Gunnar Tobin

In vivo and in vitro effects of muscarinic receptor antagonists on contractions and release of [3H]acetylcholine in the rabbit urinary bladder

The functional effects of muscarinic receptor antagonists were examined in vivo and in vitro on the rabbit urinary bladder. Inhibitory effects on carbachol-evoked contractions of detrusor strips were pronounced for 4-diphenylacetoxy-N-methylpiperidine (4-DAMP; -logIC50: 8.64), p-fluoro-hexahydro-sila-diphenidol (pFHHSiD; 7.84) and atropine (8.27), while they were less pronounced for pirenzepine (6.62) and methoctramine (5.36). 4-DAMP and methoctramine increased 3H overflow from [3H]choline-labelled strips in response to electrical stimulation, contrary to pirenzepine, which decreased the overflow. Concomitant contractions were markedly reduced by 4-DAMP and by pirenzepine, but not by methoctramine. The -logIC50 estimations for atropine-sensitive electrically evoked contractions revealed methoctramine (4.85) to be less potent on nerve-evoked contractions than on carbachol-evoked contractions, in contrast to pirenzepine (7.15) and 4-DAMP (9.15). The effects of the antagonists in anaesthetized rabbits resembled those in vitro. Thus, muscarinic receptors in the rabbit urinary bladder are heterogeneous; prejunctional facilitatory (M1) and inhibitory (M2) for acetylcholine release, and postjunctional muscarinic M3 receptors mediating contractile responses.

Altered muscarinic receptor subtype expression and functional responses in cyclophosphamide induced cystitis in rats.

In the in vitro study, it was investigated whether the expression of muscarinic receptors and cholinergic responses were altered in the situation of experimental cystitis. Rats were treated with cyclophosphamide intraperitoneally and the bladders were excised 36-100 h later. Immunohistochemistry and immunoblotting showed all subtypes of the muscarinic receptor (M1-M5) to be present in the specimens from inflamed urinary bladders and controls. In the cyclophosphamide-treated rats, the expression of muscarinic M5 receptors was increased by more than 40 times (p<0.01; n=8) both in the smooth muscle and the urothelium. Both the maximal contractile response to carbachol and to a high potassium concentration was approximately halved in cyclophosphamide-treated tissues, whereas the reduction was substantially greater in response to low carbachol concentrations (<EC(50)). The administration of 4-DAMP inhibited the carbachol-induced contractile responses of inflamed strips less potently than of controls, whereas pirenzepine and methoctramine showed equipotency in the two groups. The nitric oxide synthase inhibitor l-NNA increased the contractile effect of carbachol in inflamed detrusor strips, while it had no effect in controls. Immunoblotting showed endothelial nitric oxide synthase (eNOS) to be up-regulated in cystitis, and immunohistochemistry revealed the change to occur in the urothelium and in the suburothelial layer. The alteration of cholinergic detrusor responses in cyclophosphamide-treated rats depends mainly on a general detriment of contractility but also on indirect effects possibly via nitric oxide synthesis. The most prominent histological alterations occurred in the urothelium in which muscarinic M5 receptors increased in particular. The study further underlines that the urothelium may play significant roles in the pathogenesis of urinary bladder disorders such as interstitial cystitis.

Muscarinic Receptor Subtypes in the Lower Urinary Tract

Acetylcholine acting on muscarinic M3 receptors on the detrusor muscle is the principal stimulus for inducing the contractile response for urinary bladder voiding. The urinary bladder expresses, however, all cloned muscarinic receptor subtypes (M1–M5). In terms of quantity, the M2 subtype dominates over the M3 subtype in the detrusor, and its role in contraction seems to be primarily indirect, by blocking stimuli from cAMP-coupled receptors that induce relaxation. The excitatory M1 and inhibitory M2 and/or M4 subtypes are also expressed prejunctionally. Muscarinic M1 and M2/M4 autoreceptors facilitate and inhibit, respectively, the release of acetylcholine. The urothelium had been considered to be a passive barrier; however, during the last decade, it has been shown that the urothelium is of importance for bladder function. In a state of bladder pathology, muscarinic receptor changes occur in the detrusor, prejunctionally, and in the urothelium, but the character of the change differs between disorders. The urothelium expresses all subtypes of muscarinic receptors, and upon stimulation it releases factors affecting bladder afferents and smooth muscle. During inflammation, the expression of muscarinic M5 receptors is increased, particularly in the urothelium, together with a cholinergic-induced production of nitric oxide in the mucosa. The present review describes signalling mechanisms, expression and functional effects of muscarinic receptors in the lower urinary tract. Their roles in physiological and pathophysiological conditions, as well as clinical implications of the occurrence of different muscarinic receptors, are discussed.

Studies of muscarinic receptor subtypes in salivary gland function in anaesthetized rats.

