{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:06:24Z","timestamp":1790838384704,"version":"4.1.0"},"reference-count":41,"publisher":"Wiley","issue":"16","license":[{"start":{"date-parts":[[2019,7,2]],"date-time":"2019-07-02T00:00:00Z","timestamp":1562025600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100001003","name":"Boehringer Ingelheim","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001003","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bpspubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["British J Pharmacology"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>Background and Purpose<\/jats:title><jats:p>The bronchodilator tiotropium binds not only to its main binding site on the M<jats:sub>3<\/jats:sub> muscarinic receptor but also to an allosteric site. Here, we have investigated the functional relevance of this allosteric binding and the potential contribution of this behaviour to interactions with long\u2010acting \u03b2\u2010adrenoceptor agonists, as combination therapy with anticholinergic agents and \u03b2\u2010adrenoceptor agonists improves lung function in chronic obstructive pulmonary disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Experimental Approach<\/jats:title><jats:p>ACh, tiotropium, and atropine binding to M<jats:sub>3<\/jats:sub> receptors were modelled using molecular dynamics simulations. Contractions of bovine and human tracheal smooth muscle strips were studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Molecular dynamics simulation revealed extracellular vestibule binding of tiotropium, and not atropine, to M<jats:sub>3<\/jats:sub> receptors as a secondary low affinity binding site, preventing ACh entry into the orthosteric binding pocket. This resulted in a low (allosteric binding) and high (orthosteric binding) functional affinity of tiotropium in protecting against methacholine\u2010induced contractions of airway smooth muscle, which was not observed for atropine and glycopyrrolate. Moreover, antagonism by tiotropium was insurmountable in nature. This behaviour facilitated functional interactions of tiotropium with the \u03b2\u2010agonist olodaterol, which synergistically enhanced bronchoprotective effects of tiotropium. This was not seen for glycopyrrolate and olodaterol or indacaterol but was mimicked by the interaction of tiotropium and forskolin, indicating no direct \u03b2\u2010adrenoceptor\u2013M<jats:sub>3<\/jats:sub> receptor crosstalk in this effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Implications<\/jats:title><jats:p>We propose that tiotropium has two binding sites at the M<jats:sub>3<\/jats:sub> receptor that prevent ACh action, which, together with slow dissociation kinetics, may contribute to insurmountable antagonism and enhanced functional interactions with \u03b2\u2010adrenoceptor agonists.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bph.14707","type":"journal-article","created":{"date-parts":[[2019,5,11]],"date-time":"2019-05-11T13:10:49Z","timestamp":1557580249000},"page":"2864-2876","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Second M<sub>3<\/sub> muscarinic receptor binding site contributes to bronchoprotection by tiotropium"],"prefix":"10.1111","volume":"176","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7742-8748","authenticated-orcid":false,"given":"Loes E.M.","family":"Kistemaker","sequence":"first","affiliation":[{"name":"Department of Molecular Pharmacology University of Groningen  Groningen The Netherlands"},{"name":"Groningen Research Institute for Asthma and COPD, University Medical Center Groningen University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina R.S.","family":"Elzinga","sequence":"additional","affiliation":[{"name":"Department of Molecular Pharmacology University of Groningen  Groningen The Netherlands"},{"name":"Groningen Research Institute for Asthma and COPD, University Medical Center Groningen University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christofer S.","family":"Tautermann","sequence":"additional","affiliation":[{"name":"Department of Medicinal Chemistry Boehringer Ingelheim Pharma GmbH &amp; Co. KG  Biberach an der Riss Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Pieper","sequence":"additional","affiliation":[{"name":"Immunology and Respiratory Disease Research Boehringer Ingelheim Pharma GmbH &amp; Co. KG  Biberach an der Riss Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Seeliger","sequence":"additional","affiliation":[{"name":"Department of Medicinal Chemistry Boehringer Ingelheim Pharma GmbH &amp; Co. KG  Biberach an der Riss Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suraya","family":"Alikhil","sequence":"additional","affiliation":[{"name":"Department of Molecular Pharmacology University of Groningen  Groningen The Netherlands"},{"name":"Groningen Research Institute for Asthma and COPD, University Medical Center Groningen University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Molecular Pharmacology University of Groningen  Groningen The Netherlands"},{"name":"Groningen Research Institute for Asthma and COPD, University Medical Center Groningen University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herman","family":"Meurs","sequence":"additional","affiliation":[{"name":"Department of Molecular Pharmacology University of Groningen  Groningen The 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