Mechanisms of muscarinic modulation of protein phosphorylation in intact ventricles.

Muscarinic agonists inhibit cyclic AMP (cAMP)-induced phosphorylation of the cardiac protein phospholamban. The mechanism of this muscarinic inhibition of phosphorylation of phospholamban appears to occur at more than one level in the series of reactions comprising the adenylate cyclase, cAMP-dependent protein kinase system. Muscarinic agonists attenuate hormone and drug stimulation of cardiac adenylate cyclase. This results in reduced tissue levels of cAMP and diminished phosphorylation of cardiac proteins and consequent inhibition of biochemical and inotropic effects of drugs that act via cAMP. The mechanism of muscarinic inhibition of adenylate cyclase is only partially understood, but probably involves the inhibitory guanine nucleotide-binding regulatory protein. In addition to the inhibition of adenylate cyclase, muscarinic agonists appear to be able to inhibit the effects of cAMP. The mechanism for this second effect of muscarinic agonists is unknown.