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Acetylcholinesterase
Nicotinic
Acetylcholine
Receptor
Nicotinic
Acetylcholine
Receptor
Voltage-
dependent
L-type calcium
channel subunit
alpha-1C
Myosin light
chain kinase
Choline O-
acetyltransferase
Myosin LC-P
Myosin light
chain 3
N-type calcium
channel
Vesicular
acetylcholine
transporter
High affinity
choline
transporter 1
Calmodulin-1
Myosin light
chain
phosphatase
Ca
+
Acetylcholine
Pyridostigmine
Na
+
Pyridostigmine
Ca
+
Choline
Choline
Na
+
Ca
+
Ca
+
Pyridostigmine
Pyridostigmine
Acetyl-CoA
Choline
CoA
H
2
O
Acetic acid
Manganese
Ca
+
Calmodulin-1
Acetylcholine
Acetylcholine
Muscle
Contraction
Muscle
Relaxation
Magnesium
Presynaptic Neuron
Motor End Plate
2. An action potential
arrives at the nerve
terminal and stimulates the
opening of the calcium
channel, causing an influx
of calcium ions
1. Acetylcholine is
synthesized and stored in
synaptic vesicles at the
nerve terminal
3. Calcium ions stimulates
the release of
neurotransmitter
acetylcholine into the
synaptic cleft via
exocytosis
4. Acetylcholine in the
synaptic cleft activates
nicotinic receptors on the
post-synaptic membrane
7. Acetylcholine is broken
down by acetylcholinesterase
into choline and acetyl-coa
8. Choline is taken back up
into the nerve terminal and
recycled to create more
acetylcholine
Pyridostigmine inhibits
acetylcholinesterase,
preventing acetylcholine
breakdown
5. The activated nicotinic
receptor stimulates sodium
ion influx, depolarizing the
cell
Vesicle
Pyridostigmine is
administered orally and
diffuses into the
bloodstream and travels to
its target within the brain
Sacroplasmic Reticulum
6. Depolarization causes a
release of calcium from the
sarcoplasmic reticulum.
Calcium binds to calmodulin
that in turn activates
myosin light chain kinase.
Once phosphorylated starts
initiating muscle
contraction
Neuromuscular Junction
Pyridostigmine inhibits
choline-o-acetyltransferase,
leading to accumulation of
acetylcholine in the
synaptic cleft.
ACHE
Unknown
Unknown
CACNA1C
MYLK2
CHAT
MYL3
MYL3
CACNB1
SLC18A3
SLC5A7
CALM1
PPP1CB
Calcium
Acetylcholine
Pyridostigmine
Sodium
Pyridostigmine
Calcium
Choline
Choline
Sodium
Calcium
Calcium
Pyridostigmine
Pyridostigmine
Acetyl-CoA
Choline
Coenzyme A
Water
Acetic acid
Calcium
CALM1
Acetylcholine
Acetylcholine
Muscle
Contraction
Muscle
Relaxation
ACHE
CACNA1C
MYLK2
CHAT
MYL3
MYL3
CACNB1
SLC18A3
SLC5A7
CALM1
PPP1CB
Ca
+
ACh
Regonol
Na
+
Regonol
Ca
+
Choline
Choline
Na
+
Ca
+
Ca
+
Regonol
Regonol
Ac-CoA
Choline
CoA
H
2
O
Acoh
Mn2+
Ca
+
CALM1
ACh
ACh
Mus Con
Mus Rel