The in vivo study aimed to examine whether muscarinic receptor subtypes other than muscarinic M3 receptors exert exocrine functional roles in the rat salivary glands. The effects of pirenzepine, methoctramine and 4-diphenylacetoxy-N-methylpiperidine methiodide (4-DAMP) were examined on secretion from the major salivary glands evoked by acetylcholine (0.001-10 micromol kg(-1) i.v.) in pentobarbitone-anaesthetized rats. Observations were occasionally made on glandular blood flow. 4-DAMP (0.1-100 nmol kg(-1) i.v.) markedly and equipotently inhibited the acetylcholine-evoked fluid responses in all glands. Pirenzepine (0.1 micromol kg(-1) i.v.-10 mmol kg(-1) i.v.) showed significantly lower inhibitory potency than 4-DAMP, most conspicuously in the parotid, while methoctramine (0.1 micromol kg(-1) i.v.-10 mmol kg(-1) i.v.) exerted an even lesser inhibitory effect. Also against acetylcholine-evoked blood flow increases, 4-DAMP showed a conspicuous potency. At 1 and 10 micromol kg(-1) i.v. of pirenzepine, the antagonist reduced the protein concentration in the submandibular saliva, but not in the parotid saliva. While 4-DAMP (1 and 10 nmol kg(-1) i.v.) significantly inhibited acetylcholine-evoked protein secretory responses in the submandibular glands, methoctramine (below 10 micromol kg(-1) i.v.) affected the responses in neither gland. The reduction of the protein concentration in submandibular saliva caused by 4-DAMP and pirenzepine was inhibited by N(omega)-nitro-L-arginine methyl ester (L-NAME; 30 mg kg(-1) i.p.), while L-NAME had no or only minute effects on the parotid protein secretion. Thus, in addition to muscarinic M3 receptors, other muscarinic receptors contribute to in vivo functional responses in rat submandibular and sublingual glands. While these other receptors are muscarinic M1 receptors in the sublingual gland, they may be a different subtype, possibly muscarinic M5 receptors, in the submandibular gland. However, muscarinic M1 receptors may induce indirect effects via nitric oxide in the submandibular gland.

Cholinergic nitric oxide release from the urinary bladder mucosa in cyclophosphamide-induced cystitis of the anaesthetized rat

Background and purpose: Previous reports have suggested that nitric oxide (NO) may be released by cholinergic stimuli in the rat bladder in cyclophosphamide‐induced cystitis, affecting bladder function. In the current study, we evaluated the effects of cyclophosphamide‐induced cystitis on muscarinic whole bladder contractile responses in vivo, and further, if NO might be released from the mucosa by cholinergic stimuli.

Prejunctional facilitatory and inhibitory modulation of parasympathetic nerve transmission in the rabbit urinary bladder

Release of [3H]choline and muscle contraction in response to electrical field stimulation were measured from rabbit detrusor muscle strips previously loaded with [3H]choline. The importance of different stimulation frequencies (1 and 10 Hz) for activating either facilitatory or inhibitory prejunctional effects was examined in the presence of muscarinic and adrenergic (alpha2) receptor selective substances. At 1 Hz, neither [3H]choline overflow nor contraction was affected by the M1-selective receptor antagonist pirenzepine (10(-7) M), whereas overflow and contraction decreased at 10 Hz. The M1-selective receptor agonist McN-A-343 (10(-6) M) caused no significant changes except for reducing contractions at 10 Hz. The M2-selective receptor antagonist methoctramine (10(-6) M), on the other hand, increased overflow as well as contraction at both frequencies, most conspicuously at 1 Hz. Atropine (10(-7) M) caused a significant increase with respect to overflow only at 1 Hz, while quite the opposite effect occurred with respect to contractions (reduced only at 10 Hz). Clonidine (10(-6) M) induced inhibition of [3H]choline overflow at 10 Hz only, but without significantly changing contractile responses. The results show that in the rabbit urinary bladder a muscarinic autoreceptor mediated inhibition (M2) of the transmitter release dominates during low frequency stimulation and that a facilitation (M1) may be present at stimulations with higher frequencies. However, this amplification may also be influenced by alpha2-adrenoceptor mediated inhibition.

