Distigmine bromide (distigmine), a reversible carbamate cholinesterase inhibitor, is used in Japan for treating detrusor underactivity, myasthenia gravis, and glaucoma. Although there is clinical evidence about the effectiveness of distigmine in the treatment of detrusor underactivity, mechanisms by which distigmine restores impaired urinary bladder smooth muscle (UBSM) contractility have not been fully investigated. The aims of this study were to investigate the potentiating effects of distigmine on UBSM contractions in response to parasympathetic nerve stimulation induced by electrical field stimulation (EFS) in mice. In isolated mouse UBSM, EFS (1-16 Hz) produced tetrodotoxin-sensitive, frequency-dependent contractions. The contractile responses to EFS were largely attenuated by atropine (10-6 mol/l). UBSM contractility that occurred in the presence of atropine was nearly eliminated by the addition of α,β-methylene adenosine triphosphate (α,β-mATP, 10-4 mol/l). Distigmine (3 × 10-7 mol/l) significantly potentiated EFS-induced contractile responses engendered in the presence of α,β-mATP (10-4 mol/l), but not atropine (10-6 mol/l). These findings indicate that distigmine powerfully potentiates UBSM contractions selectively induced by parasympathetic nerve-derived acetylcholine, thereby demonstrating a potential mechanism by which it stimulates detrusor contractile function.

1.
Schmid O: Bis-carbamic acid ester compounds, and a process of making same. U.S. Patent 2789981. 1957-04-23.
2.
Herzfeld E, Kraupp O, Pateisky K, Stumpf C: [Pharmacological and clinical effects of cholinesterase antagonist hexamethylene-bis(N-methylcarbaminoyl-1-methyl-3-oxypyridiniumbromide); (BC 51)]. Wien Klin Wochenschr 1957;69:245-248.
3.
Breuel HP, Bohn-Olszewsky W, Engelsen SJ, Samhaber EM, Niklaus H: Inhibition of acetylcholinesterase by distigmine bromide (ubretid). Int J Clin Pharmacol Ther Toxicol 1993;31:230-235.
4.
Pateisky K: [Treatment of myasthenia gravis pseudoparalytica; clinical testing and therapy with BC substances (BC40, BC47, BC48 and BC 51)]. Wien Z Nervenheilkd Grenzgeb 1959;17:53-84.
5.
Emeryk E, Wasowicz B: [Evaluation of ‘ubretid' (BC 51) in the treatment of myasthenia gravis]. Neurol Neurochir Psychiatr Pol 1963;13:611-617.
6.
Ishigaki K, Murakami T, Ito Y, Yanagisawa A, Kodaira K, Shishikura K, Suzuki H, Hirayama Y, Osawa M: [Treatment approach to congenital myasthenic syndrome in a patient with acetylcholine receptor deficiency]. No To Hattatsu 2009;41:37-42.
7.
Ishikawa S, Tsukahara S, Sato Y: Local administration of 1 per cent ubretid in the handling of glaucoma, myasthenia gravis and esotropia. Ophthalmologica 1969;159:339-362.
8.
Mizukawa T, Azuma I: [Effects of ubretid eye-drops upon glaucoma]. Nihon Ganka Kiyo 1970;21:586-595.
9.
Sawada A, Hara K, Futa R, Ogata H: [Pressure-lowering effect of a new cholinesterase inhibitor, ubretid on glaucoma]. Nihon Ganka Kiyo 1971;22:676-682.
10.
Benedikt O: [Comparative studies on 1 per cent ubretid and 2 per cent pilocarpine in the therapy of glaucoma simplex]. Klin Monbl Augenheilkd 1972;160:336-340.
11.
Cameron MD: Distigmine bromide (ubretid) in the prevention of postoperative retention of urine. J Obstet Gynaecol Br Commonw 1966;73:847-848.
12.
Oka N, Hasegawa S: [Treatment of dysuria with anticholinesterases: ubretid]. Hinyokika Kiyo 1967;13:42-51.
13.
Yeo J, Southwell P, Hindmarsh E: Preliminary report on the effect of distigmine bromide on the neurogenic bladder. Med J Aust 1973;1:116-120.
14.
Philp NH, Thomas DG: The effect of distigmine bromide on voiding in male paraplegic patients with reflex micturition. Br J Urol 1980;52:492-496.
15.
Tanaka Y, Masumori N, Itoh N, Furuya S, Nishizawa O, Tsukamoto T: Symptomatic and urodynamic improvement by oral distigmine bromide in poor voiders after transurethral resection of the prostate. Urology 2001;57:270-274.
16.
Bougas DA, Mitsogiannis IC, Mitropoulos DN, Kollaitis GC, Serafetinides EN, Giannopoulos AM: Clinical efficacy of distigmine bromide in the treatment of patients with underactive detrusor. Int Urol Nephrol 2004;36:507-512.
17.
Tanaka Y, Masumori N, Tsukamoto T, Furuya S, Furuya R, Ogura H: Treatment strategy according to findings on pressure-flow study for women with decreased urinary flow rate. Adv Urol 2009;2009:782985.
18.
Horinouchi T, Aoki T, Akiyama R, Ono T, Shibano M, Tanaka Y, Koike K: Effects of distigmine, a long-acting cholinesterase inhibitor, on urinary bladder detrusor and urethra smooth muscles of guinea-pig: pharmacological analysis in vitro and in vivo. Pharmacometrics (Ōyō Yakuri) 2003;64:45-52.
