It has been demonstrated that the cholinergic system plays a role in the learning process
The vesicular transporter activity can be blocked by vesamicol, which is a non-competitive inhibitor
In this work, kinetic analyses revealed that a structural motif in AChE (a hydrophobic sequence of 35 resides peptides) was able to promote amyloid formation and its incorporation into the growing Aβ-fibrils
Interestingly, M1 receptor signaling affects several of AD major hallmarks, including cholinergic deficit, cognitive dysfunction, and tau and Aβ pathologies
However, further studies have demonstrated that nicotinic receptor activation can lead to an increase in Aβ-mediated tau phosphorylation
Stimulation of nicotinic receptors present at the CNS presynaptic neuronal membrane leads to an increase in presynaptic Ca2+ concentration, which may facilitate the release of a number of neurotransmitters, such as glutamate, GABA, dopamine, serotonin, norepinephrine, as well as ACh
Moreover,nicotinic receptors can also be regulated allosterically by Ca2+
The organophosphate compounds are irreversible AChE inhibitors that are used as insecticides and nerve gases
In a work that evaluated the function of the cholinergic system in mediating the response to stress it was found that treatment of rats with the antagonist of the nicotinic receptor, mecamylamine, attenuates the activation of the HPA axis in response to a stressor agent
Moreover, published data indicate that ACh is involved in memory
Further studies have demonstrated that endogenous acetylcholine is important for modulation of acquisition [17], encoding [18], consolidation [19], reconsolidation [20], extinction [21] and retrieval of memory
It has been demonstrated that the role of ACh in learning and memory seems to be related to the regulation of glutamatergic neurotransmission
Stress is another factor that can regulate ACh release in the forebrain and its function on the hypothalamic-pituitaryadrenal (HPA) system can modulate biological and emotional outcomes
Similarly, nicotine can mimic the ACh effects on the HPA axis by activating nicotinic receptors
ACh contributes to auditory synaptic transmission by facilitating thalamocortical communication
Recent evidences also suggest the involvement of ACh in adult neurogenesis
When cholinergic neurons are depolarized, ACh is exocytosed from synaptic vesicles and released into the synaptic cleft, where it can activate both muscarinic and nicotinic receptors
Choline that is released by ACh hydrolysis in the synaptic cleft is continuously reuptaken into the presynaptic cholinergic neuron by an active transport system (see Fig. 1)
Thus, ACh can influence the strength and fidelity of various synapses and modulate overall CNS neurotransmission
Because ACh has an important role in cognitive processes, the cholinergic system is pointed as an important factor in many forms of dementia, including AD
Thus, antidotes, including doxylamine, can be used to speed enzyme regeneration
The two best known muscarinic receptor antagonists are atropine and quinuclidinyl benzilate, which block all muscarinic receptors
CHT1 is mainly found in cholinergic neurons [92-94] and is responsible for supplying choline for the synthesis of ACh
It has been demonstrated that treatment with donepezil is associated with significant cognitive and functional benefits over the course of 12 months in patients with moderate to severe AD
In a double-blind study designed to assess patients survival with mild to moderately severe AD, the long-term treatment (2 years) with galantamine significantly reduced mortality and cognition decline, besides improving daily live activities in mild to moderate AD patients
In fact, memantine is able to reduce the excitotoxicity in AD
Rivastigmine has also been used for AD treatment due to its ease of use (transdermal patch) and good tolerability by patients
Moreover, AChE inhibitors that compete for the enzyme site, as succinylcholine, are used as anesthetic adjuvants since these drugs can promote neuromuscular blockage
Curare is the best known antagonist for nicotinic receptors, although this drug is not capable of blocking central nicotinic receptors
In a large-scale placebo-controlled clinical trial, it was demonstrated that xanomeline, a muscarinic agonist with reasonable selectivity for M1/M4 receptors, exhibits a positive effect in minimizing, in a dose-dependent manner, cognitive and psychiatric symptoms in AD, including memory deficit, mood disturbance, agitation and hallucinations
It has been demonstrated that cholinergic synapses are particularly affected by Aβ oligomers early neurotoxicity [218, 219] and that synaptic loss is the major correlate of cognitive impairment
Moreover, AF267B treatment leads to an increase in alpha secretase, which is an enzyme that can prevent the production of Aβ peptide
The loss of the nucleus basalis cholinergic neurons in AD patients is severe: from about 500,000 in the healthy adult to less than 100,000 in patients displaying advanced AD
Experimental data using non-human primates and rodents have demonstrated that injuries introduced to basal forebrain cholinergic neurons that innervate the cortex lead to attention deficit
