Most colon cancers overexpress M 3 muscarinic receptors (M3R), and post-M3R signaling stimulates human colon cancer cell proliferation. Acetylcholine (ACh), a muscarinic receptor ligand traditionally regarded as a neurotransmitter, may be produced by nonneuronal cells. We hypothesized that ACh release by human colon cancer cells results in autocrine stimulation of proliferation. H508 human colon cancer cells, which have robust M3R expression, were used to examine effects of muscarinic receptor antagonists, acetylcholinesterase inhibitors, and choline transport inhibitors on cell proliferation. A nonselective muscarinic receptor antagonist (atropine), a selective M 3R antagonist (p-fluorohexahydro-sila-difenidol hydrochloride), and a choline transport inhibitor (hemicholinum-3) all inhibited unstimulated H508 colon cancer cell proliferation by ϳ40% (P Ͻ 0.005). In contrast, two acetylcholinesterase inhibitors (eserine-hemisulfate and bis-9-amino-1,2,3,4-tetrahydroacridine) increased proliferation by 2.5-and 2-fold, respectively (P Ͻ 0.005). By using quantitative real-time PCR, expression of choline acetyltransferase (ChAT), a critical enzyme for ACh synthesis, was identified in H508, WiDr, and Caco-2 colon cancer cells. By using high-performance liquid chromatography-electrochemical detection, released ACh was detected in H508 and Caco-2 cell culture media. Immunohistochemistry in surgical specimens revealed weak or no cytoplasmic staining for ChAT in normal colon enterocytes (n ϭ 25) whereas half of colon cancer specimens (n ϭ 24) exhibited moderate to strong staining (P Ͻ 0.005). We conclude that ACh is an autocrine growth factor in colon cancer. Mechanisms that regulate colon epithelial cell production and release of ACh warrant further investigation. autocrine signaling; choline acetyltransferase; muscarinic receptors FOR BOTH MEN AND WOMEN IN the United States colon cancer is a common, frequently lethal disease. Although endoscopic or surgical cancer resection is highly successful in treating early disease, advanced colon cancer responds poorly to surgery, chemotherapy, and radiation, thereby accounting for 30% mortality. A fundamental tenet of cancer biology is that elucidating mechanisms underlying neoplastic cell proliferation will identify therapeutic targets. Hence, identifying colon cancer growth factors and growth factor receptors is a prominent research goal. Nonetheless, although it was recognized more than 15 years ago that muscarinic receptor signaling stimulates colon cancer cell proliferation (9) and that most colon cancers overexpress M 3 muscarinic receptors (M 3 R) (29), muscarinic receptor ligands and receptors have been neglected as potential therapeutic targets.Postmuscarinic receptor signaling has long been recognized as integral to gastrointestinal physiology. Cholinergic nerve endings are present in colonic mucosa and muscarinic signaling, particularly via M 3 R, plays a prominent role in mediating intestinal epithelial fluid and electrolyte transport (10,26,28,30). Muscarinic receptor ...