Hypertrophy changes the muscarinic receptor subtype mediating bladder contraction from M3 toward M2. Am J Physiol Regul Integr Comp Physiol 285: R701-R708, 2003. First published May 22, 2003 10.1152/ajpregu.00009.2003.-Major pelvic ganglion electrocautery (MPGE) and spinal cord injury in the rat induce bladder hypertrophy and a change in muscarinic receptor subtypes mediating bladder contraction from predominantly M 3 to a combination of M2 and M3. To determine whether this is a result of bladder hypertrophy or denervation, we studied the following groups: sham-operated controls, urinary diversion (DIV), MPGE together with urinary diversion (DIV-DEN), bilateral MPGE (DEN), bladder outlet obstruction (BOO), and MPG decentralization (MPG-DEC). The degree of bladder denervation was determined by the maximal carbachol response normalized to the response to electric field stimulation. Receptor subtype density was determined by immunoprecipitation. The affinity of subtypeselective muscarinic antagonists for inhibition of carbacholinduced contractions was used to determine the subtypemediating contraction. DEN, MPG-DEC, and BOO bladders were hypertrophic whereas DIV bladders were atrophic compared with sham operated. Bladder contraction in shamoperated, DIV, and DIV-DEN was mediated by the M3 receptor subtype, whereas the M 2 subtype participated in contraction in the DEN, MPG-DEC, and BOO groups. The hypertrophied bladders had an increase in total and M 2 receptor density while all experimental groups showed a reduction in M3 receptor density. Thus bladder hypertrophy, independent from bladder denervation, causes a shift in the muscarinic receptor subtype mediating bladder contraction from M3 toward M2. denervation; outlet obstruction; urinary diversion PHARMACOLOGICAL DATA, based on the actions of subtypeselective antimuscarinic agents, can distinguish four subtypes of muscarinic acetylcholine receptors (M 1 -M 4 ). Molecular techniques have identified five muscarinic receptor subtypes (M 1 -M 5 ) arising from five separate genes (7,8). Both M 2 and M 3 muscarinic receptor subtypes are found in most smooth muscles. The M 2 receptor preferentially couples to the inhibition of adenylyl cyclase through the G i family of proteins, while the M 3 receptor preferentially couples to IP 3 generation and calcium mobilization through the G q family of proteins (7,8). Pertussis toxin (PTX), which ADP ribosylates and therefore inactivates the G i family of proteins, has no apparent effect on contraction (23). Even though the M 2 muscarinic receptor density is greater than the M 3 receptor density in bladder and other smooth muscles, the affinity of subtype-selective muscarinic receptor antagonist drugs indicates that contraction is mediated by the M 3 receptor in most smooth muscles under normal conditions (7,9).A number of studies have shown that under certain conditions the M 2 receptor subtype can contribute to the contractile response. This includes selective alkylation of M 3 receptors in an environment of increased intrac...