Differential cholinoceptor subtype-dependent activation of signal transduction pathways in neonatal versus adult rat atria

Autoantibodies against Submandibular Gland Muscarinic Cholinoceptor Subtypes in Primary Sjögren Syndrome

Sjögren Syndrome (SS) is a chronic autoimmune disease characterized by parasympathetic exocrine gland dysfunction. Here, the involvement of submandibular gland muscarinic acetylcholine receptor (mAChR) M4 subtype is proposed as an IgG target together with M1 and M3 mAChR subtypes. The Kd values were total membranes 0.20 ± 0.017 nM; acini membranes 0.33 ± 0.023 nM and duct membranes 0.22 ± 0.040 nM and Bmax values were total, 1038 ± 24, acini, 1359 ± 28 and ducts, 593 ± 30. The rank order of Bmax was: acini > total > ducts, indicating that acini express the highest number of binding sites. The specific mAChR antagonists (4-DAMP [M3], tropicamide [M4], pirenzepine [M1]) and the corresponding synthetic peptides impaired IgG-mAChR subtype interactions. The specificity of these reactions was assessed by the corresponding affinity-purified anti peptide antibodies recognizing M4, M3 and M1 mAChR. These data concerning autoantibodies contribute to explain the pathogenesis of SS and also represent a new clinical marker for SS diagnosis.

The detection of the non-M2 muscarinic receptor subtype in the rat heart atria and ventricles

Mammal heart tissue has long been assumed to be the exclusive domain of the M(2) subtype of muscarinic receptor, but data supporting the presence of other subtypes also exist. We have tested the hypothesis that muscarinic receptors other than the M(2) subtype are present in the heart as minor populations. We used several approaches: a set of competition binding experiments with pirenzepine, AFDX-116, 4-DAMP, PD 102807, p-F-HHSiD, AQ-RA 741, DAU 5884, methoctramine and tripinamide, blockage of M(1) muscarinic receptors using MT7 toxin, subtype-specific immunoprecipitation experiments and determination of phospholipase C activity. We also attempted to block M(1)-M(4) receptors using co-treatment with MT7 and AQ-RA 741. Our results show that only the M(2) subtype is present in the atria. In the ventricles, however, we were able to determine that 20% (on average) of the muscarinic receptors were subtypes other than M(2), with the majority of these belonging to the M(1) subtype. We were also able to detect a marginal fraction (6 +/- 2%) of receptors that, based on other findings, belong mainly to the M(5) muscarinic receptors. Co-treatment with MT7 and AQ-RA 741 was not a suitable tool for blocking of M(1)-M(4) receptors and can not therefore be used as a method for M(5) muscarinic receptor detection in substitution to crude venom. These results provide further evidence of the expression of the M(1) muscarinic receptor subtype in the rat heart and also show that the heart contains at least one other, albeit minor, muscarinic receptor population, which most likely belongs to the M(5) muscarinic receptors but not to that of the M(3) receptors.

Mechanisms involved in the regulation of mRNA for M2 muscarinic acetylcholine receptors and endothelial and neuronal NO synthases in rat atria

BACKGROUND AND PURPOSE

Agonists of the M(2) muscarinic acetylcholine receptor (mAChR) increase mRNA for this receptor and mRNA for endothelial and neuronal isoforms of NO synthase (eNOS or nNOS). Here we examine the different signalling pathways involved in such events in rat cardiac atria.

EXPERIMENTAL APPROACH

In isolated atria, the effects of carbachol on mRNA for M(2) receptors, eNOS and nNOS were measured along with changes in phosphoinositide (PI) turnover, translocation of protein kinase C (PKC), NOS activity and atrial contractility.

KEY RESULTS

Carbachol increased mRNA for M(2) receptors, activation of PI turnover, translocation of PKC and NOS activity and decreased atrial contractility. Inhibitors of phospholipase C (PLC), calcium/calmodulin (CaM), NOS and PKC prevented the carbachol-dependent increase in mRNA for M(2) receptors. These inhibitors also attenuated the carbachol induced increase in nNOS- and eNOS-mRNA levels. Inhibition of nNOS shifted the dose response curve of carbachol on contractility to the right, whereas inhibition of eNOS shifted it to the left.

CONCLUSIONS AND IMPLICATIONS

From our results, activation of M(2) receptors induced nNOS and eNOS expression and activation of NOS up-regulated M(2) receptor gene expression. The signalling pathways involved included stimulation of PI turnover via PLC activation, CaM and PKC. nNOS and eNOS mediated opposing effects on the negative inotropic effect in atria, induced by stimulation of M(2) receptors. These results may contribute to a better understanding of the effects and side effects of cholinomimetic treatment in patients with cardiac neuromyopathy.

