sodium, chloride, potassium and HCO3 into the lumen, and with it water. Diarrhoea results.
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