Li C, Micci M, Murthy KS, Pasricha PJ. Substance P is essential for maintaining gut muscle contractility: a novel role for coneurotransmission revealed by botulinum toxin. Am J Physiol Gastrointest Liver Physiol 306: G839 -G848, 2014. First published April 3, 2014 doi:10.1152/ajpgi.00436.2012.-Substance P (SP) is commonly coexpressed with ACh in enteric motor neurons, and, according to the classical paradigm, both these neurotransmitters excite smooth muscle via parallel pathways. We hypothesized that, in addition, SP was responsible for maintaining the muscular responsiveness to ACh. We tested this hypothesis by using botulinum toxin (BoNT/A), a known blocker of vesicular release of neurotransmitters including ACh and neuropeptides. BoNT/A was injected into rat pyloric sphincter in different doses; as control we used boiled BoNT/A. At the desired time point, pylorus was dissected out and pyloric contractility was measured ex vivo in an organ bath and by measuring phosphorylation of myosin light chain 20 (MLC 20). BoNT/A (10 IU) significantly reduced the response of pyloric muscle to exogenous ACh, an effect that was accompanied by reduced MLC 20 phosphorylation in the muscle. Both effects were reversed by exogenous SP. CP-96345, a NK1 receptor antagonist, blocked the ability of exogenous SP to reverse the cholinergic hyporesponsiveness as well as the reduction in MLC 20 phosphorylation induced by BoNT/A. In conclusion, we have identified a novel role for SP as a coneurotransmitter that appears to be important for the maintenance of muscular responsiveness to the principal excitatory neurotransmitter, ACh. These results also provide new insight into the effects of botulinum toxin on the enteric nervous system and gastrointestinal smooth muscle. botulinum toxin; gut smooth muscle contractility; substance P; cholinergic responsiveness; acetylcholine; coneurotransmission; MLC phosphorylation BOTULINUM NEUROTOXIN type A (BoNT/A) is one of the most potent blockers of vesicular neurotransmitter release from neurons and is widely used as a therapeutic agent for a variety of spastic muscular disorders including those involving visceral muscle (4,10,14,24,25,30,33). The mechanisms of action of this toxin on skeletal muscle have been extensively studied; by contrast, there is little literature on how it affects gastrointestinal smooth muscle. A previous report has shown BoNT/A to have a dual effect on gut smooth muscle tone, with low concentrations inhibiting neurally mediated contractile responses and higher concentrations directly inhibiting smooth muscle contractility in response to exogenous ACh (12). This latter effect is distinct from that seen in skeletal muscle, where the application of botulinum toxin results in denervation hypersensitivity. However, the mechanism for this phenomenon remains unknown.Unlike most motor neurons innervating skeletal muscle, which are purely excitatory, enteric motor neurons can be considered as either excitatory or inhibitory in terms of their effects on smooth muscle tone. Furtherm...