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J Physiol Volume 542, Number 2, 347-354, July 15, 2002 DOI: 10.1113/jphysiol.2001.013456
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Journal of Physiology (2002), 542.2, pp. 347-354
© Copyright 2002 The Physiological Society
DOI: 10.1113/jphysiol.2001.013456

Autonomic function in mice lacking alpha5 neuronal nicotinic acetylcholine receptor subunit

Ningshan Wang *, Avi Orr-Urtreger †, Joab Chapman *‡, Ruth Rabinowitz *, Rachel Nachman * and Amos D. Korczyn *‡

*Department of Physiology and Pharmacology, Sackler Medical School, Tel Aviv University, † Genetic Institute and Department of Pediatrics and ‡ Department of Neurology, Tel Aviv Sourasky Medical Center and the Sieratzki Chair of Neurology, Tel Aviv University, Ramat Aviv, Israel

  ABSTRACT
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Abstract
Introduction
Methods
Results
Discussion
References

Neuronal acetylcholine nicotinic receptors (nAChR) are composed of 12 subunits (alpha2-10, beta2-4), of which alpha3, alpha5, alpha7, beta2 and beta4 subunits are known to exist in the autonomic nervous system (ANS). alpha5 subunits possess unique biophysical and pharmacological properties. The present study was undertaken to examine the functional role and pharmacological properties of the nAChR alpha5 subunits in the ANS using mice lacking alpha5 nAChR subunits (alpha5-/-). These mice grew to normal size showing no obvious physical or neurological deficit. They also showed normality in thermoregulation, pupil size and resting heart rate under physiological conditions. The heart rate and rectal temperature did not differ between alpha5-/- and wild-type mice during exposure to cold stress. An impairment of cardiac parasympathetic ganglionic transmission was observed during high frequency vagal stimulation, which caused cardiac arrest in all wild-type animals while alpha5-/- mice were more resistant. Deficiency of alpha5 subunits strikingly increased the sensitivity to a low concentration of hexamethonium, leading to a nearly complete blockade of bradycardia in response to vagal stimulation. Such a concentration of hexamethonium only slightly depressed the effects of vagal stimulation in control mice. Deficiency of alpha5 subunits significantly increased ileal contractile responses to cytisine and epibatidine. These results suggest that alpha5 subunits may affect the affinity and sensitivity of agonists and antagonists in the native receptors. Previous studies revealed that alpha5 subunits form functional receptors only in combination with other alpha and beta subunits. Thus, the data presented here imply that alpha5 subunits modulate the activity of nAChR in autonomic ganglia in vivo.

(Received 28 October 2001; accepted after revision 18 April 2002)
Corresponding author A. D. Korczyn: Sieratzki Chair of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel. Email: neuro13{at}ccsg.tau.ac.il

  INTRODUCTION
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Abstract
Introduction
Methods
Results
Discussion
References

The autonomic nervous system (ANS) maintains internal homeostasis by regulating cardiovascular, body temperature, gastrointestinal, genitourinary, exocrine and pupillary functions. The autonomic ganglia contain predominantly neuronal nicotinic acetylcholine receptors (nAChRs), which play a central role in neural transmission in the ANS. nAChRs are ligand-gated ion channels that are arranged in a pentameric combination composed of distinct subunits of which 12 have been identified (alpha2-10 and beta2-4) (Anand et al. 1991; Cooper et al. 1991; Sargent, 1993; Changeux & Edelstein, 2001). Of these nAChR subunits, five (alpha3, alpha5, alpha7, beta2 and beta4) are known to exist in peripheral autonomic neurons (Klimaschewski et al. 1994; Poth et al. 1997; Zhou et al. 1998; Devay et al. 1999; Erkman et al. 2000).

alpha5 subunits appear to have unique properties in their sequences and their combinations with other subunits. Like all alpha subunits, the alpha5 subunit contains a cysteine pair at positions 192-193 (Couturier et al. 1990; Wada et al. 1990; Chini et al. 1992), but it lacks the nearby tyrosine residue (Abramson et al. 1989; Cohen et al. 1991) which has been implicated in high affinity binding of agonists and competitive antagonists (Abramson et al. 1989; Cohen et al. 1991; Tomaselli et al. 1991). In vitro studies have revealed unique biophysical and pharmacological properties of alpha5 subunits, such as increase of desensitization of nAChRs and Ca2+ permeability (Ramirez-Latorre et al. 1996; Gerzanich et al. 1998) as well as altered affinities and sensitivities to nicotinic antagonists (Yu & Role, 1998), supporting the importance of alpha5 subunits in ANS function. Studies in heterologous expression systems strongly suggest that alpha5 subunits can form functional combinations with other alpha and beta subunits (Ramirez-Latorre et al. 1996; Wang et al. 1996). These subunits have been found in chicken embryonic sympathetic neurons (Yu & Role, 1998), chicken ciliary ganglia (Vernallis et al. 1993; Conroy & Berg, 1995) and the human peripheral neuroblastoma cell line SH-SY5Y (which resembles fetal sympathetic neurons in culture) (Wang et al. 1996). The subunit composition alpha3alpha5beta2, alpha3alpha5beta4 or alpha3alpha5beta2beta4, respectively, suggests that alpha5 subunits may be a component of ganglionic receptors in both human and animal ANS ganglia. Several studies have examined the differences between receptors containing an assemblance of different subunits (Ramirez-Latorre et al. 1996; Wang et al. 1996; Gerzanich et al. 1998; Yu & Role, 1998). However, most of these studies were of isolated receptors such as those expressed in Xenopus oocytes. While of importance, the relevance of such biophysical studies to the function of the ANS as a whole is only beginning to be explored. In order to investigate these physiological and pharmacological functions of native alpha5 subunits in the ANS, we report a series of autonomic tests in mice lacking nAChR subunit alpha5.

