The constitutive activity of the human muscarinic M3 receptor unmasks differences in the pharmacology of anticholinergics.

An activator protein 1-driven luciferase reporter assay was developed to monitor the activation of the human muscarinic M3 receptor (hM3-R) and evaluate functional potencies of different anticholinergics in Chinese hamster ovary cells. This assay proved to be superior to previously used functional assays [i.e., inositol phosphate accumulation (J Pharmacol Exp Ther 330:660-668, 2009)], thanks to the longer incubation times that allow reaching of pseudoequilibrium for ligands with slower dissociation kinetics, the long-acting muscarinic antagonists. Interestingly, within this system the hM3-R efficiently signaled in an agonist-independent manner. All the antagonists tested were able to inhibit the hM3-R constitutive activity in a concentration-dependent fashion, behaving as full inverse agonists. Curiously, significant differences in potency as antagonists (against carbachol) and inverse agonists were seen for some compounds (N-methyl scopolamine and tiotropium). Given the potential for inverse agonists to cause receptor up-regulation, the effect of chronic exposure to anticholinergics on the expression levels of hM3-R was also tested. Again, significant differences were seen, with some ligands (e.g., tiotropium) producing less than half of the receptor up-regulation caused by other anticholinergics. This study shows that anticholinergics can exhibit differential behaviors, which depend on the pathway investigated, and therefore provides evidence that the molecular mechanism of inverse agonism is likely to be more complex than the stabilization of a single inactive receptor conformation. In addition, differences in the potential of anticholinergics to induce hM3-R up-regulation might have clinical relevance, because many are on the market or in clinical trials as chronic treatment for chronic obstructive pulmonary disease, for example.