The effects of purified botulinum neurotoxin type A on cholinergic, adrenergic and non-adrenergic, atropine-resistant autonomic neuromuscular transmission

Aetiology and treatment of anal fissure

Anal fissure is a common problem that causes significant morbidity in a young and otherwise healthy population. Treatment has remained largely unchanged for over 150 years and the pathogenesis of this condition is not yet fully explained. Acute fissure should be treated conservatively with dietary modification. Chronic fissures do not respond to conservative treatment. The current recommended surgical treatment for chronic fissure is lateral internal sphincterotomy. However, there is a disturbance of continence in a sizeable proportion of those undergoing this procedure. As yet there is no proven non-surgical treatment for chronic fissure. Although local injection of botulinum toxin and the topical application of nitrates show early promise, further controlled trials are needed.

Botulinum toxin--a possible new treatment for axillary hyperhidrosis

The inhibitory action of botulinum toxin is not limited to the neuromuscular junction. The toxin also blocks the autonomic cholinergic fibres, including the sympathetic fibres to sweat glands. We have previously demonstrated that the toxin produces localized anhidrosis. To determine the dosage, pattern and duration of the anhidrotic effect of botulinum toxin and to test the efficacy of axillary injections, we further studied seven healthy volunteers. Two individuals had subcutaneous injections of botulinum toxin (20 mouse units, Dysport-Porton Products) in the dorsum of the hand. Five healthy volunteers had 15-50U of botulinum toxin A (Botox) injected in one axilla. A circular area of complete anhidrosis on the dorsum of the hand was evident on day 2 and persisted for 11 months. By day 3, two of the axillae (injected with 50 U each) were totally dry and in one (injected with 30 U) the sweating was substantially reduced. The effect persisted for 6-8 months before wearing off. No effect was appreciated in two axillae (injected with 15 and 20 U). No significant side-effects were encountered. Subcutaneous injections of botulinum toxin causes chemodenervation of the sweat glands. In normal individuals axillary sweating can be abolished by 50 U of botulinum toxin A (Botox). The results offer a possible novel treatment for severe cases of axillary hyperhidrosis.

Review article: the use of botulinum toxin in the alimentary tract

New and future indications for the treatment of disorders of the alimentary tract using local injections of botulinum toxin are reviewed. Clinical experience shows that overactive smooth muscle sphincters may be weakened to treat disorders such as achalasia or chronic anal fissure. By contrast, injections placed into the sphincter of Oddi have proven less effective for postcholecystectomy pain syndrome. Experimental evidence suggests that food intake may be reduced by weakening the distal stomach with botulinum toxin. This approach may possibly lead to the treatment of obesity. There are some new possible indications for the use of botulinum toxin on the alimentary tract, and infantile hypertrophic pyloric stenosis seems to be the most promising new development.

5-Hydroxytryptamine receptors that facilitate excitatory neuromuscular transmission in the guinea-pig isolated detrusor muscle

1. In isolated detrusor strips from the guinea-pig urinary bladder, contractile responses to electrical field stimulation were mostly mediated by neurally released acetylcholine (ACh) and adenosine 5'-triphosphate (ATP). 2. 5-Hydroxytryptamine (5-HT) produced a concentration-dependent increase in the amplitude of stimulated detrusor strip contractions. The 5-HT concentration-response curve showed a biphasic profile: the high potency phase was obtained at sub-micromolar concentrations (10-300 nM), while the low potency phase in the range 1-30 microM. The maximum response of the first phase was 30% of the total 5-HT response. 3. Like 5-HT, the 5-HT3 receptor agonist, 2-methyl-5-hydroxytryptamine (2-methyl-5-HT: 0.3-100 microM), the 5-HT2 receptor agonist, (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI: 30 nM-3 microM) and the 5-HT4 receptor agonist, 5-methoxytryptamine (5-MeOT: 0.1-30 microM) potentiated, though with lower potency, detrusor contractions. The resulting concentration-response curves were monophasic in nature. 2-Methyl-5-HT had a maximum effect comparable to that of 5-HT. By contrast, the maximal effects of DOI and 5-MeOT were only 20% and 30% of that elicited by 30 microM 5-HT, respectively. 4. The 5-HT3 receptor antagonist, granisetron (0.3 microM) had no effect on the high potency phase, but caused a rightward parallel shift of the low potency phase of the 5-HT curve (pKB = 7.3). Granisetron(0.3 microM) antagonized with comparable affinity (pKB = 7.1) 5-HT-induced responses after pharmacological isolation of 5-HT3 receptors with the 5-HT1/5-HT2 receptor antagonist, methiothepin (0.3 microM) and the 5-HT4 receptor antagonist, GR 125487 (30 nM). Granisetron (0.1, 0.3 and 1 microM) competitively antagonized the potentiating effect of 2-methyl-5-HT with an estimated pA2 of 7.3.5. Methiothepin (0.3 microM) and the 5-HT2A receptor antagonist, ketanserin (0.3 microM) produced a slight inhibition of the first phase of the 5-HT curve. In the presence of ketanserin, an equimolar concentration of methiothepin was ineffective in further reducing the effect of 5-HT. Similarly, the 5-HT4 receptor antagonist, GR 125487 (30 nM) slightly inhibited the first phase of the 5-HT curve. Conversely, this phase was suppressed when detrusor strips were coincubated with ketanserin (or methiothepin) and GR125487.6. In a separate set of experiments, the interactions of 5-HT with either the purinergic or cholinergic components of excitatory neuromuscular transmission were investigated. In the presence of hyoscine(1 microM), 5-HT was mostly effective at sub-micromolar concentrations, while in the presence of the P2-purinoceptor antagonist, suramin (300 microM), 5-HT-induced potentiation was mainly obtained with micromolar concentrations.7. Thus, in electrically stimulated detrusor strips from guinea-pig, 5-HT potentiated excitatory neuromuscular transmission by activating at least three separate neural 5-HT receptors. These include the 5-HT2A and 5-HT4 receptors, which mediate the 5-HT high potency phase mainly by activation of purinergic transmission. On the other hand, the potentiating effect caused by micromolar concentrations of 5-HT mostly involves cholinergic transmission and is mediated by the 5-HT3 receptors.

Efficacy and side effects of botulinum toxin treatment for blepharospasm and hemifacial spasm

PURPOSE

To analyse the effectiveness and rate of side effects of botulinum toxin treatment for blepharospasm and hemifacial spasm.