All these cholinergic alterations that take place in AD closely correlates with impaired attention and memory observed in patients
The importance of the cholinergic neurons from the nucleus basalis of Meynert on memory is highlighted by the fact that the specific degeneration of these neurons takes place in Alzheimer’s disease (AD) and contributes to the memory loss exhibited by AD patients
It has been demonstrated that stimulation of cholinergic neurons in precise regions of the brainstem can promote REM (rapid eye movement) sleep, dose-dependently
ACh synthesis takes place in the cytoplasm of cholinergic neurons
Although cholinergic neurons can synthesize choline, the de novo synthesis contributes only with a very small fraction of the total choline that is needed for ACh synthesis (see Fig. 1)
Cholinergic neurons secrete AChE into the synaptic cleft, where the enzyme is normally associated with the plasma membrane (see Fig. 1)
It has been postulated that the loss of cholinergic neurons and the consequent impairment in dopaminergic transmission could be the main factors underling AD-related psychiatric symptoms
Further highlighting the importance of the cholinergic system in the CNS, cholinergic neuronal loss, especially in the basal forebrain, occurs not only in AD, but also in Parkinson’s disease [190, 191], Down syndrome [192], amyotrophic lateral sclerosis [193, 194], progressive supranuclear palsy [195, 196], and olivopontocerebellar atrophy [197]
Cholinesterase inhibitors can increase ACh levels in the synaptic cleft and partially ameliorate cognitive symptoms, enhance quality of life and diminish caregiver burden for patients with mild to severe AD
Furthermore, it has also been proposed that the nerve growth factor (NGF) has the potential to preserve cholinergic neurons
Moreover, previous studies have shown that treatment with NGF can counteract cholinergic atrophy and memory deficits in aged rats
It has been demonstrated that phosphorylation of nicotinic receptors by protein kinase A, protein kinase C, and tyrosine kinase can regulate receptor activity
Moreover, it has been shown that blocking CA3 cholinergic receptors impairs the encoding of information and memory
In the peripheral nervous system, activation of nicotinic receptors leads to rapid synaptic transmission
In the CNS, most of the nicotinic receptors are expressed at the presynaptic neuronal membrane and their main role is to regulate the release of neurotransmitters, whereas nicotinic receptors expressed in the peripheral nervous system are mainly post-synaptic
Moreover, the M1 agonist AF267B can rescue the cognitive impairment and decrease Aβ42 and tau abnormalities in the cortex and hippocampus of a mouse model of AD
For example, it has been shown that the benzyl quinolone carboxylic acid (BQCA), which is an M1-selective allosteric agonist, is effective in increasing spontaneous excitatory postsynaptic currents in the medial prefrontal cortex (mPFC) pyramidal cells and improving memory in a transgenic mouse model of AD
Moreover, the use of M2 antagonists, such as SCH-57790 and SC-72788, can lead to blockage of M2-mediated inhibition of presynaptic release of ACh, which can activate M1 and nicotinic receptors, ameliorating cognitive impairment in AD
Interestingly, it has been demonstrated that an increase in neuronal firing can lead to an increase in choline uptake and in the synthesis of ACh
It is possible that the presence of CHT1 in the membrane of synaptic vesicles and the consequent increase in CHT1 relocation to the plasma membrane following neuronal depolarization could explain why an increase in neuronal firing promotes increased choline reuptake and, thus, ACh synthesis
ChAT activity is regulated by neuronal depolarization, influx of Ca2+ and phosphorylation of the enzyme by a wide variety of protein kinases
The cholinergic system is involved in critical physiological processes, such as attention, learning, memory, stress response, wakefulness and sleep, and sensory information
Given its widespread distribution in the brain, it is not surprising that cholinergic neurotransmission is responsible for modulating important neural functions
On the other hand, the facilitation of the cholinergic transmission by using the cholinesterase inhibitors can improve attention in humans
Disruption of cholinergic inputs to the cortex can impair attention and the use of instructive cues needed for decision-making related to ongoing behavior
Another important function of the cholinergic system is to regulate the sleep cycle
Moreover, the interaction of the cholinergic and glutamatergic systems seems to be important not only for cognitive processes but also for neuroprotection, as it has been shown that nicotinic receptors agonists are neuroprotective in a mechanism that is Ca2+-dependent and that involves the glutamatergic system
In fact, the memory deficit and neuropathology severity observed in patients exhibiting AD highly correlate with changes in hippocampal synaptic transmission, especially with changes in synaptophysin expression, a presynaptic vesicle protein
Not only nicotine, but also DMPP (1,1-Dimethyl-4- phenylpiperazinium) and cystine can act as nicotinic receptor agonists