  METHODS
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Abstract
Introduction
Methods
Results
Discussion
References

Congenic mice lacking alpha5 subunits (alpha5-/-) and their wild-type littermate control mice were used for these experiments (Orr-Urtreger et al. 2000). Mice were back-crossed eight generations onto C57Bl/6J background. The mice were housed in group cages, with food and water freely available, in thermostable rooms (21 °C). A light-dark schedule of 12:12 h was maintained. The animals used in this study were cared for in accordance with the NIH Guide for the Care and Use of Laboratory Animals (Clark, 1996) and the experiments were carried out with local ethical committee approval. At the end of experiments the animals were killed by injection (I.P.) of an overdose of pentobarbital. The experiments were performed with the experimenter blind to the mouse genotype and the mice were re-genotyped after the animals were killed. Mice lacking alpha5 nAChRs grew to normal size without showing any obvious physical, neurological or autonomic deficits. No differences of body weight were found between alpha5-/- and wild-type mice.

Thermoregulation

The mice were kept in individual cages, moving freely. To investigate thermoregulation in alpha5-/- mice, rectal temperature was measured in an ambient temperature of 21 °C and during exposure to an acute cold stress, using a rectal probe (Yokogawa MF-28) inserted to a depth of 1.5 cm. Rectal temperature was measured three times, and the highest temperature was recorded as baseline. The baseline rectal temperature was measured at 14.00 h for 5 days in 21 °C. During cold stress (6 °C), the rectal temperature was measured at half-hour intervals for 4.5 hours. The mice were then immediately returned to the animal facility, where the rectal temperature continued to be measured until their recovery.

Changes of body temperature were also measured for 210 min after injection of 30 mg kg-1 morphine (Adler et al. 1988), in an attempt to cause central, rather than environmental, hypothermia.

Pupil size changes

Injection of morphine induces mydriasis in small animals, such as mice and rats. The effect is primarily due to disruption of parasympathetic innervation of the iris (Murray et al. 1983; Klemfuss & Adler, 1986). Pupillary diameters were measured using an Olympus binocular microscope with a magnification of times 20. One of the oculars was fitted with a divided 0.1 mm ruler. All the measurements were made while the animals were non-sedated and held gently under the microscope in an ambient temperature of 21 °C. Total handling time was less than 5 s. Both pupils of each animal were always measured, and the average value was recorded. (-)-Morphine hydrochloride was injected subcutaneously at a dose of 30 mg kg-1 to groups of mice (Korczyn et al. 1979; Korczyn & Maor, 1982). Pupillary diameter was measured prior to, as well as 15, 30, 60, 90, 120, 150 and 180 min after drug administration.

Regulation of heart rate

Under pentobarbital (30 mg kg-1, I.P.) anaesthesia, the right cervical vagus was exposed and placed on silver electrodes, connected with a stimulator (Grass SD9). The heart rate (HR) was measured on a polygraph (Grass model 7P6B) with paper speed of 30 mm s-1. For nerve stimulation, voltage was set at 2 V and trains of square wave pulses were delivered (duration, 0.2 ms). The stimulation frequency was gradually increased (5, 10, 20, 40, 60, 100 and 160 pulses s-1). Each train was given for 10 s with 2-5 min intervals. HR was recorded prior to (HRr), as well as during the period of vagal stimulation (HRvs) and immediately after, and 30, 60, 90 and 120 s after each vagal stimulation subsequently until recovery. The effect of vagal stimulation on heart rate was defined as (HRvs - HRr) times 100/HRr. To keep the depth of anaesthesia, additional doses of pentobarbital (10 mg kg-1) were administered at intervals of about 1 h.

To observe the effects of ganglionic blockade on vagal stimulation, hexamethonium (Sigma, St Louis, MO, USA) was injected intraperitoneally at 3, 15 and 30 mg kg-1 to groups of mice. HRr was measured 10 min after injection of each concentration of hexamethonium, repeating the vagal stimulations and measurement of HRvs as detailed above.

In separate experiments, HR was measured during exposure to cold stress of 6 °C at 30 min intervals for 270 min.

Ileal contractile responses to nicotinic agonists

Preparation of ilea. Mice were killed by cervical dislocation. The abdomen was opened and the ileum carefully removed immediately and kept in Krebs solution with bubbling oxygen containing 5 % CO2. Distal segments (2-2.5 cm long) of ileum from the same animal were cleaned from adhering tissue and used freshly. Preparations were suspended with silk thread number 3 and attached to an isometric force transducer FTO3C, which was connected to a Grass polygraph (model 7B). The response amplitude was calibrated so that each gram of tension equalled 3 cm in amplitude. Before drug administration the ileum segments were allowed to equilibrate for at least 1 h at resting tension of 1 g in a 10 ml organ bath filled with Krebs solution, kept at 37 °C and constantly aerated with bubbling oxygen containing 5 % CO2 with replacement of the Krebs solution every 20 min.

The optimal concentrations to elicit contractile responses were determined in preliminary experiments. The non-specific muscarinic agonist, bethanechol and the nicotinic agonists cytisine, dimethylphenylpiperazinium iodide (DMPP) and nicotine itself were used at concentrations of 0.1, 1, 3, 10, 30 and 100 µM. The nicotinic agonist epibatidine was applied at concentrations of 0.01, 0.1, 0.3, 1, 3 and 10 µM (all drugs were Sigma products). Log concentration-response curves were drawn for wild-type mice. For each drug, experiments were performed on ilea of six mice. The results showed that consistent concentration-response curves were elicited for these drugs. Maximal responses were induced by bethanechol, cytisine, DMPP and nicotine at concentrations of 10-30 µM and by epibatidine at concentrations of 0.1-0.3 µM. The response to the four nicotinic agonists was independent of the order of administration. For subsequent studies, each agonist was used at a single concentration (cytisine 10 µM, DMPP 10 µM, nicotine 10 µM and epibatidine 0.1 µM), repeated three times in the same preparation. These concentrations evoked efficient and consistent responses and no tachyphylaxis was observed.

