A new class of subtype-selective muscarinic acetylcholine (mACh) receptor agonist that activates the receptor through interaction at a site distinct from the orthosteric acetylcholine binding site has been reported recently. Here, we have compared the effects of orthosteric (oxotremorine-M, arecoline, pilocarpine) and allostericagonists on M 1 mACh receptor internalization and downregulation, as well as functional coupling in a Chinese hamster ovary (CHO) cell line. In contrast to full and partial orthosteric agonists, which cause significant receptor internalization and down-regulation, prolonged exposure to AC-42 did not significantly alter either cell-surface or total cellular M 1 mACh receptor expression. 77-LH-28-1, an AC-42 homolog, did cause some receptor internalization, but not down-regulation. The presence of atropine completely prevented the orthosteric agonist-induced adaptive changes in receptor populations; however, in contrast, the copresence of atropine and AC-42 significantly increased both cell-surface receptor and total M 1 mACh receptor expression. Maximal phosphoinositide hydrolysis responses to the partial agonist arecoline were similar in CHO-M 1 cells pretreated for 24 h with either AC-42 or vehicle; in contrast, these responses were markedly reduced when cells were pretreated with oxotremorine-M or pilocarpine. These data indicate that, whereas AC-42 binding to the M 1 mACh receptor can initiate signal transduction, the AC-42-liganded receptor is resistant to the usual mechanisms regulating receptor internalization and down-regulation. In addition, our data suggest unusual interactions between allosteric agonists and orthosteric antagonists to regulate cell-surface and total cellular receptor expression. proteins and inhibition of adenylyl cyclase activity (Caulfield and Birdsall, 1998). The mACh receptors are widely distributed throughout the periphery and central nervous system, and have been implicated as potential therapeutic targets in an array of diseases, including chronic obstructive pulmonary disease, irritable bowel syndrome, Alzheimer's disease, and schizophrenia (see Eglen et al., 1999;Felder et al., 2000;Langmead et al., 2008b).A major obstacle in the development of successful cholinergic therapies has been the lack of mACh receptor subtypespecific ligands, and the potentially serious side-effect profile of agents that interact with multiple mACh receptor subtypes (Bymaster et al., 1998;Eglen et al., 1999;Bartolomeo