METHODS

In a prospective trial, 81 patients with blepharospasm and 70 with hemifacial spasm were treated with botulinum toxin A in the neuroophthalmology clinic at St Vincent's Hospital, Melbourne. Some 989 treatments were given and the mean follow-up time was 28.7 months.

RESULTS

The duration of action was longer for patients with hemifacial spasm than for those with blepharospasm (median 12.0 weeks compared with 7.0 weeks, P < 0.0001). There was no change in the duration of effect over time with repeated treatments of the same dose (F = 0.4, P > 0.05). Once an effective dosage was reached, increasing the dose further did not prolong the duration of effect. There were no systemic side effects, but there were a number of local transient side effects. The most significant side effect was ptosis, which occurred in 12% of treatments given to those patients with blepharospasm and hemifacial spasm.

CONCLUSION

Botulinum toxin is an effective treatment for blepharospasm and hemifacial spasm, but there are a number of side effects, the most significant being ptosis.

Role of nitric oxide in fetal lower urinary tract function

We studied the role of nitric oxide (NO) in normal function of the lower urinary tract in fetal lambs. Fetal surgery was performed in pregnant ewes at 118 days' gestation (term 145-days) to place arterial, venous, and double-lumen urachal catheters. Five animals had a catheter secured in the distal urethra (to measure voided volume), and six underwent ligation of the urethra. Urodynamic studies were performed via the urachal catheter under baseline conditions, during systemic blockade of NO synthesis with N omega-nitro-L-arginine, and with systemic NO stimulation by L-arginine 48 hours postoperatively. Nitric oxide blockade caused an 88% mean increase in bladder capacity (volume to initiation of voiding) (p < 0.001) and a 5.8-fold increase in mean postvoid residual volume (p < 0.0001) despite normal maximal bladder pressures, suggesting inadequate sphincteric relaxation. Qualitatively, NO inhibition increased the presence of low-level bladder contractions and caused a trend toward decreased bladder compliance. Increase of NO substrate by L-arginine infusion restored baseline findings if performed after N omega-nitro-L-arginine. Stimulation of NO by L-arginine infusion caused continuous efflux of the infusate secondary to a persistently open sphincter. In conclusion, NO is active in the function of the lower urinary tract in the fetal lamb and appears to influence both sphincter and detrusor activity.

Effects of intrasphincteric botulinum toxin on the lower esophageal sphincter in piglets

BACKGROUND

The toxin of Clostridium botulinum (BoTx) inhibits the release of acetylcholine from nerve terminals and causes paralysis of skeletal muscle. The present study examined the hypothesis that BoTx may have a similar effect on gastrointestinal smooth muscle.

METHODS

Baseline lower esophageal sphincter (LES) pressures were obtained in five piglets, and normal saline was injected endoscopically into the LES. One week later, LES pressure was measured again, followed by injection of BoTx into the LES. After another week, LES pressure was measured again.

RESULTS

Compared with a baseline LES pressure of 8.2 +/- 1.5 mm Hg, LES pressure decreased to 3.2 +/- 1.0 mm Hg after BoTx injection, a reduction of about 60% (P < 0.01). By contrast, LES pressure did not change significantly after normal saline injection. The animals showed no evidence of toxicity. Data from other experiments showed that after injection with toxin, the LES responds normally to bethanechol and pentagastrin but displays a paradoxical response to edrophonium and cholecystokinin.

CONCLUSIONS

BoTx is a potent inhibitor of resting LES tone. Its relatively specific anticholinergic effect may help clarify the role of cholinergic and noncholinergic pathways in the regulation of gastrointestinal sphincters.

Botulinum toxin therapy: distant effects on neuromuscular transmission and autonomic nervous system

To evaluate distant effects of botulinum toxin, single fibre electromyography on the extensor digitorum communis muscle and six tests of cardiovascular reflexes were performed in five patients injected with BoTox (Oculinum(R) 20-130 units) for craniocervical dystonia and hemifacial spasm. Patients underwent two sessions of treatment and the second time the dosage was doubled. Botulinum toxin injection induced an increase of mean jitter value above normal limits in all cases. An increase of fibre density was recorded six weeks after the treatment. Cardiovascular reflexes showed mild abnormalities in four patients. The data confirm distant effects of botulinum toxin on neuromuscular transmission and on autonomic function.

Omega conotoxin and prejunctional modulation of the biphasic response of the rat isolated urinary bladder to single pulse electrical field stimulation

1. Single pulse electrical field stimulation (EFS) produces a biphasic response of muscle strips of the rat isolated urinary bladder consisting of an early and a late contraction which were atropine-resistant and atropine-sensitive, respectively. Repeated application of desensitizing doses of the P2 purinoceptor agonist, alpha, beta-methylene ATP (mATP) inhibited the early response while leaving unaffected the late component. 2. Omega conotoxin (CTX, 0.1 microM) inhibited both the early and the late response either in control conditions or after enhancement by physostigmine (0.1 microM). The effect of CTX was, in both cases, more pronounced on the late than the early response to EFS. CTX (0.1 microM) failed to affect contraction produced by ATP or acetylcholine at concentrations (0.3 mM and 0.5 microM) which produced a response similar to that to EFS. 3. The effect of physostigmine was more intense for the late than the early response and was abolished by atropine. In the presence of CTX, physostigmine enhanced both the early and the late components of the mechanical response to EFS. 4. Nifedipine (0.1-1 microM) reduced to a similar extent both the early and late responses. Bay K 8644 (1 microM) produced a marked enhancement of the response to EFS, which, however, did not have a distinct late peak. In the presence of Bay K 8644, either atropine (3 microM) or tetrodotoxin (1 microM) had minor inhibitory effects indicating the myogenic origin of the response. 5. Neurokinin A (0.1-1 nM) enhanced both the early and late responses to EFS without affecting the contraction produced by exogenous acetylcholine or ATP. A consistent potentiation was evident also in the presence of CTX and for the early response, in the presence of atropine. Clonidine (3 microM) inhibited the response to EFS either in the absence or the presence of physostigmine. The inhibitory effect of clonidine, shown previously to depend upon activation of prejunctional alpha 2-adrenoceptors, was still observed in presence of CTX or atropine. 6. It is concluded that CTX-sensitive voltage dependent calcium channels play a more important role in determining the cholinergic rather than the non-cholinergic, putatively purinergic, component of the biphasic response of the rat bladder to single pulse EFS. The action of CTX is likely to be exerted on N-type rather than L-type (dihydropyridine-sensitive) calcium channels. Prejunctional modulation (enhancement by neurokinin A, inhibition by clonidine) occurs even in the presence of CTX-sensitive channels blockade.

