Antimuscarinic drugs exert β-arrestin-biased agonism at the muscarinic acetylcholine type 1 receptor to promote DRG neuritogenesis

Sci Signal. 2026 Mar 31;19(931):eady7187. doi: 10.1126/scisignal.ady7187. Epub 2026 Mar 31.

Abstract

Pirenzepine (PZ) and muscarinic toxin 7 (MT7) are muscarinic acetylcholine type 1 receptor (M1R) antagonists that promote neuritogenesis in primary adult rodent dorsal root ganglion (DRG) sensory neurons, in part through β-arrestin-dependent activation of ERK1/2. Here, we found that PZ and MT7 exhibited β-arrestin-biased agonism at M1R. PZ and MT7 recruited β-arrestin 2 to M1R and increased ERK phosphorylation in both HEK293 cells and DRG neurons in a concentration-dependent manner. Moreover, ERK activation by MT7 occurred only in M1R-positive DRG neurons and did not require G protein signaling or receptor internalization. PZ stimulated M1R phosphorylation at multiple serine and threonine residues. Mutation of Ser251 and Thr254 in M1R suppressed PZ- and MT7-dependent activation of β-arrestins and PZ-dependent β-arrestin binding and ERK activation. The β-arrestin-biased activities of PZ and MT7 required the activity of casein kinase 2 (CK2) but not that of Gαq or GPCR kinases (GRKs). Pharmacological or siRNA-based inhibition of CK2 blocked PZ-dependent β-arrestin recruitment, ERK activation, and neurite outgrowth in DRG neurons. These results implicate a GRK- and G protein-independent mechanism for the β-arrestin-biased agonism and antimuscarinic effects of PZ and MT7.

MeSH terms

  • Animals
  • Elapid Venoms
  • Ganglia, Spinal* / cytology
  • Ganglia, Spinal* / drug effects
  • Ganglia, Spinal* / metabolism
  • HEK293 Cells
  • Humans
  • Mice
  • Muscarinic Antagonists* / pharmacology
  • Neuronal Outgrowth* / drug effects
  • Phosphorylation / drug effects
  • Pirenzepine* / pharmacology
  • Rats
  • Rats, Sprague-Dawley
  • Receptor, Muscarinic M1* / agonists
  • Receptor, Muscarinic M1* / genetics
  • Receptor, Muscarinic M1* / metabolism
  • beta-Arrestin 2 / metabolism
  • beta-Arrestins* / metabolism

Substances

  • Receptor, Muscarinic M1
  • beta-Arrestins
  • Muscarinic Antagonists
  • Pirenzepine
  • muscarinic toxin 7
  • beta-Arrestin 2
  • Elapid Venoms