Injection protocol

To characterize the contractile responses to different nicotinic agonists, bethanechol was used as a reference agent, applied in progressively increasing concentrations to give a final concentration of 1-10 µM. The agonists were injected as follows: bethanechol (1, 3 and 10 µM), cytisine (10 µM), DMPP (10 µM), epibatidine (0.1 µM) and nicotine (10 µM) at 40 min intervals with four washouts following each administration of drug. At the end of the test bethanechol 3 µM was applied to ensure the preparations were still viable.

Data analysis

The contractile responses to ganglionic agonists were calculated as a percentage of the response to 10 µM bethanechol in the same preparation. The data from the four preparations from the same mouse were averaged. Bonferroni multiple comparison tests were used for comparing the responses of alpha5-/- mice and their wild-type controls.

  RESULTS
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Abstract
Introduction
Methods
Results
Discussion
References

Physiological normality of alpha5-/- mice

All the alpha5-/- mice grew to normal size showing no obvious physical, neurological or autonomic deficit.

Rectal temperatures. The rectal temperatures of the alpha5-/- (n = 13) and wild-type mice (n = 27) in ambient temperature of 21 °C were similar (mean 38.5 ± 0.2 and 38.4 ± 0.3 °C, respectively). During exposure to cold stress, the rectal temperature of the mutant and wild-type mice decreased gradually to 26.7 ± 4.3 and 28.6 ± 5.4 °C, respectively (P > 0.05, unpaired t test) after 270 min, with similar recovery after being returned to 21 °C ambient temperature (data not shown).

After injection of 30 mg kg-1 morphine, hypothermia developed within 30 min, reaching a nadir of 34.3 ± 0.9 and 34.4 ± 0.8 °C in alpha5-/- (n = 7) and wild-type mice (n = 16), respectively. The rectal temperature recovered to baseline at 240 min after injection of the drug. There was no difference between the two groups of mice.

Pupillary size. All the mice showed normal pupillary size. The mean pupil diameters were 0.51 ± 0.16 and 0.52 ± 0.12 mm in alpha5-/- mice (n = 15) and in wild-type mice (n = 25), respectively. Administration of (-)-morphine hydrochloride (30 mg kg-1) caused a mydriatic effect. The maximal pupillary sizes were 1.81 ± 0.94 and 1.80 ± 0.37 mm in alpha5-/- (n = 11) and wild-type (n = 14) mice, respectively. Thus, deficiency of alpha5 subunits did not change the effects of morphine on parasympathetic ganglionic transmission.

Heart rate. The heart rates of mice were similar and not significantly different between the alpha5-/- (n = 14) and wild-type (n = 23) mice at rest, during exposure to cold stress or when anaesthetized (Fig. 1). In awake mice the resting heart rates (HRr) were 470 ± 61 and 421 ± 82 beats min-1, respectively. Exposure to cold stress induced extreme tachycardia in both strains of mice. Figure 1 illustrates the HR 30 min after exposure to 6 °C in alpha5-/- (n = 8) and wild-type (n = 7) mice, which were not significantly different (680 ± 52 and 706 ± 32 beats min-1, respectively, but significantly higher than that at rest, P < 0.001, t test). The HR under pentobarbital anaesthesia was also similar in alpha5-/- (n = 7) and wild-type (n = 6) mice, 401 ± 94 and 370 ± 43 beats min-1, respectively, although interestingly in both awake and anaesthetized states the alpha5-/- mice had a slightly higher HR.

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Figure 1. Heart rate of alpha5-/- and wild-type mice

HRr, the heart rate (beats min-1, bpm) in awake (alpha5-/-, n = 14 and wild-type, n = 23) mice at rest (column 1); HRc, the heart rate 30 min after exposure to cold stress (column 2) in alpha5-/- (n = 8) and wild-type (n = 7) mice; HRa, resting heart rate of alpha5-/- (n = 7) and wild-type (n = 6) mice under anaesthesia (column 3). There was no significant difference in heart rate between mutant and control mice. * P < 0.001, t test (HRc vs. HRr). Vertical bars indicate S.E.M.

Vagal stimulation

Vagal stimulation caused a frequency-dependent bradycardia and finally asystole in both mutant and wild-type mice (Fig. 2A). In alpha5-/- mice at 5 and 10 pulses s-1 stimulation the HR was about 16 and 39 % lower than at baseline, respectively, while in the wild-type mice the HR was 15 and 33 % lower than their baseline, respectively (Fig. 2A). Stimulation at 60 pulses s-1 caused asystole in all six control mice, while only in three out of seven alpha5-/- mice (chi2 = 4.95, P < 0.05). The remaining four alpha5-/- mice did not develop asystole even after maximal stimulation (160 pulses s-1/5 V), but their HRvs was 70 % lower than their baseline (HRvs = 123 ± 34 beats min-1).

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Figure 2. Effects of vagal stimulation on heart rate and its blockade by hexamethonium in alpha5-/- (n = 7) and wild-type (n = 6) mice

The effects of vagal stimulation on heart rate (HR) are presented as (HRvs - HRr) times 100/HRr. HRvs, HR following vagal stimulation. HRr, resting HR before each vagal stimulation. pps, pulses s-1. Each vagal stimulation was given for 10 s at 5 min intervals (2 V, 0.2 ms duration). A, baseline of effects of vagal stimulation on HR. B, blockade by 3 mg kg-1 of hexamethonium. C, blockade by 15 mg kg-1 of hexamethonium. D, blockade by 30 mg kg-1 of hexamethonium. * P < 0.01, t test, alpha5-/- vs. control mice. The vertical bars indicate S.E.M.