Colocalization of peptides and a catecholamine-synthesizing enzyme in intramural neurones of the newborn guinea-pig urinary bladder in culture

The patterns of colocalization of somatostatin (SOM), neuropeptide Y (NPY) and the catecholamine-synthesizing enzyme, dopamine beta-hydroxylase (DBH), were examined in intramural neurones in dissociated cell culture preparations from the detrusor muscle of the urinary bladder of the newborn guinea-pig using an elution-restaining immunocytochemical technique. Large numbers of the intramural neurones contained NPY-like (70-85% of the total neuronal population) and SOM-like (60-75%) immunoreactivities, in contrast to a small population (1-6%) of neurones containing immunoreactivity to DBH. Some neurones were immunoreactive to NPY (15-20%) and SOM (5-10%) alone, while 55-70% of the total neuronal population showed immunoreactivity to both NPY and SOM. NPY-like immunoreactive neuronal cell bodies that did not contain SOM were predominantly binucleate, whereas neuronal cell bodies immunoreactive to SOM alone were mainly mononucleate. Although not seen in every culture preparation, neuronal cell bodies containing both NPY-like and DBH-like immunoreactivities were also observed (less than 5% of the total neuronal population), and most, if not all, of these neuronal cell bodies were binucleate. SOM-like and DBH-like immunoreactivities were not seen in the same neuronal cell body throughout this study. These results show that intramural bladder neurones can be divided into distinct subpopulations based upon the coexistence of specific peptides and enzymes, and the possibility that they sustain local integrative and modulatory roles in bladder function is discussed.

Atropine-resistant transmission in partially depolarized rat urinary bladder

1. Phasic contractile responses of the intact rat urinary bladder to the muscarinic agonists carbachol and pilocarpine became nearly blocked as the concentrations were progressively increased to 200-500 microM. In contrast, tonic contractile responses remained elevated throughout progressive increases in agonist concentration. 2. Nerve-induced phasic contractions to 1 Hz stimuli were potentiated throughout progressive increases in the concentration of muscarinic agonists. However, these responses were more atropine sensitive than untreated controls and responses to 1 Hz stimuli were nearly abolished. 3. After inhibition of cholinesterase, the action of cholinergic transmitter released during prolonged nerve stimulation may extend to the tonic contractile state of the bladder and potentiate responses to 1H stimuli. Nerve-induced responses were more atropine sensitive than untreated controls. 4. Bladder tone was increased and nerve-induced contractions to 1-Hz stimuli were also potentiated in an elevated K+ environment. However, atropine sensitivity of nerve-induced responses w s reduced. 5. Nerve-induced bladder contractions were linked to the tonic contractile state of the bladder muscle, controlled physiologically by muscarinic receptors. Since phasic contractile responses to muscarinic agonists were abolished at high concentrations by receptor desensitization, nerve-induced responses must be elicited under these conditions by a non-cholinergic transmitter.

Isolated human bladder: evidence for an adenine dinucleotide acting on P2X-purinoceptors and for purinergic transmission

In isolated strips of human urinary bladder detrusor muscle, ATP, alpha, beta-methylene ATP and P1,P6-diadenosine hexaphosphate caused concentration-dependent contractions. ATP was less potent than the two synthetic purine compounds and gave smaller maximum responses. Responses to ATP, P1,P6-diadenosine hexaphosphate and noncholinergic nerve stimulation were blocked following desensitization of P2X-purinoceptors by alpha,beta-methylene ATP. Thus, adenine dinucleotides can act on P2X-purinoceptors and there is an element of purinergic neuromuscular transmission in the human urinary bladder.

Electrical and mechanical responses of guinea-pig bladder muscle to nerve stimulation

1 The electrical and mechanical responses to transmural stimulation of intrinsic nerves have been recorded from smooth muscle strips dissected from the dome of the guinea-pig bladder, by use of intracellular microelectrodes, and conventional tension recording techniques. 2 Stimulation of intrinsic nerves evoked action potentials in all cells studied. Hyperpolarization of the cells by extracellular current injection revealed subthreshold excitatory junction potentials (e.j.ps) in about a quarter of the cells studied. 3 Action potentials could still be evoked in the presence of atropine and neostigmine, but were abolished after desensitization of the cells to alpha, beta-methylene ATP, a stable analogue of ATP. 4 In the presence of neostigmine, the evoked action potential was followed by a slow depolarization of the membrane. The mechanical response increased in amplitude and duration. 5 The contractile response to transmural nerve stimulation was reduced but not abolished in the presence of either atropine or desensitizing doses of alpha, beta-methylene ATP. Atropine was more effective at high frequencies of stimulation (greater than or equal to 30 Hz), and alpha, beta-methylene ATP at low frequencies (less than or equal to 15 Hz). In combination the drugs abolished the response. 6 The results suggest that the mechanical response to excitatory nerve stimulation is biphasic. The early transient response is elicited by e.j.ps and evoked spikes, is resistant to atropine, but sensitive to desensitization of purinoceptors. The late response is mediated through muscarinic receptors, involves little membrane depolarization, and is unaffected by desensitization of purinoceptors. These responses are analogous to the responses seen in rabbit bladder, and in the sympathetically innervated rat tail artery and guinea-pig vas deferens.

Localization of muscarinic receptors on somatostatin-like immunoreactive neurones of the newborn guinea pig urinary bladder in culture

Muscarinic receptors were localized on cells cultured from the detrusor muscle of the newborn guinea pig urinary bladder by autoradiography using the irreversible muscarinic antagonist [3H]propylbenzilylcholine mustard, before being immunostained with an antibody to somatostatin. Many mononucleate and binucleate intramural neurones immunoreactive for somatostatin were observed (60-75% of the total population), a subpopulation of which (40-60%) expressed muscarinic receptors. Autoradiographic grains were distributed over the whole cell body surface and the entire length of the neurites. An even distribution of silver grains was also seen on cultured smooth muscle cell surfaces, but not on other cell types present in the culture preparations. The demonstration of muscarinic receptors on specific neuropeptide-containing cells in culture is consistent with the existence of specialized cholinergic, intraganglionic circuits within the bladder wall, and suggests that somatostatin may also be involved in the integration and/or modulation of bladder function.

