Preclinical
and clinical data suggest that muscarinic acetylcholine
receptor activation may be therapeutically beneficial for the treatment
of schizophrenia and Alzheimer’s diseases. This is best exemplified
by clinical observations with xanomeline, the efficacy of which is
thought to be mediated through co-activation of the M1 and M4 muscarinic
acetylcholine receptors (mAChRs). Here we examined the impact
of treatment with xanomeline and compared it to the actions of selective
M1 and M4 mAChR activators on in vivo intracellular
signaling cascades in mice, including 3′-5′-cyclic adenosine
monophosphate response element binding protein (CREB) phosphorylation
and inositol phosphate-1 (IP1) accumulation in the striatum, hippocampus,
and prefrontal cortex. We additionally assessed the effects of xanomeline
on hippocampal electrophysiological signatures in rats using ex vivo recordings from CA1 (Cornu Ammonis 1) as well as in vivo hippocampal theta. As expected, xanomeline’s
effects across these readouts were consistent with activation of both
M1 and M4 mAChRs; however, differences were observed across different
brain regions, suggesting non-uniform activation of these receptor
subtypes in the central nervous system. Interestingly, despite having
nearly equal in vitro potency at the M1 and the M4
mAChRs, during in vivo assays xanomeline produced
M4-like effects at significantly lower brain exposures than those
at which M1-like effects were observed. Our results raise the possibility
that clinical efficacy observed with xanomeline was driven, in part,
through its non-uniform activation of mAChR subtypes in the central
nervous system and, at lower doses, through preferential agonism of
the M4 mAChR.