Different concentrations of hexamethonium failed to alter the HR at rest in both mutant and control mice. However, the response to vagal stimulation showed striking differences between the two strains. While 30 mg kg-1 of hexamethonium completely blocked (Fig. 2D) the HR responses in both alpha5-/- and wild-type mice, lower concentrations showed a differential sensitivity of alpha5-/- mice to hexamethonium. For example, while 3 mg kg-1 produced only a slight depression of the vagal response in wild-type mice, a nearly complete abolition of the response to vagal stimulation occurred in alpha5-/- mice (Fig. 2B). Asystole was completely eliminated by all concentrations of hexamethonium in both mutant and control mice, except for three out of six control mice at 3 mg kg-1 hexamethonium (chi2 = 0.18).

Contractile responses of ileum to ganglionic agonists

Preliminary experiments revealed that the doses at a final concentration of 10 µM for cytisine, DMPP and nicotine and 0.1 µM for epibatidine induced efficient submaximal ileal contractions. There was no tachyphylaxis in either alpha5-/- or wild-type mice.

Bethanechol induced a dose-dependent contractile response in ilea. There was no difference in the mean magnitude of contraction between mutant (n = 6) and wild-type (n = 20) mice ilea in different concentrations (P > 0.05, t test, Table 1). A single application giving a final concentration of 3 µM bethanechol was repeated after administration of all nicotinic agonists, with similar responses to that induced by the same dose at the beginning of the experiments, ensuring that the ilea were still viable.

tab1

The agonist-induced responses of the ileum in alpha5-/- and wild-type mice are illustrated in Fig. 3. A significantly higher response was observed to cytisine and epibatidine in alpha5-/- mice that were 11 % (P < 0.01, t test) and 10 % (P < 0.05, Bonferroni multiple comparison tests) higher than that in wild-type mice. The responses to DMPP and nicotine were similar in alpha5-/- mice and wild-type mice (Fig. 3).

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Figure 3. Ileal contractile responses to nicotinic agonists in alpha5-/- (n = 6) and wild-type (n = 20) mice

Ileal contractile responses are represented as a percentage of response to bethanechol at a concentration of 10 µM. The nicotinic agonists were used at concentrations of 10 µM for cytisine, dimethylphenylpiperazinium iodide (DMPP) and nicotine and 0.1 µM for epibatidine. * P < 0.05, ** P < 0.01, Bonferroni multiple comparison tests, in alpha5-/- mice compared to littermate wild-type animals. Vertical bars indicate S.E.M.

  DISCUSSION
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Abstract
Introduction
Methods
Results
Discussion
References

In this study, we investigated the functional role and pharmacological properties of alpha5 nAChR subunits using mice genetically lacking these subunits. Results of studies using knockout animals should be interpreted cautiously. The alpha5 subunit is not indispensable, as is evidenced by the apparent normal development of the mutated mice. Obviously, other subunits can form functional receptor compositions that will replace the normally existing, alpha5-containing, nicotinic receptors in the ANS and elsewhere. Thus an intact response or behaviour in alpha5 knockout animals cannot be taken to imply that alpha5 subunits are not normally involved in these functions. On the other hand, any abnormal response or behaviour seen in these knockout animals suggests that alpha5 subunits are normally involved in this function. The data obtained from our study show not only normal growth and development, but also normality of alpha5-/- mice in body thermoregulation, pupil size and heart rate under physiological conditions. Based on these results, we suggest that although alpha5 nAChR subunits are normally present in the ANS (Poth et al. 1997; Yu & Role, 1998), nicotinic receptors containing alpha5 subunits are not essential for the transmission the autonomic nervous signals for these functions. Nevertheless, alpha5-/- mice were not normal. Cardiac parasympathetic ganglionic transmission induced by direct cervical vagal stimulation was less effective in knockout animals. This probably implies that the ACh released from vagal terminals is less effective at stimulating the intracardiac parasympathetic postsynaptic nicotinic receptors, although this is only expressed when the stimulation is almost maximal. Strikingly, the deficiency of alpha5 subunits increased the sensitivity to a low concentration of hexamethonium leading to a nearly complete elimination of HR response to vagal stimulation (Fig. 2). Such a concentration of hexamethonium only slightly depressed the effects in control mice. This observation is also consistent with a reduced effect of ACh, which is only expressed when a substantial proportion of nicotinic receptors are blocked by hexamethonium. On the other hand, deficiency of alpha5 subunits significantly increased ileal contractile responses to cytisine and epibatidine.

In principle, elimination of one subunit can change the ganglionic function in several ways. Firstly, it is possible that since receptors with this type of subunit will not be formed, the total number of receptors will be reduced, possibly resulting in diminished response to ACh. However, we do not necessarily know what is the concentration of the ACh receptors in the specific system, and whether there are enough remaining receptors to prevent this presumed effect. It may also be that the remaining receptors, without the knocked-out subunit, are composed of subunits which are more effective than the lost ones. Alternatively it may be that the system will compensate for the lack of the subunit and synthesize the normal (or even higher) number of receptors consisting of other constructs, which again may respond differently to ACh than the deleted ones, theoretically even enhancing the response to ACh. In addition we may expect to see differences in the effects of cholinomimetic drugs and of antagonists, since these may need specific subunits for ligation.