Inhibition of transmitter release by botulinum neurotoxin A. Contribution of various fragments to the intoxication process

1. The contribution of a proteolytic fragment (H2L) of botulinum neurotoxin type A (comprised of the aminoterminal region of the heavy-chain disulphide-linked to the light chain) to inhibition of neurotransmitter release was investigated, using central cholinergic synapses of Aplysia, rodent nerve-diaphragm preparations and cerebrocortical synaptosomes. 2. No reduction in neurotransmitter release was observed following external application to these preparations of highly purified H2L or after intracellular injection into Aplysia neurons. 3. The lack of activity was not the result of alteration in the light chain of H2L during preparation of the latter because (a) renaturation of this light chain with intact heavy chain produced a toxic di-chain form and (b) simultaneous application of heavy chain and light chain from H2L inhibited transmitter release in Aplysia. 4. Bath application of H2L and heavy chain together inhibited release of transmitter; however, at the neuromuscular junction the potency of this mixture was much lower than that of native toxin. A similar blockade resulted when heavy chain was applied intracellularly and H2L added to the bath, demonstrating that H2L is taken up into cholinergic neurons of Aplysia. This uptake is shown to be mediated by the amino-terminal moiety of heavy chain (H2), because bath application of light chain plus H2 led to a decrease in acetylcholine release from a neuron that had been injected with heavy chain. 5. A role within the neuron is implicated for a carboxy-terminal portion of heavy chain (H1) since intracellular injection of light chain and H2 did not affect transmitter release. Although the situation is unclear in mammalian nerves, these collective findings indicate that blockade of transmitter release in Aplysia neurons requires the intracellular presence of light chain and H1 (by inference), whilst H2 contributes to the internalization step.

Abnormalities of responses to autonomic stimulation in the mouse urinary bladder associated with Semliki Forest virus-induced demyelination

The responses to autonomic stimulation of the urinary bladder were studied in mice infected with Semliki Forest Virus, which has been proposed as an animal model for multiple sclerosis. Mice infected with Semliki Forest Virus showed a decreased body weight when compared with control animals, although their bladders were proportionately heavier. The pharmacological results indicated a selective change in purinergic transmission in the bladders of mice infected with Semliki Forest Virus, while cholinergic transmission remained unchanged. This was demonstrated by a significant increase in the contractile response to beta,gamma-methylene ATP accompanied by an increase in the proportion of the nerve-mediated response blocked by alpha,beta-methylene ATP. In contrast, the contractile response to acetylcholine and the atropine-sensitive component of the neurogenic response were not significantly different between the two groups of animals. Active length-tension curves were also unchanged in the mice infected with Semliki Forest Virus when compared with controls. The results are discussed in relation to those obtained from models of urinary bladder dysfunction associated with hypertrophy; whether the alteration of atropine-resistant (purinergic) function reported here is a general secondary feature of this type of bladder dysfunction or a change specific to the Semliki Forest Virus model of multiple sclerosis is not resolved. This study provides evidence that peripheral changes as well as central nervous system demyelination occur in the Semliki Forest Virus-infected mouse.

Functional studies on the cholinergic and sympathetic innervation of the rat proximal urethra: effect of pelvic ganglionectomy or experimental diabetes

1. Isolated rings of rat proximal urethra contracted in response to acetylcholine, noradrenaline, phenylephrine, tachykinins or field stimulation. In the presence of field stimulation-induced contractions, isoprenaline or CGRP produced an inhibitory effect on evoked contractions. 2. Electrical field stimulation produced frequency-related contractions which, when using trains of stimuli, consisted of a phasic and a tonic response. These contractions were abolished by tetrodotoxin (1 microM) but unaffected by hexamethonium (10 microM). 3. Atropine (3 microM) produced a partial inhibition of these nerve-mediated contractions, slightly more evident on the tonic than the phasic response. In the presence of atropine (3 microM), phentolamine (3 microM) or prazosin (1-10 nM) produced an almost complete inhibition of the response to field stimulation. 4. After bilateral removal of the pelvic ganglia, electrical field stimulation was still able to induce tetrodotoxin-sensitive contractions of the rat proximal urethra. However, the inhibitory effect of atropine was much reduced as compared to controls, while the phentolamine-sensitive portion of the response was increased. 5. DMPP (0.1 mM) a nicotinic receptor agonist, produced a contraction (phasic and tonic components) which was strongly inhibited by hexamethonium (10 microM), abolished by prazosin (1 microM) and reduced by tetrodotoxin (3 microM). 6. In urethral rings from diabetic rats (i.v. streptozotocin 7-9 weeks before) the contractile response to acetylcholine or noradrenaline as well as the response to field stimulation were unchanged as compared to controls. 7. Capsaicin (1 microM) produced an inhibitory effect on the nerve-mediated contractions of the rat proximal urethra. This response was abolished by pelvic ganglionectomy but was unaffected in streptozotocin-treated rats. 8. These findings provide functional evidence that both cholinergic and noradrenergic nerves mediate the contractions of the rat proximal urethra. In addition, capsaicin-sensitive sensory nerves can produce certain local motor responses through release of endogenous neuropeptides. In vivo studies are needed to examine the interplay between these differents sets of motor nerves in the regulation of proximal urethra motility.

Neurotransmitter release is blocked intracellularly by botulinum neurotoxin, and this requires uptake of both toxin polypeptides by a process mediated by the larger chain

Botulinum neurotoxins (types A and B), which are microbial proteins consisting of two disulfide-linked chains, inhibit specifically and with high potency the release of acetylcholine from peripheral nerve terminals. As a prerequisite for a long-term development of effective treatments for botulism, the internalization and inhibitory action of the toxin and its constituent chains were examined by electrophysiological methods at identified synapses in Aplysia preparations that allow both intracellular and bath application of the neurotoxins. Intracellular recordings from cholinergic cells of the buccal ganglion demonstrated that extra- or intracellular application of low doses of botulinum neurotoxin results in a specific blockade of evoked transmitter release, without changing the quantal size; an intraneuronal site of action has thus been established. In contrast, release from noncholinergic neurons of cerebral ganglion was prevented by the neurotoxin only after injection into the cell. Purified preparations of the individual renatured chains, shown to be nontoxic in a mouse bioassay, failed to affect acetylcholine release when applied extra- or intracellularly. However, inhibition of release was observed after intracellular administration of both chains or when the light chain was injected and the heavy chain was bath-applied. These findings show that both chains are required on the cytosolic side of the neuronal plasma membrane for expression of toxicity and that the cholinergic specificity of the neurotoxin is attributable to its heavy chain, which mediates targeting and subsequent neuronal uptake.