ATROPINE OFTEN RESULTS IN COMPLETE ATRIOVENTRICULAR BLOCK OR SINUS ARREST AFTER CARDIAC TRANSPLANTATION: AN UNPREDICTABLE AND DOSE-INDEPENDENT PHENOMENON

BACKGROUND

A paradoxic response to atropine with development of atrioventricular (AV) block has been described in patients after heart transplantation (HTx). We investigated further the incidence and dose-response relationship of this paradoxic atropine response and explored predictive factors.

METHODS

We investigated 25 clinically stable patients (age 55 +/- 2 years) 18 to 126 months after HTx. After endomyocardial biopsy, a temporary pacemaker was introduced and patients were monitored. Atropine was given in ascending doses (0.004 mg/kg body weight initially, total cumulative dose 0.035 mg/kg body weight). Physiologic tests were performed to evaluate the presence of reinnervation.

RESULTS

In 20% of the patients (5/25), a paradoxic response to atropine was observed. Four patients exhibited third degree AV block, one of whom also demonstrated sinus arrest. A fifth patient showed sinus arrest only. In all patients but one, there was no ventricular escape rhythm before ventricular pacing was commenced (10 sec after block). The observed adverse effect was not correlated with the applied atropine dosage, and predisposing factors could not be identified, apart from a slightly lower resting heart rate (80 +/- 5 vs. 90 +/- 2 beats/min, P = 0.07).

CONCLUSION

A significant proportion of patients respond paradoxically to atropine after HTx, leading to asystole as the result of sinus arrest or AV block. Although a plausible explanation for this effect remains speculative, our data indicate that the use of atropine or other anticholinergic drugs in patients after HTx is contraindicated.

Autoantibodies against neonatal heart M1 muscarinic acetylcholine receptor in children with congenital heart block

Isolated congenital heart block may be associated with autoimmune disorder such as Sjögren Syndrome and systemic lupus erythematosus. In this work we demonstrate circulating autoantibodies against neonatal heart M1 muscarinic acetylcholine receptor (mAChR) in the sera of children with congenital heart block. This antibody were able to react with the second extracellular loop of the human M1 mAChR as demonstrated using a synthetic peptide in enzyme immune assay and binding assay. Affinity purified anti-peptide IgG as well as total IgG from children with congenital heart block, interfered with the specific radioligand occupancy from neonatal heart M1 mAChR, interacting irreversibly. The antipeptide antibodies also displayed an 'agonist-like' activity, i.e. decreased contractility, activated nitric oxide synthase activity and increased production of cyclic GMP. All of these effects were selectively blunted by pirenzepine and neutralized by the synthetic M1 peptide. Both binding and biological effects were obtained using neonatal rat heart instead adult heart and were independent of Ro/SS-A and La/SS-B antibodies and were also absent in the sera of normal children. A clinical relevance of these findings is demonstrated by a strong association between the existence of circulating M1 mAChR antipeptide antibodies and the presence of isolated congenital heart block, making these antibodies a proper marker of this disease.

Differential activation of nitric oxide synthase through muscarinic acetylcholine receptors in rat salivary glands

Muscarinic receptors play an important role in secretory and vasodilator responses in rat salivary glands. Nitric oxide synthase (NOS) appears to be one of the multiple effectors coupled to muscarinic receptors in both submandibular and sublingual glands although some differences have been found depending on the gland studied. First, submandibular glands had a lower basal activity of nitric oxide synthase than sublingual glands and the concentration-response curve for carbachol was bell-shaped in the former but not in sublingual glands. Second, cGMP levels displayed a similar profile to that observed for NOS activity in both glands. Third, protein kinase C also coupled to muscarinic receptor activation in the glands might have a regulatory effect on nitric oxide production since its activity was higher in basal conditions in submandibular than sublingual glands and it also increased in the presence of the agonist at a concentration that inhibited NOS activity in submandibular glands. The effects appear to be partly related to the expression of a minor population of M(1) receptors in submandibular glands absent in sublingual as determined in binding and signaling experiments with the muscarinic receptor antagonist pirenzepine.