The physiological relevance of alpha5 receptor subunits depends either on their abundance, as well as on their association with other nAChR subunit constructs. In heterogeneous expression system, alpha5 subunits cannot form functional channels when they are expressed alone or in combination with any other single alpha or beta subunit (Conroy et al. 1992; Ramirez-Latorre et al. 1996; Wang et al. 1996). The functional compositions can be with another kind of alpha subunit and one (or two) kinds of beta subunits, such as alpha3alpha5beta2, alpha3alpha5beta4 or alpha3alpha5beta2beta4. (Ramirez-Latorre et al. 1996; Wang et al. 1996; Fucile et al. 1997; Nelson & Lindstrom, 1999). In the ANS, studies showed varied abundance of alpha5 subunit distribution and subunit composition in different tissues. For example, rat intracardiac ganglia cultured parasympathetic neurons express alpha5 subunit mRNA in about 30 % of detected neurons (co-expressed in 30 % of detected neurons with alpha3 (100 %) and beta2 (55 %) or beta4 (55 %) subunits (Poth et al. 1997), but in all the neurons in rat cervical sympathetic ganglia (Skok et al. 1999). In chick ciliary ganglion neurons, which normally express alpha3, alpha5, beta2 and beta4 subunits, alpha5 subunits were present in about 80 % of neurons (Conroy & Berg, 1995). Although they do not form ACh binding sites, alpha5 subunits participate in the formation of ion channels (Wang et al. 1996; Nelson & Lindstrom, 1999; Groot-Kormelink et al. 2001). Previous studies have shown that alpha5 subunits altered channel properties when co-expressed with alpha3-containing receptors, such as alpha3beta2 and alpha3beta4 receptors in different degrees in an expression system, for example, they increase desensitization and Ca2+ permeability of nAChR (Wang et al. 1996; Gerzanich et al. 1998; Yu & Role, 1998). The alpha3alpha5beta4 nAChRs have a higher conductance, longer open time and an increased burst duration in comparison to channels composed of only alpha3beta4 subunits (Wang et al. 1996; Nelson & Lindstrom, 1999). These results suggest the physiological importance of alpha5 subunits in the ANS. Thus, deficiency of alpha5 subunits can be presumed to influence autonomic ganglionic transmission to end-organs. However, in the present study, most autonomic physiological functions, for example in cardiac regulation, did not differ between alpha5-/- and wild-type mice. Similar results in HR at rest have also been seen in several reported results relating to HR regulation, such as in mice overexpressing beta1-adrenergic receptor kinase 1 inhibitor (Koch et al. 1995), G-protein-coupled receptor kinase (Rockman et al. 1996) and in knockout mice lacking beta1-adrenergic receptors (Rohrer et al. 1996) and cardiac G-protein-potassium channel subunit GIRK4 (Wickman et al. 1998). Thus, HR is determined by several regulation factors. The normality of HR in alpha5-/- mice suggests at least two mechanistic possibilities on ganglion transmission to the heart. First, it has been evident that alpha5 subunits can be functional when combined with other alpha and beta subunits, for example, alpha3beta2 and alpha3beta4 (Ramirez-Latorre et al. 1996; Wang et al. 1996), which are important components in autonomic transmission (Xu et al. 1999a,b). Receptors of alpha3beta2 or alpha3beta4 composition are functional with or without alpha5 subunits and they could allow normal physiological function in vivo. Based on this prerequisite, the second possibility is that cardiac nAChRs or their signal transduction may have adapted during development in the alpha5-/- mice, probably by replacing alpha5 with other nAChR subunits, e.g. beta subunits (Wang et al. 1996; Nelson & Lindstrom, 1999) or that the total amount of missed receptors did not reach a critical level influencing ganglionic transmission under physiological conditions. However with excessive excitation (for example after high frequency vagal stimulation) 'resting receptors' in the repertoire (Margiotta & Gurantz, 1989) are called into play and remaining receptors cannot deliver the full effect of the released ACh. Our results show that differences between the alpha5-/- and wild-type controls were only minimal during the normal repertoire of behaviour examined, and differences were seen mainly when pharmacological manipulations were applied. This suggests that the alpha5-/- receptors respond differently when drugs with slightly altered affinity to the nicotinic receptors (whether agonists or antagonists) are used. This may suggest that genetic changes (even small polymorphisms) while consistent with normal development and function, may underlie abnormal responses to drugs. Although so far we are unable to determine the exact composition of nAChRs in mice lacking alpha5 subunits, the results suggest that the participation of alpha5 subunits in formation of ion channels, probably affects ganglion transmissions.