Characterization of the inhibitory action of botulinum neurotoxin type A on the release of several transmitters from rat cerebrocortical synaptosomes

Under optimised conditions for intoxication, botulinum neurotoxin type A was shown to inhibit approximately 90% of Ca2+-dependent K+-evoked release of [3H]acetylcholine, [3H]noradrenaline, and [3H]dopamine from rat cerebrocortical synaptosomes; cholinergic terminals were most susceptible. In each case, the dose-response curve for the neurotoxin was extended, with about 50% of evoked release being inhibited at approximately 10 nM whereas 200 nM was required for the maximal blockade. This may suggest some heterogeneity in the release process. The action of the toxin was time and temperature dependent and appeared to involve binding and sequestration steps prior to blockade of release. The neurotoxin failed to exert any effect on synaptosomal integrity or on Ca2+-independent release of the transmitters tested; it produced only minimal changes in neurotransmitter uptake although small secondary effects were detected with cholinergic terminals. Blockade by the neurotoxin of Ca2+-dependent resting release of transmitter was apparent; Sr2+, Ba2+, or high concentrations of Ca2+ restored the resting release of 3H-catecholamine but not [3H]acetylcholine. Interestingly, none of the latter conditions or 4-aminopyridine could reverse the toxin-induced blockade of evoked release. This lack of specificity in its action on synaptosomes, and other published findings, lead to the conclusion that toxin-sensitive component(s) exist in all nerve terminals that are concerned with transmitter release.

Role of adenine compounds in autonomic neurotransmission

Clearly adenine compounds exert numerous effects throughout the autonomic nervous system. The responses of various peripheral tissues to purines are summarized in Table 2. The evidence supporting a possible excitatory neurotransmitter function for ATP is very good in the vas deferens and good in both the bladder detrusor and certain blood vessels. ATP may also be an excitatory neurotransmitter in the colon, hepatocytes and frog atrium. These responses appear to be mediated by P2x-purinoceptors. There is good evidence supporting a role for ATP as an inhibitory neurotransmitter in the taenia coli and duodenum, and some support in the anal sphincter and possibly the rabbit portal vein; these responses appear to be mediated by P2y-purinoceptors. There is good evidence against ATP being an inhibitory neurotransmitter in the stomach fundic muscle and ileum. ATP (or more likely its metabolite adenosine) may act as an inhibitory neurotransmitter by interacting with postsynaptic P1-purinoceptors in cultured sympathetic neurones and also in the parasympathetic vesicle ganglion of the cat. It seems likely that ATP released from heart, platelets or vascular endothelium could be an endogenous relaxant of blood vessels through its actions on the endothelium. Although the addition of exogenous adenosine affects many tissues, evidence supporting modulatory functions for endogenous extracellular adenosine has only been clearly demonstrated in the ileum, gallbladder, vas deferens, fallopian tubes, kidney, blood vessels, carotid sinus, heart and adipose tissue. Both ATP and adenosine, released during periods of hypoxia or ischemia, could exert negative inotropic, chronotropic and dromotropic actions in the heart. In many cases, the potential sources of extracellular purines have not been established. This is particularly important when attempting to establish a neurotransmitter function for ATP in a tissue. For instance, the one outstanding piece of evidence required to confirm that ATP is an excitatory neurotransmitter released from sympathetic nerves in blood vessels is the unequivocal demonstration that it is, in fact, released from the sympathetic nerves when they are stimulated. To date, only the release of radiolabeled metabolites of ATP, possibly from post- rather than presynaptic sites, has been detected. Studies of the release of ATP are complicated by its rapid degradation extracellularly by ecto-ATPase. Unfortunately, there are no specific inhibitors of ecto-ATPase available at present, but one hopes that a suitable inhibitor will be developed shortly.(ABSTRACT TRUNCATED AT 400 WORDS)

Neuroeffector mechanisms in the voiding cycle of the guinea-pig urinary bladder

1. The effect of drugs expected to modify cholinergic (atropine, physostigmine) or GABA-ergic (GABA, picrotoxin, bicuculline methiodide, BMI) neurotransmission were investigated on the voiding cycle of the urinary bladder in urethane-anaesthetized guinea-pigs. 2. Transvesical saline infusion elicited a series of regular voiding cycles which were abolished by topical tetrodotoxin as well as by topical or intravenous (i.v.) hexamethonium, thus indicating their reflex neurogenic origin. 3. Either i.v. or topical atropine decreased amplitude and duration of micturition contraction, reduced efficiency of bladder voiding and, in about 30% of preparations, suppressed micturition (overflow incontinence). Either topical or i.v. physostigmine potentiated, in an atropine-sensitive manner, voiding efficiency. 4. GABA was administered during the ascending limb of the voiding cycle: i.v. GABA inhibited while topical GABA increased efficiency of the first voiding cycle. Both direction and intensity of the effect of GABA were dependent upon initial pressures. The second and following voiding cycles after GABA administration were inhibited transiently. 5. Either topical or i.v. picrotoxin or BMI potentiated the efficiency of the voiding cycle of the guinea-pig bladder. In these preparations either i.v. or topical GABA (administered during the ascending limb of the voiding cycle) produced only inhibitory effects on voiding efficiency. 6. These findings indicate that, in guinea-pigs, bladder voiding is largely dependent upon an intact cholinergic neurotransmission. Although amplitude of the initial voiding contraction is largely atropine-resistant, its duration and, consequently, degree of bladder voiding, are strongly influenced by blockade (atropine) or potentiation (physostigmine) of cholinergic neurotransmission. Endogenous GABA-ergic mechanism modulate, possibly at peripheral level, the voiding efficiency of the guinea-pig bladder. GABA exerts a complex neuromodulatory influence on voiding function, its overall effect being mainly influenced by resting parameters.

