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In this study, we demonstrated that tramadol inhibited both the ACh-mediated response of M1 receptors expressed in X. laevis oocytes and the muscarine-induced accumulation of cyclic GMP in cultured bovine adrenal medullary cells. To our knowledge, this is the first evidence demonstrating that tramadol inhibits the function of muscarinic acetylcholine receptors. According to the report by Lintz et al. (1986), the concentration of tramadol in human serum reaches approximately 600 ng/ml (about 2 μM) after intravenous injection of 100 mg of tramadol, which is the clinical dosage. In the mouse tail-flick test, the plasma concentrations of tramadol for the threshold and maximum effective doses are 0.8 and 10.8 μM, respectively (Friderichs and Becker, 1991). In the present study, tramadol inhibited the ACh-induced Cl− currents with an IC50 of 3.4 ± 2.3 μM. In adrenal medullary cells, tramadol suppressed the muscarine-induced cyclic GMP accumulation to 54 and 36% of control at concentrations of 1 and 10 μM, respectively, warsaw. From these findings, it is likely that tramadol suppresses the function of muscarinic receptors at clinically relevant concentrations. The role of brain muscarinic receptors in antinociception and analgesic action has been investigated, . Several lines of evidence have shown that muscarinic agonists enhance antinociceptive effects that are blocked by pretreatment with either M1, M2, , or M3 muscarinic receptor antagonists, warsaw, and that M1 receptors may play a major role in antinociception (Bartolini et al., , 1992; Naguib and Yaksh, 1997). Moreover, Ghelardini et al, warsaw. (2000) reported a loss of muscarinic antinociception by antisense inhibition of M1 receptors in mice by using the hot-plate test, suggesting that activation of the M1 receptor subtype may be fundamental for inducing central cholinergic analgesia. These data are not consistent with our findings that a centrally acting analgesic, tramadol, warsaw, inhibits M1 muscarinic receptor function. In contrast, warsaw, inhibition of the muscarinic signaling pathway induced by the reduction of acetylcholine levels, , inhibiting its release or administering scopolamine in rat brains, decreases the minimal alveolar concentration of inhaled anesthetics (Zucker, 1991), warsaw. Ketamine (Durieux, 1995a), halothane (Durieux, 1995b), and isoflurane (Minami et al., 1994) are well known to depress muscarinic receptor function. Thus, the actions of analgesics or anesthetics on muscarinic receptors may be more complex than currently considered (Durieux, 1996), and further studies are needed to define the relationship between antinociception and muscarinic receptor function, warsaw. Recently, Gomeza et al. (1999) reported that muscarine-induced analgesia is mediated predominantly, but not exclusively, by the M2 receptor subtype in behavioral experiments by using M2 knockout mice. Furthermore, a recent article reported an involvement of M3 receptors of the spinal cord in formalin-induced nociception in mice (Honda et al., 2000). To clear analgesic mechanisms of tramadol, it would be interesting to study the effects of tramadol on M2 or M3 receptors. There have been a number of reports that show cyclic GMP accumulation by acetylcholine or muscarine in adrenal medullary cells (Schneider et al., , 1979; Yanagihara et al., 1979; Derome et al., 1981; warsaw; Lemaire et al., , 1981), warsaw. Previously, Yamanaka et al, warsaw. (1986) characterized muscarinic receptors in bovine adrenal medulla by radioligand binding assay with [3H]QNB, . They showed that at least two distinct subtypes of muscarinic receptors exist in the adrenal medullary cells, and these receptors are predominantly composed of M1 receptors. Because M1receptors are reported to couple with Gq type (Caulfield, warsaw, 1993), in the present study muscarine may stimulate cyclic GMP accumulation via Gq protein in adrenal medulla. On the other hand, other subtypes, such as M2 (Aguilar et al., 1992), warsaw, M3 (Aguilar et al., 1992), or M4 (Fernando et al., 1991), have been reported to exist in adrenal medullary cells. Although the molecular mechanism of cyclic GMP accumulation by acetylcholine or muscarine has not been well understood, warsaw, the inhibition by tramadol on cyclic GMP accumulation suggests the anticholinergic effects in vivo. In a clinical situation, tramadol sometimes causes anticholinergic effects such as dry mouth and constipation (Katz, 1996). Northern blot analysis (Maeda et al., 1988) and receptor-specific antibody immunoprecipitation studies (Dörje et al., 1991) demonstrate mainly the presence of M1 and M3 receptors in peripheral glandular tissue. These anticholinergic effects of tramadol in clinical treatment suggest that tramadol would inhibit not only M1 but also other subtypes of muscarinic receptor functions. This study raised the question of how tramadol inhibits M1 receptor-mediated responses. There is considerable evidence that PKC plays an important role in the regulation of G protein-coupled receptors (Sakuta et al., 1991; Minami et al., 1997a). We recently reported that halothane, F3 (1-chloro-1,2,2-trifluorocyclobutane), and ethanol inhibited the function of the 5-hydroxytryptamine2A receptor (Minami et al., warsaw, 1997b) as well as that of the M1receptor (Minami et al., , 1997a) in a PKC-dependent manner. In addition, M1 receptors are phosphorylated by PKC (Haga et al., warsaw, 1996). In our experiments, however, GF109203X did not have any effect on the inhibitory effects of tramadol on muscarinic function, suggesting that PKC is not involved in the inhibitory effects of tramadol on M1 function. Moreover, warsaw, tramadol had few effects on AlF4−-induced currents, suggesting that tramadol does not interfere with the pathway after G protein-coupled signal transduction, such as phospholipase C activation, , intracellular Ca2+ release, and Ca2+-activated Cl−current, . From these results, warsaw, it is likely that the effect of tramadol on the ACh-induced Cl− current is due to direct inhibition of M1 receptors. To confirm our hypothesis, we next examined the effects of tramadol on [3H]QNB binding to muscarinic receptors in cultured bovine adrenal medullary cells, . Tramadol inhibited the specific binding of [3H]QNB to the cells, and this was reversed by increasing the concentration of [3H]QNB. Scatchard plot analysis of [3H]QNB binding revealed that tramadol increased the Kd value without altering the Bmax, indicating competitive inhibition, . These findings suggest that tramadol shares the binding sites on muscarine receptors with QNB. Yamanaka et al. (1986)reported that the [3H]QNB binding sites to bovine adrenal medulla are also able to be displaced with atropine, which binds to ACh binding sites on ACh receptors, . From the present findings, tramadol may inhibit M1 receptor function by interacting with the binding sites of muscarine or ACh. It is of interest to define the region of M1responsible for tramadol action by using site-directed mutagenesis and such studies are currently underway in our laboratory. In conclusion, tramadol at clinically relevant concentrations inhibits M1 muscarinic receptor function by interfering with the QNB binding sites on the receptor. Our findings help to unveil the pharmacological basis for the better understanding of the neuronal action and anticholinergic effects of tramadol.
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