Our results showed supersensitive responses to hexamethonium in blockade of ACh transmission to heart induced by direct vagal stimulation (Fig. 2) and increased ileal contractile responses to nicotinomimetic drugs, cytisine and epibatidine, but not to nicotine itself or DMPP (Fig. 3) in mice lacking alpha5 subunits. Studies in native receptors and in heterologously expressed alpha5-containing receptors, showed functional deletion of the alpha5 subunits by antisense oligonucleotide treatment in embryonic chick sympathetic neurons increased 4-fold the apparent affinities for cytisine, as well as for ACh and nicotine. The whole cell currents elicited by ACh are 25 % larger in alpha5 subunit deleted neurons than that in controls (McGehee & Role, 1995; Yu & Role, 1998). The inclusion of alpha5 subunits altered the affinities and sensitivities to nicotinic agonists by different degrees in alpha3-containing nAChRs expressed in heterologous expression systems and showed that these effects are beta subunit composition related (Wang et al. 1996; Gerzanich et al. 1998; Yu & Role, 1998; Nelson & Lindstrom, 1999). For example, incorporating alpha5 subunits in recombinant human alpha3beta2 receptors expressed in Xenopus oocytes, increased the sensitivity for ACh and nicotine, but the EC50 for cytisine did not change and for DMPP it was reduced. While the sensitivity to ACh, nicotine and DMPP were similar between alpha3alpha5beta4 and alpha3beta4 receptors, the incorporation of alpha5 subunits into alpha3beta4 receptors increased the sensitivity to cytisine (Wang et al. 1996; Gerzanich et al. 1998). The efficacies of the drugs were also changed: nicotine switching from a partial agonist in alpha3beta2 receptors to full agonist in alpha3alpha5beta2 receptors, and DMPP increasing in efficacy compared with ACh (Wang et al. 1996; Gerzanich et al. 1998; Nelson & Lindstrom, 1999). The different influence of alpha5 in alpha3-containing receptors to agonists may be based on profiles of alpha3 and beta composition themselves. In vitro studies show the differences between beta2 and beta4 subunits on the affinity of agonists, such as epibatidine and DMPP on beta2-containing receptors, while cytisine is thought effective in beta4-containing receptors (Covernton et al. 1994; Parker et al. 1998). Also beta2-containing receptors have higher affinity and sensitivity to nicotine and ACh than beta4-containing receptors; nicotine is a partial agonist in beta4-containing receptors (Luetje & Patrick, 1991; Papke & Heinemann, 1991; Patrick et al. 1993; Covernton et al. 1994; Sivilotti et al. 1997). Hexamethonium is a non-selective ganglionic blocker; it blocks all alpha3beta2 and alpha3beta4 receptors with or without alpha5 subunits (Nelson & Lindstrom, 1999), although according to our results of increased sensitivity to hexamethonium blockade of vagal stimulation and the increased ileal contractile responses to cytisine and epibatidine in alpha5-/- mice, it seems that the pharmacological changes are not due to loss of ACh binding sites, but appear because the alpha5 subunits seem to regulate agonist and antagonist ligand-binding to the nicotinic receptors and may modulate the interactions between other alpha and beta subunits in vivo. These effects of alpha5 subunits altering pharmacological and physiological properties may be due to their structural participation in functional receptor complexes and due to the contributions of alpha5 subunit M2 segment to the lining of the ion channels (Ramirez-Latorre et al. 1996). Although they are not directly involved in the agonist binding sites, alpha5 subunits may be responsible for the changes in overall structure of the AChRs, which influence the ability of the AChRs to make the concerted changes in subunit orientation needed for channel opening (Ramirez-Latorre et al. 1996; Wang et al. 1996; Gerzanich et al. 1998), resulting in alteration of the EC50 or efficacy of some drugs to the receptors.

To date, the pharmacological data obtained from studies in vitro are poorly matched to in vivo results (Sivilotti et al. 1997; Nelson & Lindstrom, 1999). Furthermore, compensatory effects might occur during animal development (Yu & Role, 1998). Although previous studies have shown distinct differences in pharmacological properties between alpha3beta2 and alpha3beta4 receptors in vitro (for example, higher efficiency of cytisine on beta4-containing receptors and of nicotine, epibatidine and DMPP on beta2-containing receptors), we are unable to fully explain the increased ileal responses to cytisine and epibatidine, but not to nicotine and DMPP in alpha5-/- mice. In similar experiments with the same agonists, ileal contractions were greatly reduced to all four agonists in beta4 knockout mice (Wang et al. 2001), while there was no significant reduction in responses to the four agonists in beta2 knockout mice (authors' unpublished data). These data suggest that the effects of alpha5 subunits are not drug selective in native receptors.

In summary, alpha5 nAChR subunits are normally present in ANS ganglia and possess unique physiological and pharmacological properties, probably modulating postsynaptic nAChR channels responses to endogenous ACh and regulating responses to ganglion drugs in receptor complexes. Since the autonomic ganglia operate without direct inhibition (Skok, 1983), such effects of alpha5 subunits may lower the safety factor in transmission systems.

  REFERENCES
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Abstract
Introduction
Methods
Results
Discussion
References