A study of bladder dysfunction during streptozotocin-induced diabetes in the rat using an in vitro whole bladder preparation

An in vitro whole bladder preparation has been used in this study to examine the effects of eight and 16 week streptozotocin-induced diabetes on detrusor function in the rat. In eight week animals cystometric recordings showed an increase in bladder capacity associated with a decrease in intraluminal pressure. Concentration-response curves revealed a significant increase in sensitivity of the detrusor to beta,gamma-methylene ATP, a potent purinergic agonist, and a trend towards subsensitivity to acetylcholine in bladders from eight week diabetic rats when compared to controls. The atropine-resistant (purinergic) response to neurogenic stimulation was increased over the frequency range two to 30 Hz and was significantly greater at two Hz. In 16 week animals the cystometrogram had partially recovered; capacity had decreased compared to eight week diabetics and intraluminal pressure was within the normal range. Concentration-response curves revealed no significant difference in the response to acetylcholine and a greatly reduced response to beta,gamma-methylene ATP in the 16 week diabetics compared to controls. The atropine-resistant neurogenic response was slightly, but not significantly reduced. The results are discussed in relation to clinical urodynamic measurements of human detrusor dysfunction in diabetes.

Selective location of acceptors for botulinum neurotoxin A in the central and peripheral nervous systems

The main site of action for botulinum neurotoxin is cholinergic motor nerve terminals where specific acceptors concentrate the toxin on the cell surface, thereby facilitating its internalization and inactivation of a component essential for transmitter release. In this study, the interaction in vitro of [125I]botulinum neurotoxin type A with central and peripheral nerve terminals of different types was investigated using Ultrofilm and electron-microscope autoradiography. It was found that: (i) The neurotoxin binds to synapse-rich areas of rat brain, particularly in the hippocampus and cerebellum; identity of the neuron types labelled is unclear although cholinergic nerves seem to be labelled, perhaps not exclusively, in many areas. (ii) Toxin uptake at central nerve terminals appears to be minimal and its penetration into intact brain slices is restricted; this may account for the toxin's lower central toxicity. (iii) Selective labelling of cholinergic nerves but not purinergic, peptidergic or adrenergic nerve terminals in mouse ileum suggests that the toxin may be a specific marker for cholinergic nerves in the periphery. Based on these localization studies and published pharmacological observations, it is concluded that efficient toxin-induced blockade of neurotransmission depends on the presence of specific acceptors of high affinity for the toxin and of an effective neuronal uptake mechanism. Inhibition of the release of numerous transmitters from different kinds of nerve terminals lacking one of these features can be produced by high toxin concentrations when uptake occurs via low affinity acceptors or by non-specific means. Notably, this widespread action of the toxin indicates the occurrence of a common intracellular target in several, possibly all, nerve types.

Urinary bladder intramural neurones: an electrophysiological study utilizing a tissue culture preparation

An enzymic dispersion technique was used to free the intramural ganglia from their usual close association with the other components of the urinary bladder wall. The isolated ganglia obtained were viable and could be kept in culture for several weeks. The development of the cultures was monitored by phase-contrast microscopy and their electrophysiological properties were investigated using intracellular recording techniques. Neurones could be visually identified after 2-3 days in culture; cell groups contained from 2-50 neurones. Three types of spontaneous activity were seen: small changes in membrane potential and action potentials, and slow oscillatory conductance changes. These events were not blocked by hexamethonium but were abolished by hyperpolarizing current. Most neurones spiked without adaptation to direct stimulation; in a few cells the train of spikes was damped out. No neurones generated long afterhyperpolarizations. Indirect stimulation produced responses in the ganglia which are consistent with synaptic activity. Summation of inputs was demonstrated. These results provide evidence for local intraganglionic circuits since the ganglia or neurone groups are unequivocally extrinsically denervated. It was concluded that the intramural ganglia have the capacity to integrate preganglionic input and the question of whether or not they might mediate reflex activity is raised.

The contributions of noradrenaline and ATP to the responses of the rabbit central ear artery to sympathetic nerve stimulation depend on the parameters of stimulation

The possibility that ATP and noradrenaline act as cotransmitters from sympathetic perivascular nerves was studied in the isolated rabbit central ear artery. Electrical stimulation of the perivascular nerves for either 1 s, or continuously until a maximum response was reached, produced frequency-dependent contractions that were sensitive to tetrodotoxin and guanethidine. Contractions to continuous stimulation were significantly greater than those to a 1 s train of stimulation. Prazosin (10(-6) M) significantly reduced, but did not abolish, all neurogenic contractions such that contractions to both a 1 s train and to continuous stimulation were now of a similar magnitude. A higher concentration of prazosin (10(-5) M) had no additional inhibitory effect on neurogenic contractions even though it further significantly inhibited contractions to exogenous noradrenaline. The greatest resistance to alpha-adrenoceptor blockade was seen at low frequencies. Desensitisation of the postjunctional P2-purinoceptor by repeated administration of alpha, beta-methylene ATP inhibited the non-adrenergic neurogenic contractions and contractions to exogenous ATP, but had no effect on contractions to exogenous noradrenaline. It is concluded that ATP and noradrenaline are excitatory cotransmitters from sympathetic perivascular nerves innervating the rabbit central ear artery. The relative contribution of each compound to neurogenic contractions of the ear artery is highly dependent on the parameters of stimulation used. Short pulse bursts (1 s) at low frequency (2-5 Hz) favour the prazosin-resistant (purinergic) component of the response.

The postganglionic excitatory innervation of the mouse urinary bladder and its modulation by prejunctional GABAB receptors

Field stimulation produced reproducible contractions of the mouse isolated urinary bladder whose amplitude was frequency-related. These contractions were partially sensitive to atropine (3 microM), unaffected by hexamethonium (10 microM) and almost abolished by tetrodotoxin (0.5 microM). Atropine (3 microM) suppressed contractions produced by exogenous acetylcholine thereby indicating atropine-resistance of the nerve-mediated contractions. Nerve-mediated contractions of the mouse urinary bladder were enhanced by physostigmine (0.1-0.5 microM) and inhibited by hemicholinium-3 (0.5 mM) thus confirming the presence of a cholinergic component in the excitatory postganglionic innervation. Atropine (3 microM) inhibition of the nerve-mediated contractions increased with increasing duration and strength of the train of stimulation. The nerve-mediated contractions of the mouse bladder were unaffected by phentolamine (0.2 microM), propranolol (0.3 microM) or indomethacin (5 microM). ATP (1mM) the major candidate for the role of nonadrenergic-noncholinegic (NANC) excitatory neurotransmitter in the mammalian urinary bladder produced a contraction of the mouse isolated bladder. Exposure to the stable ATP analogue alpha, beta-methylene ATP (APCPP) or beta, gamma-methylene ATP (APPCP) produced a partial desensitization of the nerve-mediated response which, for APCPP, was greater in the presence than in the absence of atropine (3 microM). In the presence of atropine (3 microM) and after APCPP desensitization the amplitude of the response to field stimulation amounted to about 20% of the original response and was sensitive to tetrodotoxin, indicating that it is nerve-mediated. GABA (0.001-0.3 mM) inhibited the amplitude of field stimulation induced contractions of mouse urinary bladder. This effect was mimicked by the selective GABAB receptor agonist, (+/-)-baclofen, but not by the selective GABAA receptor agonist, homotaurine. GABA and (+/-)-baclofen exhibited cross-desensitization. The GABA-or (+/-)-baclofen-induced inhibition of the nerve-mediated contractions were reduced by previous exposure to homotaurine (1 mM) or to 5-aminovaleric acid (2 mM), two GABAB receptor antagonists. On the other hand the inhibitory effects of GABA or (+/-)-baclofen were unaffected by picrotoxin (0.1 mM), a selective GABAA receptor antagonist. The inhibitory effect of GABA on nerve-mediated contractions was reduced in the presence of atropine or hemicholinium-3 as well as following desensitization of P2-purinoreceptors.(ABSTRACT TRUNCATED AT 400 WORDS)

