Skeletal muscle neuromuscular junction

Clinical use of reversible inhibitors is directed to eye, skeletal muscle, neuromuscular junctions, gastrointestinal tract, urinary tract, respiratory tract, and heart and used in treatment of glaucoma (an ocular disease caused by increased intraocular pressure due to inadequate drainage of aqueous humor at filtration angle), myasthenia gravis (an autoimmune disease... 

NM Muscle type, end plate receptor Skeletal muscle neuromuscular junction Pentamer [(k1)2B1i 7)] Na +, K+ depolarizing ion channel... 

The most prominent pharmacologic effects of cholinesterase inhibitors are on the cardiovascular and gastrointestinal systems, the eye, and the skeletal muscle neuromuscular junction (as described in the Case Study). Because the primary action is to amplify the actions of endogenous acetylcholine, the effects are similar (but not always identical) to the effects of the direct-acting cholinomimetic agonists. 

The cholinesterase inhibitors have important therapeutic and toxic effects at the skeletal muscle neuromuscular junction. Low (therapeutic) concentrations moderately prolong and intensify the actions of physiologically released acetylcholine. This increases the strength of contraction, especially in muscles weakened by curare-like neuromuscular blocking agents... 

Myasthenia gravis is an autoimmune disease affecting skeletal muscle neuromuscular junctions. In this disease, antibodies are produced against the main immunogenic region found on subunits of the nicotinic receptor-channel complex. 

Ganglionic nicotinic receptors, like those of the skeletal muscle neuromuscular junction, are subject to both depolarizing and nondepolarizing blockade (see Chapters 7 and 27). Nicotine itself, carbamoylcholine, and even acetylcholine (if amplified with a cholinesterase inhibitor) can produce depolarizing ganglion block. 

Toxic action is complex, involving both stimulation and blockade of autonomic ganglia and skeletal muscle neuromuscular junctions, as well as direct effects on the central nervous system. Paralysis and vascular collapse are prominent features of acute poisoning, but death is usually due to respiratory paralysis, which may ensue promptly after the first symptoms of poisoning. Nicotine is not an inhibitor of cholinesterase enzyme. 

It is clear that these criteria are fulfilled in the cases of ACh and NE acting as neurotransmitters at different synapses. Let us consider, for example, the effects of ACh at the synapse made by a motor neuron with fast skeletal muscle ( neuromuscular junction ). 

Mammalian tissues contain many subtypes of nicotinic receptors that are located in various tissues, including autonomic ganglia, skeletal muscle (neuromuscular junction), spinal cord, and various brain regions. Differences in binding properties to the... 

Skeletal muscles -neuromuscular junction Contraction, when the effect is prolonged it leads to a depolarisation blockade resulting in a flaccid paralysis Muscle relaxation in surgery... 

The ensuing discussion will deal with that major category of receptors that are essentially components of cellular membranes. For example, the acetylcholine receptor involving skeletal muscles exerts its effect at the end of the motor nerve and its junction with the muscle (neuromuscular junction, see Chapter 7) by a depolarizing action. The fact that receptors are embedded in muscle cell membranes can be surmised by the fact that the contractile effect can be initiated by simply applying acetylcholine to the surface of the muscle preparation intracellular injection of the agonist produces no effect. A more interesting... 

Another possible target for toxins are the receptors for neurotransmitters since such receptors are vital, especially for locomotion. In vertebrates the most strategic receptor is that for acetylcholine, the nicotinic receptor. In view of the breadth of action of the various conotoxins it is perhaps not surprising that alpha-conotoxin binds selectively to the nicotinic receptor. It is entirely possible that similar blockers exist for the receptors which are vital to locomotion in lower species. As mentioned previously, lophotoxin effects vertebrate neuromuscular junctions. It appears to act on the end plate region of skeletal muscle (79,59), to block the nicotinic receptor at a site different from the binding sites for other blockers (81). 

In the periphery at the mammalian neuromuscular junction each muscle fibre is generally influenced by only one nerve terminal and the one NT acts on one type of receptor localised to a specific (end-plate) area of the muscle. The system is fitted for the induction of the rapid short postsynaptie event of skeletal muscle fibre contraction and while the study of this synapse has been of immense value in elucidating some basic concepts of neurochemical transmission it would be unwise to use it as a universal template of synaptic transmission since it is atypical in many respects. 

Measuring muscle-evoked responses to repetitive motor nerve electrical stimulation permits detection of presyn-aptic neuromuscular junction dysfunction. In botulism and the Lambert-Eaton syndrome, repetitive stimulation elicits a smaller than normal skeletal muscle response at the beginning of the stimulus train, due to impaired initial release of acetylcholine-containing vesicles from presyn-aptic terminals of motor neurons followed by a normal or accentuated incremental muscle response during repeated stimulation. This incremental response to repetitive stimulation in presynaptic neuromuscular disorders can be distinguished from the decremental response that characterizes autoimmune myasthenia gravis, which affects the postsynaptic component of neuromuscular junctions. 

ACh is necessary for control of skeletal muscle in verterbrates, acting as the neurotransmitter at the neuromuscular junction. It is also involved in transmission in the autonomic nervous system (see below, under "Neuroanatomy"). Central ACh is produced in two general areas in the brain incuding the basal forebrain (medial septal nuclei, diagonal band... 

Neuromuscular junction a chemical synapse between a spinal motor neuron axon and a skeletal muscle fiber. 

With severe intoxication by all routes, an excess of acetylcholine at the neuromuscular junctions of skeletal muscle causes weakness... 

With severe intoxication by all routes, an excess of acetylcholine at the neuromuscular junctions of skeletal muscle causes weakness aggravated by exertion, involuntary twitchings, fasciculations, and eventually paralysis. The most serious consequence is paralysis of the respiratory muscles. Effects on the central nervous system include giddiness, confusion, ataxia, slurred speech, Cheyne-Stokes respiration, convulsions, coma, and loss of reflexes. The blood pressure may fall to low levels, and cardiac irregularities, including complete heart block, may occur. ... 

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