ABRAMSON, S. N., LI, Y., CULVER, P. & TAYLOR, P. (1989). An analog of lophotoxin reacts covalently with Tyr190 in the alpha-subunit of the nicotinic acetylcholine receptor. Journal of Biological Chemistry 264, 12666-12672 [Abstract]
ADLER, M. W., GELLER, E. B., ROSOW, C. E. & COCHIN, J. (1988). The opioid system and temperature regulation. Annual Review of Pharmacology and Toxicology 28, 429-449 [Medline]
ANAND, R., CONROY, W. G., SCHOEPFER, R., WHITING, P. & LINDSTROM, J. (1991). Neuronal nicotinic acetylcholine receptors expressed in Xenopus oocytes have a pentameric quaternary structure. Journal of Biological Chemistry 266, 11192-11198 [Abstract]
CHANGEUX, J. & EDELSTEIN, S. J. (2001). Allosteric mechanisms in normal and pathological nicotinic acetylcholine receptors. Current Opinion in Neurobiology 11, 369-377 [Medline]
CHINI, B., CLEMENTI, F., HUKOVIC, N. & SHER, E. (1992). Neuronal-type alpha-bungarotoxin receptors and the alpha 5-nicotinic receptor subunit gene are expressed in neuronal and nonneuronal human cell lines. Proceedings of the National Academy of Sciences of the USA 89, 1572-1576 [Abstract]
CLARK, D. (1996). Guide for the Care and Use of Laboratory Animals. National Academy Press, Washington, DC
COHEN, J. B., SHARP, S. D. & LIU, W. S. (1991). Structure of the agonist-binding site of the nicotinic acetylcholine receptor. [3H]Acetylcholine mustard identifies residues in the cation-binding subsite. Journal of Biological Chemistry 266, 23354-23364 [Abstract]
CONROY, W. G. & BERG, D. K. (1995). Neurons can maintain multiple classes of nicotinic acetylcholine receptors distinguished by different subunit compositions. Journal of Biological Chemistry 270, 4424-4431 [Abstract/Full Text]
CONROY, W. G., VERNALLIS, A. B. & BERG, D. K. (1992). The alpha 5 gene product assembles with multiple acetylcholine receptor subunits to form distinctive receptor subtypes in brain. Neuron 9, 679-691 [Medline]
COOPER, E., COUTURIER, S. & BALLIVET, M. (1991). Pentameric structure and subunit stoichiometry of a neuronal nicotinic acetylcholine receptor. Nature 350, 235-238 [Medline]
COUTURIER, S., ERKMAN, L., VALERA, S., RUNGGER, D., BERTRAND, S., BOULTER, J., BALLIVET, M. & BERTRAND, D. (1990). Alpha 5, alpha 3, and non-alpha 3. Three clustered avian genes encoding neuronal nicotinic acetylcholine receptor-related subunits. Journal of Biological Chemistry 265, 17560-17567 [Abstract]
COVERNTON, P. J., KOJIMA, H., SIVILOTTI, L. G., GIBB, A. J. & COLQUHOUN, D. (1994). Comparison of neuronal nicotinic receptors in rat sympathetic neurones with subunit pairs expressed in Xenopus oocytes. Journal of Physiology 481, 27-34 [Abstract]
DEVAY, P., MCGEHEE, D. S., YU, C. R. & ROLE, L. W. (1999). Target-specific control of nicotinic receptor expression at developing interneuronal synapses in chick. Nature Neuroscience 2, 528-534 [Medline]
ERKMAN, L., MATTER, J., MATTER-SADZINSKI, L. & BALLIVET, M. (2000). Nicotinic acetylcholine receptor gene expression in developing chick autonomic ganglia. European Journal of Pharmacology 393, 97-104 [Medline]
FUCILE, S., BARABINO, B., PALMA, E., GRASSI, F., LIMATOLA, C., MILEO, A. M., ALEMA, S., BALLIVET, M. & EUSEBI, F. (1997). Alpha 5 subunit forms functional alpha 3 beta 4 alpha 5 nAChRs in transfected human cells. NeuroReport 8, 2433-2436 [Medline]
GERZANICH, V., WANG, F., KURYATOV, A. & LINDSTROM, J. (1998). Alpha 5 subunit alters desensitization, pharmacology, Ca++ permeability and Ca++ modulation of human neuronal alpha 3 nicotinic receptors. Journal of Pharmacology and Experimental Therapeutics 286, 311-320 [Abstract/Full Text]
GROOT-KORMELINK, P. J., BOORMAN, J. P. & SIVILOTTI, L. G. (2001). Formation of functional alpha3beta4alpha5 human neuronal nicotinic receptors in Xenopus oocytes: a reporter mutation approach. British Journal of Pharmacology 134, 789-796 [Abstract/Full Text]
KLEMFUSS, H. & ADLER, M. W. (1986). Autonomic mechanisms for morphine and amphetamine mydriasis in the rat. Journal of Pharmacology and Experimental Therapeutics 238, 788-793 [Abstract]
KLIMASCHEWSKI, L., REUSS, S., SPESSERT, R., LOBRON, C., WEVERS, A., HEYM, C., MAELICKE, A. & SCHRODER, H. (1994). Expression of nicotinic acetylcholine receptors in the rat superior cervical ganglion on mRNA and protein level. Brain Research. Molecular Brain Research 27, 167-173 [Medline]
KOCH, W. J., ROCKMAN, H. A., SAMAMA, P., HAMILTON, R. A., BOND, R. A., MILANO, C. A. & LEFKOWITZ, R. J. (1995). Cardiac function in mice overexpressing the beta-adrenergic receptor kinase or a beta ARK inhibitor. Science 268, 1350-1353
KORCZYN, A. D., BOYMAN, R. & SHIFTER, L. (1979). Morphine mydriasis in mice. Life Sciences 24, 1667-1673 [Medline]
KORCZYN, A. D. & MAOR, D. (1982). Central and peripheral components of morphine mydriasis in mice. Pharmacology, Biochemistry and Behavior 17, 897-899
LUETJE, C. W. & PATRICK, J. (1991). Both alpha- and beta-subunits contribute to the agonist sensitivity of neuronal nicotinic acetylcholine receptors. Journal of Neuroscience 11, 837-845 [Abstract]
MARGIOTTA, J. F. & GURANTZ, D. (1989). Changes in the number, function, and regulation of nicotinic acetylcholine receptors during neuronal development. Developmental Biology 135, 326-339 [Medline]
MCGEHEE, D. S. & ROLE, L. W. (1995). Physiological diversity of nicotinic acetylcholine receptors expressed by vertebrate neurons. Annual Review of Physiology 57, 521-546 [Medline]
MURRAY, R. B., ADLER, M. W. & KORCZYN, A. D. (1983). The pupillary effects of opioids. Life Sciences 33, 495-509
NELSON, M. E. & LINDSTROM, J. (1999). Single channel properties of human alpha3 AChRs: impact of beta2, beta4 and alpha5 subunits. Journal of Physiology 516, 657-678 [Abstract/Full Text]