Ethylcholine mustard aziridinium ion (AF64A) impairs cholinergic neuromuscular transmission in the guinea-pig ileum and urinary bladder, and cholinergic neuromodulation in the enteric nervous system of the guinea-pig distal colon

AF64A was examined for its ability to impair cholinergic neurotransmission in the autonomic nervous system. In the guinea-pig ileum AF64A impaired cholinergic neuromuscular transmission. In the guinea-pig urinary bladder AF64A selectivity impaired the cholinergic but not the purinergic component of neuromuscular transmission. In the guinea-pig colon circular muscle AF64A impaired cholinergic neuromodulation of the inhibitory transmission but not the inhibitory transmission itself. The nature of impairment of cholinergic transmission by AF64A is discussed.

Reversible esophageal motor dysfunction in botulism

Two cases of botulism with autonomic and neuromuscular system involvement are presented. In both patients, dryness of the mouth and difficulties in swallowing were predominant symptoms. Esophageal manometry revealed a marked decrease in peristaltic amplitude, which was most pronounced in the upper third of the esophagus. These functional abnormalities returned to normal following recovery from the acute disease.

Pharmacological evidence for the existence of two components in the twitch response to field stimulation of detrusor strips from the rat urinary bladder

Isolated strips from the anterior dome of the rat urinary bladder respond to single pulse field stimulation with a contraction. Two distinct components of this contraction ("early' and "late') could be observed, both of which were unaffected by hexamethonium (10 microM) and almost abolished by tetrodotoxin (1 microM) indicating their dependence on neurotransmitter release from postganglionic nerve endings. Atropine (3 microM) inhibited the "late' component (over 60%) to a significantly greater extent than the "early' component (less than 10%) Amplitude of the "early' component was usually greater than that of the "late' component. There was almost no difference between the "early' and "late' component in respect of their relationship to stimulus strength and pulse duration. Physostigmine (0.03 microM) enhanced both components of the nerve-mediated contraction, although enhancement of the "late' component was much greater than that of the "early' one. Tetraethylammonium (TEA, 0.5-5 mM) enhanced, in a concentration-related manner, both "early' and "late' components of the nerve-mediated contraction. Following exposure to physostigmine or TEA (5 mM) both "early' and "late' components of contraction were almost completely inhibited by tetrodotoxin. Atropine inhibition was more evident on the "late' as compared to "early' component of contraction. These findings demonstrate the presence, in the twitch response of rat isolated urinary bladder to field stimulation, of two nerve-mediated components which exhibit a different susceptibility to atropine and physostigmine.

A comparative study of electrical field stimulation of the guinea-pig, ferret and marmoset urinary bladder

The spontaneous and electrically evoked activity was examined in guinea-pig, ferret and marmoset urinary bladder. Electrical field stimulation of detrusor strips in vitro induced a rapid, frequency-dependent contraction with a maximum response at 40 Hz. This contraction was partly decreased by either atropine (0.29 microM) or desensitisation to alpha, beta-methylene ATP (alpha, beta-MeATP) (5 microM), and was totally blocked by a combination of the two. Atropine blocked responses to carbachol (30 microM) but not to ATP (80 microM), whereas desensitisation to alpha, beta-MeATP blocked those to ATP but not to carbachol. The nature of the excitatory neurotransmission mechanism in the bladder of those species examined in the present experiments was shown to be similar to that of other species described previously.

Further evidence for involvement of adenosine-5'-triphosphate in non-adrenergic non-cholinergic relaxation of the isolated rat duodenum

The nature of the inhbitory non-adrenergic non-cholinergic (NANC) neurotransmitter responsible for neurogenic relaxation of rat duodenum was studied with in vitro techniques. Adenosine 5'-triphosphate (ATP)(1 mM), gamma-aminobutyric acid (GABA, 1 mM), dimethylphenylpiperazinium (DMPP, 0.1 mM) and field stimulation (60 V, 2 ms, 0.1 Hz) produced transient relaxation followed by rebound contraction. In contrast vasoactive intestinal polypeptide (VIP) (0.3 microM) and noradrenaline (1 microM) induced relaxation which set in more slowly and lasted longer. Tetrodotoxin (0.85 microM) abolished field stimulation-induced relaxation but not ATP-, VIP- or noradrenaline-induced relaxation. Nucleotide pyrophosphatase (0.25 U/ml), but not the proteolytic enzyme alpha-chymotrypsin (2 U/ml), selectively antagonized NANC relaxation. The rank order of potency of various adenine derivatives for inducing relaxation was adenosine-5'-triphosphate greater than adenosine-5'-diphosphate much greater than adenosine greater than adenosine-5'-monophosphate. ATP-induced relaxation was selectively antagonized by the putative P2 purinoceptor antagonist reactive blue 2, but unaffected by the selective P1 purinoceptor antagonist 8-phenyltheophylline. The duration of ATP- as well as beta-gamma-methylene adenosine-5'-triphosphate (a stable analogue of ATP)-induced relaxation was similar and was unaffected by indomethacin 10 microM (which abolished the rebound contraction). In those preparations whose contractile tone was increased by using a high-K+ medium the ability of ATP to elicit relaxation was markedly reduced, while GABA- and DMPP-induced relaxation was abolished. On the other hand, ATP-, GABA- and DMPP-induced relaxation of the tonic component of 5-hydroxytryptamine (5-HT)(0.1 mM)-induced contraction was similar to that observed in control conditions. These findings add further weight to the proposal that endogenous ATP is involved in determining NANC relaxation of rat duodenum.