Sjögren autoantibodies modify neonatal cardiac function via M1 muscarinic acetylcholine receptor activation

Isolated congenital heart block may be associated with primary Sjögren syndrome. In this work we describe circulating antibodies in the sera of primary Sjögren syndrome patients that are able to interact with neonatal myocardium by activating muscarinic acetylcholine receptors of M1 subtype. We report on the presence of autoantibodies against the second extracellular loop of human M1 muscarinic acetylcholine receptors in primary Sjögren syndrome mothers whose children have congenital heart block using a synthetic peptide in indirect immunofluorescence technique. Autoantibodies from primary Sjögren syndrome patients gave positive image on neonatal atria but not on adult atria slices. The synthetic M1 peptide selectively abrogated indirect immunofluorescence recognition. The primary Sjögren syndrome-immunoglobulin G also displayed an 'agonist like' activity modifying the intracellular events associated with muscarinic acetylcholine receptor activation. The mechanism appears to occur secondarily to stimulation of phosphoinositides turnover via phospholipase C activation. This, in turn, triggers cascade reactions involving calcium/calmodulin and leads to activation of nitric oxide synthase and soluble guanylate cyclase. All of these effects were selectively blunted by pirenzepine and neutralized by M1 synthetic peptide. These biological effects were not obtained using adult instead of neonatal rat atria and neither occurred with the sera of normal healthy women of childbearing age. It could be concluded that antibodies against neonatal M1 muscarinic acetylcholine receptor may be another serum factor to be considered in the pathophysiology of the development of congenital heart block associated with primary Sjögren syndrome mothers.

Activation of nitric oxide signaling through muscarinic receptors in submandibular glands by primary Sjögren syndrome antibodies

Primary Sjögren Syndrome is a chronic autoimmune disease characterized by exocrine gland dysfunction. Here we present evidence of the activation of nitric oxide signaling cascade by circulating antibodies of patients with Sjögren Syndrome in rat submandibular glands. Constitutive nitric oxide synthase and cyclic GMP levels are modulated by Sjögren IgGs through the activation of muscarinic acetylcholine receptors on the glands. The effects are similar to those produced by the agonist carbachol and blocked by the antagonist atropine. The involvement of M1 subtype of muscarinic receptors is proposed since both a synthetic peptide homologous to an extracellular domain of M1 receptor and pirenzepine, a selective M1 antagonist, partially blocked the effects. We conclude that Sjögren Syndrome antibodies can activate nitric oxide signaling in submandibular glands by interacting with muscarinic acetylcholine receptors.

Role of nitric oxide production through M2-cholinergic receptors in cultured rat ventricular myocytes

We previously reported that carbachol (CCh) caused the enhancement of NO production coinciding with negative chronotropy in cultured rat ventricular myocytes. In this study, we examined which subtype of muscarinic cholinergic receptor mediated these effects of CCh by measuring the NOx production with an HPLC-Griess reaction system and monitoring the beating with a Fotonic Sensor. The enhancement of NO production and negative chronotropy by 10(-4) M CCh stimulation were significantly inhibited by 10(-6) M atropine, 10(-6) M methoctramine, 3 x 10(-4) M L-NMMA, and 10(-5) M methylene blue. On the other hand, 10(-6) M pirenzepine and 10(-6) M HHSiD had no influence on the negative chronotropy by 10(-4) M CCh stimulation. Both 10(-6) M pirenzepine and 10(-6) M HHSiD suppressed the enhancement of NO production by 10(-4) M CCh stimulation slightly though not statistically. In addition, the m2 cholinergic receptor gene was expressed in our cell preparations, as demonstrated by reverse-transcriptase/PCR analysis. We concluded that M2-cholinergic receptor-mediated negative chronotropy may be due in part to activation of the NO-signaling pathway in cultured rat ventricular myocytes.

Muscarinic receptor subtypes in the porcine lung during postnatal development

The responsiveness of the pulmonary circulation to acetylcholine changes in the newborn piglet. Therefore muscarinic receptors have been studied in the developing porcine lung from birth to adulthood using ligand binding, Northern blotting and in situ hybridisation. Maximal binding capacity of [N-methyl-3H] scopolamine and the affinity of the receptor in lung membranes increased between birth and 16 days (p < 0.05). Subtype affinity changed with age, but always M3, > M1 > M2. Northern blots of porcine muscarinic receptor subtypes showed m1, m2 and m3 mRNA present in lung membranes. m2 mRNA was present at all ages and decreased with age. m1 mRNA was absent at birth and m3 mRNA was absent at 3 days. Autoradiographic localisation showed ligand binding to the parenchyma and airway smooth muscle and nerves, there was no binding to intrapulmonary vessels. In situ hybridisation localised mRNA of all three subtypes to the smooth muscle cells of both vessels and airways. Changes in the receptor subtypes may explain the pharmacological changes during postnatal adaptation.