ORR-URTREGER, A., KEDMI, M., KARMELI, F., YARON, Y. & RACHMILEWITZ, D. (2000). The severity of experimental colitis in mice is dependent on the presence of the alpha5 neuronal nicotinic acetylcholine receptor (nAChR). subunit. American Journal of Human Genetics 67, 184
PAPKE, R. L. & HEINEMANN, S. F. (1991). The role of the beta 4-subunit in determining the kinetic properties of rat neuronal nicotinic acetylcholine alpha 3-receptors. Journal of Physiology 440, 95-112 [Abstract]
PARKER, M. J., BECK, A. & LUETJE, C. W. (1998). Neuronal nicotinic receptor beta2 and beta4 subunits confer large differences in agonist binding affinity. Molecular Pharmacology 54, 1132-1139 [Abstract/Full Text]
PATRICK, J., SEQUELA, P., VERNINO, S., AMADOR, M., LUETJE, C. & DANI, J. A. (1993). Functional diversity of neuronal nicotinic acetylcholine receptors. Progress in Brain Research 98, 113-120 [Medline]
POTH, K., NUTTER, T. J., CUEVAS, J., PARKER, M. J., ADAMS, D. J. & LUETJE, C. W. (1997). Heterogeneity of nicotinic receptor class and subunit mRNA expression among individual parasympathetic neurons from rat intracardiac ganglia. Journal of Neuroscience 17, 586-596 [Abstract/Full Text]
RAMIREZ-LATORRE, J., YU, C. R., QU, X., PERIN, F., KARLIN, A. & ROLE, L. (1996). Functional contributions of alpha5 subunit to neuronal acetylcholine receptor channels. Nature 380, 347-351 [Medline]
ROCKMAN, H. A., CHOI, D. J., RAHMAN, N. U., AKHTER, S. A., LEFKOWITZ, R. J. & KOCH, W. J. (1996). Receptor-specific in vivo desensitization by the G protein-coupled receptor kinase-5 in transgenic mice. Proceedings of the National Academy of Sciences of the USA 93, 9954-9959 [Abstract]
ROHRER, D. K., DESAI, K. H., JASPER, J. R., STEVENS, M. E., REGULA, D. P. JR, BARSH, G. S., BERNSTEIN, D. & KOBILKA, B. K. (1996). Targeted disruption of the mouse beta1-adrenergic receptor gene: developmental and cardiovascular effects. Proceedings of the National Academy of Sciences of the USA 93, 7375-7380 [Abstract]
SARGENT, P. B. (1993). The diversity of neuronal nicotinic acetylcholine receptors. Annual Review of Neuroscience 16, 403-443 [Medline]
SIVILOTTI, L. G., MCNEIL, D. K., LEWIS, T. M., NASSAR, M. A., SCHOEPFER, R. & COLQUHOUN, D. (1997). Recombinant nicotinic receptors, expressed in Xenopus oocytes, do not resemble native rat sympathetic ganglion receptors in single-channel behaviour. Journal of Physiology 500, 123-138 [Abstract]
SKOK, M. V., VOITENKO, L. P., VOITENKO, S. V., LYKHMUS, E. Y., KALASHNIK, E. N., LITVIN, T. I., TZARTOS, S. J. & SKOK, V. I. (1999). Alpha subunit composition of nicotinic acetylcholine receptors in the rat autonomic ganglia neurons as determined with subunit-specific anti-alpha(181-192) peptide antibodies. Neuroscience 93, 1427-1436 [Medline]
SKOK, V. I. (1983). Fast synaptic transmission in autonomic ganglia. In Autonomic ganglia, ed. ELFVIN, L.-G., pp. 265-280. John Wiley & Sons Ltd, New York
TOMASELLI, G. F., MCLAUGHLIN, J. T., JURMAN, M. E., HAWROT, E. & YELLEN, G. (1991). Mutations affecting agonist sensitivity of the nicotinic acetylcholine receptor. Biophysical Journal 60, 721-727 [Abstract]
VERNALLIS, A. B., CONROY, W. G. & BERG, D. K. (1993). Neurons assemble acetylcholine receptors with as many as three kinds of subunits while maintaining subunit segregation among receptor subtypes. Neuron 10, 451-464 [Medline]
WADA, E., MCKINNON, D., HEINEMANN, S., PATRICK, J. & SWANSON, L. W. (1990). The distribution of mRNA encoded by a new member of the neuronal nicotinic acetylcholine receptor gene family (alpha 5). in the rat central nervous system. Brain Research 526, 45-53 [Medline]
WANG, F., GERZANICH, V., WELLS, G. B., ANAND, R., PENG, X., KEYSER, K. & LINDSTROM, J. (1996). Assembly of human neuronal nicotinic receptor alpha5 subunits with alpha3, beta2, and beta4 subunits. Journal of Biological Chemistry 271, 17656-17665 [Abstract/Full Text]
WANG, N., ORR-URTREGE, A., CHAPMAN, J., RABINOWITZ, R., NACHMAN, R. & KORCZYN, A. D. (2001). Nicotinic acetylcholine receptor subunits alpha5 and beta4 in ileal contractile response to ganglionic agonists. Annals of Neurology 50, S35-S36
WICKMAN, K., NEMEC, J., GENDLER, S. J. & CLAPHAM, D. E. (1998). Abnormal heart rate regulation in GIRK4 knockout mice. Neuron 20, 103-114 [Medline]
XU, W., GELBER, S., ORR-URTREGER, A., ARMSTRONG, D., LEWIS, R. A., OU, C. N., PATRICK, J., ROLE, L., DE BIASI, M. & BEAUDET, A. L. (1999a). Megacystis, mydriasis, and ion channel defect in mice lacking the alpha3 neuronal nicotinic acetylcholine receptor. Proceedings of the National Academy of Sciences of the USA 96, 5746-5751 [Abstract/Full Text]
XU, W., ORR-URTREGER, A., NIGRO, F., GELBER, S., SUTCLIFFE, C. B., ARMSTRONG, D., PATRICK, J. W., ROLE, L. W., BEAUDET, A. L. & DE BIASI, M. (1999b). Multiorgan autonomic dysfunction in mice lacking the beta2 and the beta4 subunits of neuronal nicotinic acetylcholine receptors. Journal of Neuroscience 19, 9298-9305 [Abstract/Full Text]
YU, C. R. & ROLE, L. W. (1998). Functional contribution of the alpha5 subunit to neuronal nicotinic channels expressed by chick sympathetic ganglion neurones. Journal of Physiology 509, 667-681 [Abstract/Full Text]
ZHOU, Y., DENERIS, E. & ZIGMOND, R. E. (1998). Differential regulation of levels of nicotinic receptor subunit transcripts in adult sympathetic neurons after axotomy. Journal of Neurobiology 34, 164-178 [Medline]

Acknowledgements

This work was supported by the Sieratzki Chair of Neurology, Tel Aviv University, and the Miriam Turjanski de Gold and Dr Roberto Gold Fund for Neurological Research and by a NARSAD award to A. Orr-Urtreger. This work is part of the PhD thesis submitted by N. Wang to Tel Aviv University.


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