Evidence against VIP or substance P being the transmitter in non-cholinergic excitatory nerves supplying the guinea-pig bladder

In the guinea-pig bladder, contractile responses to substance P (0.3 microM) and VIP (3 microM) were unaffected by P2-purinoceptor desensitization with alpha,beta-methylene ATP (3 X 10(-6) M), while the responses to stimulation of the non-cholinergic excitatory nerves (4-16 Hz) were abolished. The evidence presented suggests that ATP or a related purine nucleotide, and not VIP or substance P, is responsible for the non-cholinergic excitatory component of the nerve-mediated response.

Intimacy of the neuroeffector junction and resistance to alpha-adrenoceptor-blockade of the neurogenic contractile response in vasa deferentia from guinea pig and rat

The effect of phentolamine on the neurogenic contractile response in vasa deferentia from rat and guinea pig was studied during Wallerian degeneration. This response was also investigated after partial denervation (surgery or chemical sympathectomy by guanethidine treatment) in vasa deferentia from guinea pig. During Wallerian degeneration the response showed a gradual increase in sensitivity to phentolamine and was abolished in the late stages. The neurogenic contractile response of the partially denervated vas deferens was blocked by low concentrations of phentolamine. It is concluded that decreased intimacy of the neuroeffector junctions leads to increased susceptibility to alpha-adrenoceptor blockade of the contractile response to nerve stimulation. It is further concluded that the motor transmission in the vas deferens is essentially adrenergic. The resistance to alpha-adrenoceptor blockade of the initial phase of the contractile response to nerve stimulation of intact vasa deferentia from guinea pig and rat might well be explained by the "proximity theory" of Dale & Gaddum although participation of supplementary mediators cannot be excluded.

Comments on the atropine resistance of the neurogenic contractile response of the rat detrusor muscle

The resistance to atropine or scopolamine of the neurogenic contractile response to field stimulation of intramural nerves of the rat detrusor was studied during the early phase of Wallerian degeneration in vitro and in vivo. The neurogenic contractile response to low frequency stimulation of control bladders was completely resistant to atropine or scopolamine in vitro. As a matter of fact the response was enchanced by the drugs. In vivo a transient shortening of the response could be seen. 26-34 h after bilateral extirpation of the pelvic ganglia there was prominent degeneration activity in the bladders in vitro as well as in vivo. Atropine or scopolamine inhibited this activity in vivo but enhanced it in vitro. The neurogenic contractile response to field stimulation of the bladder nerves was blocked in vivo but not in vitro by the antimuscarinic drugs 26-34 h after neurectomy. The results support the concept that the excitatory neurotransmission in the detrusor is essentially cholinergic. An explanation of the difference between the in vivo and the in vitro results based on differences in degree of blockade of pre- and post-junctional muscarinic receptors and diffusion of the antimuscarinics in the tissue is proposed.

Effects of neuropeptide Y (NPY) on mechanical activity and neurotransmission in the heart, vas deferens and urinary bladder of the guinea-pig

The effects of preincubation for 10 min with synthetic porcine neuropeptide Y (NPY) on muscle tone and autonomic transmission in the guinea-pig right atrium, vas deferens, urinary bladder, portal vein and trachea were analysed in vitro. NPY induced a metoprolol-resistant, long-lasting, positive inotropic and chronotropic effect per se in the spontaneously beating right atrium. Furthermore, NPY caused a reversible inhibition of both the metoprolol and atropine-sensitive auricle responses to field stimulation (2 Hz or 4 Hz for 2 s) without affecting the response to exogenous noradrenaline (NA) or acetylcholine (ACh). NPY did not induce any contraction of the vas deferens, but inhibited both the rapid twitch response and the sustained tonic contraction induced by field stimulation. The NPY-induced inhibition of the tonic contraction was more long-lasting than that of the twitch response. The tonic contraction was blocked by phentolamine and the twitch response by alpha-, beta-methylene ATP tachyphylaxis. NPY did not inhibit the contractile effects of NA, ATP or alpha-, beta-methylene ATP. NPY also induced a reversible reduction of the non-cholinergic, non-adrenergic contractile response to field stimulation of the urinary bladder. In the portal vein, NPY (up to 5 X 10(-7) M) did not inhibit the spontaneous motility or the phentolamine-sensitive contractile responses to field stimulation and NA. The atropine-sensitive contraction of the trachea or the non-adrenergic, non-cholinergic relaxation induced by field stimulation were not significantly influenced by NPY in doses up to 5 X 10(-7) M.(ABSTRACT TRUNCATED AT 250 WORDS)

Acceptors for botulinum neurotoxin reside on motor nerve terminals and mediate its internalization

Botulinum neurotoxin (BoNY) type A, a causative agent of botulism, is a di-chain protein (molecular weight 140,000) from Clostridium botulinum, and the most neurotoxic substance known. Some cases of sudden infant cot deaths have been attributed to such a neuroparalytic condition. BoNT inhibits irreversibly the release of acetylcholine from peripheral nerves in a highly selective manner. Hence, it is potentially an invaluable probe for studying the mechanism of transmitter release. Here we demonstrate specific labelling of murine motor nerve terminals with neurotoxic, 125I-labelled BoNT (type A) by autoradiography. We observed saturable, temperature-sensitive binding of BoNT to sites which reside solely on the nerve terminal membrane; these were distributed on all unmyelinated areas, at an average density of 150-500 per micron2 of membrane. The binding was mediated by the larger subunit of the toxin and was inhibited partially by tetanus toxin, another microbial protein. No specific binding was detectable on any other cell types examined, including noradrenergic terminals. Following binding, internalization of radioactivity was observed; this process was energy-dependent as it could be prevented totally by azide or dinitrophenol (DNP). This direct demonstration of separable steps, including highly selective binding and acceptor-mediated internalization, is reconcilable with the unique potency and the multiphasic inhibitory action of BoNT on transmitter release, as shown electrophysiologically.

Autonomic neurotransmitters and trophic factors

Substantial changes to the classical view of two transmitters in the autonomic nervous system are discussed: there is now evidence that about 16 putative neurotransmitter substances exist; some transmitter substances coexist within single nerve terminals, and upon release may act as co-transmitters or as pre- or post-junctional neuromodulators, and autonomic nerves release 'trophic factors' which have long-term influences on development and regeneration. Thus these findings influence interpretation of the autonomic nervous system's function and pathophysiology.