19.
Sekiya S, Ookawa N, Horinouchi, Tanaka Y, Koike K: Effects of distigmine, a long-acting cholinesterase inhibitor, on urinary bladder contractile functions assessed by using cystometry method in anesthetized guinea-pigs. Pharmacometrics (Ōyō Yakuri) 2006;70:29-34.
20.
Sekiya S, Takahashi H, Seki Y, Teraoka A, Aikawa N, Tanaka Y, Koike K: Comparison of the effects of distigmine and neostigmine on guinea-pig urinary bladder contractile functions assessed by in vivo and in vitro studies. Pharmacometrics (Ōyō Yakuri) 2008;75:85-96.
21.
Obara K, Aikawa N, Sato K, Chino D, Tanaka Y: Comparison of the effects of distigmine and bethanechol on guinea-pig lower urinary tracts contractile functions assessed by in vivo and in vitro studies. Pharmacometrics (Ōyō Yakuri) 2013;85:101-114.
22.
Harada T, Fushimi K, Kato A, Ito Y, Nishijima S, Sugaya K, Yamada S: Demonstration of muscarinic and nicotinic receptor binding activities of distigmine to treat detrusor underactivity. Biol Pharm Bull 2010;33:653-658.
23.
Ambache N, Zar MA: Non-cholinergic transmission by post-ganglionic motor neurones in the mammalian bladder. J Physiol 1970;210:761-783.
24.
Burnstock G, Dumsday B, Smythe A: Atropine resistant excitation of the urinary bladder: the possibility of transmission via nerves releasing a purine nucleotide. Br J Pharmacol 1972;44:451-461.
25.
Westfall DP, Fedan JS, Colby J, Hogaboom GK, O'Donnell JP: Evidence for a contribution by purines to the neurogenic response of the guinea-pig urinary bladder. Eur J Pharmacol 1983;87:415-422.
26.
Moss HE, Burnstock G: A comparative study of electrical field stimulation of the guinea-pig, ferret and marmoset urinary bladder. Eur J Pharmacol 1985;114:311-316.
27.
Brading AF, Mostwin JL: Electrical and mechanical responses of guinea-pig bladder muscle to nerve stimulation. Br J Pharmacol 1989;98:1083-1090.
28.
Kura H, Obara K, Yabu H: Contractile responses to electrical field stimulation and ATP in guinea-pig urinary bladder. Comp Biochem Physiol C 1992;102:193-197.
29.
Shinkai M, Takayanagi I, Kato T: Tachykinin receptors of the NK2 type involved in the acetylcholine release by nicotine in guinea-pig bladder. Br J Pharmacol 1993;108:759-762.
30.
Yoshida M, Homma Y, Inadome A, Yono M, Seshita H, Miyamoto Y, Murakami S, Kawabe K, Ueda S: Age-related changes in cholinergic and purinergic neurotransmission in human isolated bladder smooth muscles. Exp Gerontol 2001;36:99-109.
31.
Tsai MH, Kamm KE, Stull JT: Signalling to contractile proteins by muscarinic and purinergic pathways in neurally stimulated bladder smooth muscle. J Physiol 2012;590:5107-5121.
32.
Fujiwara M, Andersson K, Persson K: Nitric oxide-induced cGMP accumulation in the mouse bladder is not related to smooth muscle relaxation. Eur J Pharmacol 2000;401:241-250.
33.
Moon A: Influence of nitric oxide signalling pathways on pre-contracted human detrusor smooth muscle in vitro. BJU Int 2002;89:942-949.
34.
Kajioka S, Nakayama S, Seki N, Naito S, Brading AF: Oscillatory membrane currents paradoxically induced via NO-activated pathways in detrusor cells. Cell Calcium 2008;44:202-209.
35.
Gillespie JI, Drake MJ: The actions of sodium nitroprusside and the phosphodiesterase inhibitor dipyridamole on phasic activity in the isolated guinea-pig bladder. BJU Int 2004;93:851-858.
36.
Lagou M, Drake MJ, Markerink-VAN Ittersum M, DE Vente J, Gillespie JI: Interstitial cells and phasic activity in the isolated mouse bladder. BJU Int 2006;98:643-650.
37.
Smet PJ, Moore KH, Jonavicius J: Distribution and colocalization of calcitonin gene-related peptide, tachykinins, and vasoactive intestinal peptide in normal and idiopathic unstable human urinary bladder. Lab Invest 1997;77:37-49.
38.
Watts SW, Cohen ML: Effect of bombesin, bradykinin, substance P and CGRP in prostate, bladder body and neck. Peptides 1991;12:1057-1062.
39.
Maggi CA, Santicioli P, Patacchini R, Geppetti P, Giuliani S, Astolfi GM, Baldi E, Parlani M, Theodorsson E, Fusco B, et al: Regional differences in the motor response to capsaicin in the guinea-pig urinary bladder: relative role of pre- and postjunctional factors related to neuropeptide-containing sensory nerves. Neuroscience 1988;27:675-688.
40.
Kullmann FA, Kurihara R, Ye L, Wells GI, McKenna DG, Burgard EC, Thor KB: Effects of the 5-HT4 receptor agonist, cisapride, on neuronally evoked responses in human bladder, urethra, and ileum. Auton Neurosci 2013;176:70-77.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.