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Here, by Western blotting, immunohistochemistry and immunofluorescence, we identified that CHRNA4 (a subunit of nAChR) exists only on rat adult Leydig cells. We studied the effect of CAC on the synthesis of testosterone in rat adult Leydig cells and mouse MLTC\u20101 tumour cells. Rat Leydig cells and MLTC\u20101 cells were treated with CAC (5, 10 and 50\u00a0\u03bcmol\/L) or nAChR agonists (50\u00a0\u03bcmol\/L nicotine or 50\u00a0\u03bcmol\/L lobeline) for 12\u00a0hours, respectively. We found that CAC significantly increased testosterone output in rat Leydig cells and mouse MLTC\u20101 cells at 5\u00a0\u03bcmol\/L and higher concentrations. However, nicotine and lobeline inhibited testosterone synthesis. CAC increased intracellular cAMP levels, and nicotine and lobeline reversed this change in rat Leydig cells. CAC may increase testosterone synthesis in rat Leydig cells and mouse MLTC\u20101 cells by up\u2010regulating the expression of <jats:italic>Lhcgr<\/jats:italic> and <jats:italic>Star<\/jats:italic>. Up\u2010regulation of <jats:italic>Scarb1<\/jats:italic> and <jats:italic>Hsd3b1<\/jats:italic> expression by CAC was also observed in rat Leydig cells. In addition to cAMP signal transduction, CAC can induce ERK1\/2 phosphorylation in rat Leydig cells. In conclusion, CAC binds to nAChR on Leydig cells, and activates cAMP and ERK1\/2 phosphorylation, thereby up\u2010regulating the expression of key genes and proteins in the steroidogenic cascade, resulting in increased testosterone synthesis in Leydig cells.<\/jats:p>","DOI":"10.1111\/jcmm.16029","type":"journal-article","created":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T02:17:36Z","timestamp":1603851456000},"page":"14184-14194","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Cisatracurium stimulates testosterone synthesis in rat and mouse Leydig cells via nicotinic acetylcholine receptor"],"prefix":"10.1111","volume":"24","author":[{"given":"Chaobo","family":"Ni","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Second Affiliated Hospital &amp; Yuying Children's Hospital of Wenzhou Medical University Wenzhou China"},{"name":"Department of Anesthesiology and Pain Research Center 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