Month: August 2023

Why are peripheral effects of AChE inhibitors predominantly parasympathomimetic?

Acetylcholinesterase (AChE) inhibitors will prevent the breakdown of acetylcholine (ACh) and so increase ACh levels. Increased ACh levels at autonomic nervous system ganglia should activate both the sympathetic and parasympathetic nervous systems. However, the adverse effects of AChE inhibitors outside of the CNS are mostly parasympathomimetic. Why do AChE inhibitors not stimulate the sympathetic nervous system as well?

Acetylcholinesterase (AChE) inhibitors increase the concentration of acetylcholine (ACh) at synapses by blocking its breakdown. This will activate both the sympathetic and parasympathetic systems, as the preganglionic neurons in both systems release ACh.

However, the impact of AChE inhibitors is more prominent on the parasympathetic nervous system for several reasons:
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When sympathetic and parasympathetic systems collide: The dominance of excitatory effects

When the autonomic nervous system ganglia are activated (for example, by low-dose nicotine), both the sympathetic and parasympathetic nervous system innervations of target organs and tissues are simultaneously stimulated. However, the “fright, fight or flight” sympathetic and “rest and digest” parasympathetic nervous systems have opposing effects in most target organs and tissues. So why do the sympathetic and parasympathetic nervous systems not just cancel each other out when activated at the same time?

It is true that in the realm of autonomic nervous system functioning, the sympathetic and parasympathetic systems often represent two sides of the same coin. These systems largely produce opposing effects on the same target organs and tissues. However, what happens when both systems are simultaneously activated? Contrary to intuitive thinking, they don’t simply cancel each other out. Instead, the dominion of activation or excitatory effects takes centre stage.

The Principle of Dominant Excitation: When both the sympathetic and parasympathetic systems are co-activated, it isn’t a zero-sum game. Rather than neutralizing each other, the excitatory effects from each system generally prevail. This principle is observed in a variety of physiological contexts. Continue reading

Why is hydroxychloroquine used for systemic lupus erythematosus (SLE)?

Why is an antimalarial drug, hydroxychloroquine, used as a rheumatological immunosuppressant in disorders such as systemic lupus erythematosus (SLE)?

Hydroxychloroquine (HCQ), originally developed as an antimalarial, has become a cornerstone in the treatment of autoimmune diseases, including systemic lupus erythematosus (SLE), primary Sjögren’s syndrome, and rheumatoid arthritis. How does this drug help address the challenges posed by these autoimmune diseases?

1. Interference with lysosomal activity and autophagy:
HCQ increases the pH within intracellular lysosomes, interrupting the autophagy of macromolecules and antigen processing in antigen-presenting cells. This leads to diminished T cell stimulation, providing an advantage in autoimmune conditions like SLE by modulating immune responses.

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Why do corticosteroids increase circulating neutrophils?

Corticosteroids are anti-inflammatory, reducing the number and activity of various inflammatory cell types, including lowering blood lymphocyte, monocyte, and basophil counts and preventing neutrophils from reaching sites of inflammation. So why do corticosteroids increase the number of neutrophils in circulation? 

The effects of corticosteroids reducing the infiltration of neutrophils to sites of inflammation within tissues and increasing the number of neutrophils staying in circulation are two sides of the same mechanism.

Surface expression of proteins, such as L-selectin, is involved in the rolling capture and adherence of neutrophils to blood vessel walls, which is necessary to enable extravasation through blood vessel walls and migration into tissues. Corticosteroids acting via glucocorticoid receptors regulate the expression of many genes involved in inflammatory responses. Continue reading

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