NITRIC OXIDE SYNTHASE IMMUNOREACTIVE NERVES IN RAT AND FERRET SALIVARY GLANDS, AND EFFECTS OF DENERVATION

Nitric oxide has been implicated in mechanisms mediating nerve-evoked vasodilatory and secretory responses in salivary glands. In the present study, the occurrence and distribution of nitric oxide synthase (NOS)-immunoreactive nerves in ferret and rat salivary glands were investigated using immunocytochemistry with rabbit and sheep NOS antisera, and using NADPH-diaphorase enzyme histochemistry. In the parotid, submandibular and sublingual glands of the rat and the ferret, NOS-immunoreactive varicose terminals encircled acini and arteries of various sizes. In the ferret, collecting ducts were also supplied with NOS-immunoreactive fibres. In the rat, only the granular ducts of the submandibular gland were supplied with such fibres. The NOS-immunoreactive innervation of acinar cells was more abundant in the rat than in the ferret, whereas the opposite was true for the innervation of blood vessels. No NOS immunoreactivity was observed in the vascular endothelium. In both species, NOS-positive ganglionic cell bodies were found in the hilar regions of the submandibular and sublingual glands, whereas none could be detected in the parotid glands. NADPH-diaphorase reactivity had the same neuronal distribution as NOS immunoreactivity and, in addition, NADPH-diaphorase reactivity was expressed in ductal epithelium. Neither sympathetic denervation (by removal of the superior cervical ganglion) nor treatment with the sensory neurotoxin capsaicin reduced the NOS-immunoreactive innervation of the parotid gland. However, parasympathetic denervation (by cutting the auriculo-temporal nerve) caused an almost total disappearance of the NOS-immunoreactive innervation. The present findings provide a morphological background to the suggested role of nitric oxide in parasympathetic secretory and vascular responses of salivary glands.

Oral Pilocarpine for Treatment of Opioid-induced Oral Dryness in Healthy Adults

Pilocarpine induces a profuse flow of saliva when administered orally, but effects on drug-induced oral dryness have not been examined. The aim of this trial was to investigate if pilocarpine increases production of saliva in individuals suffering from dry mouth due to treatment with opioids. Sixty-five individuals were enrolled in a randomized, double-blind, placebo-controlled trial. The subjects received tramadol (50 mg t.d.s.) to induce oral dryness, and were thereafter assigned to one of three groups. Secretion rate of saliva was measured before and after tramadol, and after the oral administration of pilocarpine (5 mg), placebo, or no treatment. Baseline characteristics did not differ among the groups (mean ± SEM: 0.37 ± 0.06 mL/min), and tramadol lowered the secretion at the same level in all groups (0.15 ± 0.02 mL/min). Pilocarpine increased the flow above that observed with placebo (0.66 ± 0.19 vs. 0.15 ± 0.02 mL/min). Thus, pilocarpine re-establishes the flow of saliva in the state of tramadol-induced oral dryness.

Presynaptic muscarinic M1 and M2 receptor modulation of auriculotemporal nerve transmission in the rat

Parotid secretory and vascular responses to electrical stimulation of the parasympathetic innervation were measured in anaesthetized rats. Stimulation was performed at 1, 10 and 40 Hz. Atropine (1.5 micromol/kg i.v.) almost abolished the secretion to stimulation of peptide depleted nerves at 40 Hz, thus confirming the existence of a pure cholinergic response. Atropine also reduced secretion by 74% during stimulation of non-depleted nerves at the same frequency. Selective blockade by the muscarinic M1 receptor antagonist pirenzepine and by the muscarinic M2 receptor antagonist methoctramine was found to occur at doses (50 nmol/kg i.v. and of 300 nmol/kg i.v., respectively) that did not inhibit the responses to exogenous acetylcholine. In the presence of methoctramine, the nerve-evoked fluid responses were increased by 200% at 1 Hz independently of the total number of impulses (10-300), suggesting that M2 receptor activation normally has an inhibitory effect on transmitter release. The magnitude of the increase was inversely related to frequency of stimulation, and changes in the secretory responses occurred at 40 Hz only when non-depleted nerves were stimulated over the longest period employed. The fluid response then increased by 35% and protein concentration by 200%. The vasodilator responses increased at 1 and 10 Hz, but not at 40 Hz. Pirenzepine reduced the secretory and vascular responses at 10 and 40 Hz but only during stimulation over short periods of time. This suggests that M1 receptor activation normally has a facilitatory effect on neurotransmitter release. During stimulation of non-depleted nerves at 10 Hz for 10 impulses, the fluid response was reduced by 29% and the protein concentration by 26%. When the peptide depleted nerves were stimulated at 10 Hz, pirenzepine also reduced the fluid response (by 43%), but not the protein concentration. It is concluded that the release of transmitter from postganglionic nerve fibres in the rat auriculotemporal nerve is modulated by presynaptic muscarinic receptors. Muscarinic M1 receptors normally facilitate cholinergic and peptidergic transmission during short, intense stimulation. On the other hand, muscarinic M2 receptors normally inhibit cholinergic transmission at low frequencies; at higher frequencies, peptidergic transmission is also inhibited, but only after some delay.

Interaction of Nerve Agent Antidotes with Cholinergic Systems

The poisoning with organophosphorus compounds represents a life threatening danger especially in the time of terroristic menace. No universal antidote has been developed yet and other therapeutic approaches not related to reactivation of acetylcholinesterase are being investigated. This review describes the main features of the cholinergic system, cholinergic receptors, cholinesterases and their inhibitors. It also focuses on the organophosphorus nerve agents, their properties, effects and a large part describes various possibilities in treatments, mainly traditional oxime therapies based on reactivation of AChE. Furthermore, non-cholinesterase coupled antidotal effects of the oximes are thoroughly discussed. These antidotal effects principally include oxime interactions with muscarinic and nicotinic receptors.