Agonists of nicotinic ACh receptors can improve, while antagonists for the receptor impair, performance in cognitive tasks
The first selective agonist identified for muscarinic receptors was muscarine and, so far, there is no agonist available with a specific selectivity for one particular subtype of muscarinic receptor
Muscarinic receptors are G protein coupled receptors that are capable of modulating a wide variety of ion channels
As a consequence, stimulation of ACh muscarinic receptors can promote the opening or closing of Ca2+, K+, or Cl- channels, which might facilitate either depolarization or hyperpolarization, depending on the cell type where these receptors are expressed
Activation of muscarinic receptors can block various types of K+ currents by inhibiting many resting and voltage-gated K+ channels
In addition to decreasing K+ currents, muscarinic receptors located at the presynaptic region can also inhibit GABAergic neurotransmission
Two choline transporters have been identified in neurons: a ubiquitous, low-affinity, sodium-independent transporter that can only be inhibited by high concentrations of hemicholinium-3 (HC-3) (Ki of about 50 μM), and a highaffinity, sodium-dependent, HC-3-sensitive (Ki of 10-100 nM) choline transporter (CHT1)
A molecular modeling study showed that AChE interacts with the Aβ peptide and promotes amyloid fibril formation
ACh present at the synaptic cleft is rapidly inactivated by the enzyme acetylcholinesterase (AChE), releasing choline and acetate
Furthermore, some evidences also suggest the involvement of AChE in the pathogenesis of AD
In fact, it has been shown that APP interacts with CHT1 proteins increasing their endocytosis from the cell surface [258] and that mice that display disruption of CHT1 gene expression exhibit symptoms related to ACh deficit
Stimulation of Gαq coupled muscarinic receptors leads to activation of phospholipase C and formation of inositol phosphates and other second messengers, which can promote closure of K+ channels, thus facilitating cell excitability
On the other hand, stimulation of Gαq coupled muscarinic receptors generates intracellular second messengers that can facilitate N-methyl-D-aspartate (NMDA) currents
It has been demonstrated that M1 muscarinic receptors coupling to G-proteins is impaired in the neocortex of AD patients and that the extent of M1/G-protein uncoupling is related to the severity of cognitive symptoms in AD
It has been shown that activation of M1 receptors decreases tau hyperphosphorylation via activation of PKC and inhibition of GSK-3β
Activation of Gαi coupled muscarinic receptors leads to inhibition of adenylyl cyclase and reduction of cyclic adenosine monophosphate (cAMP) levels, promoting inhibition of voltage-gated Ca2+ channels and, thus, diminishing cell excitability
In addition, activation of M2 receptors can cause an increase in Aβ production
Cholinergic nicotinic receptors expressed in muscle and ganglia are comprised of two α subunits plus each of the other three
Nicotinic receptors are formed by five different subunits: α, β, δ, and γ (fetal) or ε (adult)
Interestingly, PKC can phosphorylate VAChT and regulate its vesicular localization
The enzyme choline acetyltransferase (ChAT) can synthesize ACh from choline and acetyl-coenzyme A (acetyl-CoA)
Moreover, Huntington’s disease appears to be associated with decreased ChAT activity
Moreover, it has been demonstrated that ChAT transcription is severely diminished in the remaining cholinergic neurons, which leads to decreased ChAT activity and progression of dementia
On the other hand, neuronal nicotinic receptors are formed by the combination of only two types of subunits (α2-10 and β2-4)
Following that, the neurotransmitter is transported by the vesicular acetylcholine transporter (VAChT) from the cytosol into synaptic vesicles
Each molecule of ACh transported by VAChT is in exchange for two vesicular protons, which leads to the fulfill of synaptic vesicles with the neurotransmitter
In addition, quantitative autoradiography assay revealed that choline uptake was reduced in the hippocampus of these animals and that the expression of muscarinic and nicotinic cholinergic receptors was diminished
Corroborating this hypothesis, it has been demonstrated that dopamine efflux is increased in the nucleus accumbens of M4 knockout mice
A VAChT knockdown mouse model, expressing about 68% less VAChT protein, shows major neuromuscular deficits
Furthermore, cognitive impairment can take place even due to a mild decrease in VAChT protein expression (about 45%)
Moreover, mice that display a disruption of CHT1 gene expression exhibit symptoms related to ACh deficit and inevitable death within an hour of birth
Importantly, the neurons that form the nucleus basalis of Meynert undergo extensive degeneration in AD
In addition to cognitive alterations, psychiatric symptoms are frequently observed in AD patients, including apathy and depression
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If you find BEL Commons useful in your work, please consider citing: Hoyt, C. T., Domingo-Fernández, D., & Hofmann-Apitius, M. (2018). BEL Commons: an environment for exploration and analysis of networks encoded in Biological Expression Language. Database, 2018(3), 1–11.