Agonists muscarinic

Initial attempts to treat AD using direct cholinergic agonists were limited by low efficacy and side-effect issues (140—142). Thus trials using RS-86 (25), oxotremorine [70-22-4] (26), arecoline [63-75-2] (27), and pilocarpine [92-32-7] (28) to treat AD were equivocal (Eig. 5). However, the identification of multiple subtypes of muscarinic receptors has stimulated a search for subtype specific muscarinic agonists which may limit side effects while increasing efficacy. 

CI-979 (29) is a balanced muscarinic agonist having equal affinities for cloned ml and m2 receptors (144). However, unlike prototypical muscarinic compounds such as (25), (29) increases central muscarinic tone, as indicated by behavioral and electroencephalogram (EEG) parameters, at doses lower than those requited to produce gastrointestinal effects (144). CI-979 is well tolerated in humans up to a dose of 1 mg. Dose-limiting side effects such as stomach pain and emesis were observed at a dose of 2 mg. 

FIGURE 7.7 Effect of the allosteric modulator ebumamonine on the potency of muscarinic agonists on m2 receptors. It can be seen that while no change in potency is observed for APE (arecaidine propargyl ester) pilocarpine is antagonized and arecoline is potentiated, illustrating the probe dependence of allosterism. From [1],... 

Muscarinic agonists and antagonists are used for the treatment of a variety of pathophysiological conditions. For example, muscarinic agonists (pilocarpine, carba-chol, or aceclidine) reduce intraocular pressure when... 

Pilocarpine, arecoline and, of course, muscarine itself are naturally occurring muscarinic agonists, while oxotremorine is a synthetic one, which, as its name implies, can cause muscle tremor through a central effect. 

In contrast to the nicotinic antagonists and indeed both nicotinic and muscarinic agonists, there are a number of muscarinic antagonists, like atropine, hyoscine (scopolamine) and benztropine, that readily cross the blood-brain barrier to produce central effects. Somewhat surprisingly, atropine is a central stimulant while hyoscine is sedative, as least in reasonable doses. This would be the expected effect of a drug that is blocking the excitatory effects of ACh on neurons but since the stimulant action of atropine can be reversed by an anticholinesterase it is still presumed to involve ACh in some way. Generally these compounds are effective in the control of motion but not other forms of sickness (especially hyoscine), tend to impair memory (Chapter 18) and reduce some of the symptoms of Parkinsonism (Chapter 15). 

In fact, there is a good deal of evidence to support this suggestion. First, more than half the neurons in the PPT fire rhythmically only when PGO waves are evident and their firing starts immediately before the PGO waves appear. Second, in cats, REM sleep is augmented by direct injection of either carbachol, or more selective muscarinic agonists, or the anticholinesterase, neostigmine, into the pontine reticular formation (one of the projection sites for PPT). Third, REM sleep is abolished by lesion of the PPT nucleus but, interestingly, not by lesion of the LDT. 

Marks, G. A. Birabil, C. G. (2001). Comparison of three muscarinic agonists... 

The reaction of 5-[2-(iV,./V-dimethylamino)ethyl]-l,2,4-oxadiazole with methyl iodide forms the quaternary ammonium salt 170 (Scheme 22), which undergoes elimination in the presence of base (diisopropylethylamine (DIEA), TEA, l,8-diazabicyclo[4.3.0]undec-7-ene, etc.) to form an intermediate 5-vinyl-l,2,4-oxadiazole 171, which undergoes in situ Michael addition with nucleophiles to furnish the Michael adducts 172. As an example, also shown in Scheme 22, 3-hydroxy-pyrrolidine allows the synthesis of compound 172a in 97% yield. Mesylation followed by deprotonation of the 1,2,4-oxadiazole methylene at C-5 enables Sn2 displacement of the mesylate to give the 5-azabicycloheptyl derivative 173, which is a potent muscarinic agonist <1996JOC3228>. 

The reaction between 2-oximino acetonitriles 183 and disulfur dichloride was used to prepare several 3-chloro-4-alkyl-l,2,5-thiadiazoles for muscarinic agonist studies <1995USP5418240, 1998H(48)2111, 1996EJM221,... 

Both the M2 and M4 receptors are, as indicated above, coupled to Gj pathways and appear to mediate similar responses. The M2 receptor is widely expressed in the CNS but also present in heart and smooth muscle, while M4 is preferentially expressed in the CNS, especially in forebrain. Ablation of the M2 receptor leads to complete loss of muscarinic-agonist-stimulated bradycardia [55]. In the CNS, deletion of the M2 receptor abolishes oxotremorine induced akinesia and tremors [56]. Memory and learning tasks including passive avoidance and working memory are impaired in M2-receptor knockout mice, and there is decreased LTP in hippocampal slices [12],... 

---