The microbial cells move through the mucous layer of the intestines before attaching to epithelial cells and releasing cholera enterotoxin, a A-B toxin associated with adenylate cyclase. The enterotoxin stimulates the increase of cyclic AMP levels, activating chloride channels and releasing ions into the intestinal lumen. An increase in osmotic pressure in the lumen causes water (and electrolytes) to leave the body and enter into the lumen, hence rapid dehydration and electrolyte imbalance.