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PubMed2003

Expression and distribution of a small-conductance calcium-activated potassium channel (SK3) protein in skeletal muscles from myotonic muscular dystrophy patients and congenital myotonic mice.

The SK3 channel, a small-conductance calcium-activated potassium channel, is expressed in immature fibers of skeletal muscle and becomes down regulated after innervation. We have previously shown that the level of mRNA of the SK3 channel is increased in muscle from myotonic dystrophy. In this study, we have carried out an immunohistochemical study using a polyclonal anti-SK3 antibody. SK3 protein is partly expressed at the cell membrane of normal sized fibers in myotonic dystrophy. Although SK3 channels are also expressed in muscles from polymyositis and amyotrophic lateral sclerosis, the positive staining is observed only in regenerating or denervated fibers. No expression of SK3 protein in a myotonic mouse (ADR) suggests that the increase in the SK3 channel in myotonic dystrophy is not due to hyperexcitability. These data support the hypothesis of a differentiation defect in myotonic dystrophy.

Animals↗
PubMed1994

Adenosine triphosphate-sensitive potassium channel blocking agent ameliorates, but the opening agent aggravates, ischemia/reperfusion-induced injury. Heart function studies in nonfibrillating isolated hearts.

OBJECTIVES: This study was conducted to elucidate the role of the adenosine triphosphate (ATP)-sensitive potassium channel blocking agent glibenclamide and the opener cromakalim in the mechanism of reperfusion-induced injury. BACKGROUND: Recently, ATP-sensitive potassium channel openers have been proposed to reduce ischemia/reperfusion-induced injury, including arrhythmias and heart function. Thus, one might hypothesize that pharmacologic agents that enhance the loss of potassium ions in the myocardium through ATP-sensitive potassium channels would be arrhythmogenic, and agents that interfere with tissue potassium ion loss would be antiarrhythmic. METHODS: Isolated "working" guinea pig hearts and phosphorus-31 nuclear magnetic resonance spectroscopy were used to study the recovery of myocardial function and phosphorus compounds after 30, 40 and 50 min of normothermic global ischemia followed by reperfusion in untreated control and glibenclamide- and cromakalim-treated groups. RESULTS: After 30 min of ischemia, 1, 3, 10 and 30 mumol/liter of glibenclamide dose-dependently reduced the incidence of reperfusion-induced ventricular fibrillation (total) from its control value of 92% to 75%, 33% (p < 0.05), 33% (p < 0.05) and 42% (p < 0.05), respectively. The incidence of ventricular tachycardia followed the same pattern. A reduction of arrhythmias was also observed after 40 and 50 min of ischemia followed by reperfusion in the glibenclamide-treated hearts. Cromakalim, at the same concentrations, did not reduce the incidence of reperfusion-induced arrhythmias. During reperfusion, glibenclamide (3 and 10 mumol/liter) improved the recovery of coronary blood flow, aortic flow, myocardial contractility and tissue ATP and creatine phosphate content, but cromakalim failed to ameliorate the recovery of postischemic myocardium compared with that in the drug-free control hearts. CONCLUSIONS: The preservation of myocardial potassium ions and phosphorus compounds by glibenclamide can improve the recovery of postischemic function, but the use of ATP-sensitive potassium channel openers as antihypertensive or antiarrhythmic agents may be of particular concern in those postinfarction patients who are known to be at high risk for sudden cardiac death.

Adenosine Triphosphate↗
PubMed2002

Expression of mRNA transcripts for ATP-sensitive potassium channels in human myometrium.

The molecular mechanisms regulating human uterine quiescence and parturition are poorly understood. Potassium channels are central to regulation of cell membrane potential and contractility of smooth muscle. The aim of this study was to examine the expression of ATP-sensitive potassium channel (K(ATP) channel) subunits in human myometrium, and to investigate for possible differential expression of these subunits in myometrium obtained from three different functional states: (i) non-pregnant (NP); (ii) late pregnant not in labour (PNL); and (iii) late pregnant in labour (PL). RT-PCR detected the presence of mRNA for four subunits of K(ATP) channels (Kir6.1, Kir6.2, SUR1 and SUR2B) in the three tissue types. Quantitative analysis of these subunits was achieved with real-time RT-PCR using Lightcycler(TM) technology. This analysis showed that there were significantly higher levels of Kir6.1 and SUR2B transcripts in NP myometrium compared with those measured in myometrium obtained during pregnancy (P < 0.001). Lower levels of Kir6.2 and SUR1 mRNA expression were found, although higher transcript levels in NP myometrium (P < 0.05) were still observed. Our results indicate that the major K(ATP) channel expressed in human myometrium is composed of Kir6.1 and SUR2B, and that down-regulation of this channel may facilitate myometrial function during late pregnancy.

ATP-Binding Cassette Transporters↗
PubMed2005

Slow inactivation in voltage gated potassium channels is insensitive to the binding of pore occluding peptide toxins.

Voltage gated potassium channels open and inactivate in response to changes of the voltage across the membrane. After removal of the fast N-type inactivation, voltage gated Shaker K-channels (Shaker-IR) are still able to inactivate through a poorly understood closure of the ion conduction pore. This, usually slower, inactivation shares with binding of pore occluding peptide toxin two important features: i), both are sensitive to the occupancy of the pore by permeant ions or tetraethylammonium, and ii), both are critically affected by point mutations in the external vestibule. Thus, mutual interference between these two processes is expected. To explore the extent of the conformational change involved in Shaker slow inactivation, we estimated the energetic impact of such interference. We used kappa-conotoxin-PVIIA (kappa-PVIIA) and charybdotoxin (CTX) peptides that occlude the pore of Shaker K-channels with a simple 1:1 stoichiometry and with kinetics 100-fold faster than that of slow inactivation. Because inactivation appears functionally different between outside-out patches and whole oocytes, we also compared the toxin effect on inactivation with these two techniques. Surprisingly, the rate of macroscopic inactivation and the rate of recovery, regardless of the technique used, were toxin insensitive. We also found that the fraction of inactivated channels at equilibrium remained unchanged at saturating kappa-PVIIA. This lack of interference with toxin suggests that during slow inactivation the toxin receptor site remains unaffected, placing a strong geometry-conservative constraint on the possible structural configurations of a slow inactivated K-channel. Such a constraint could be fulfilled by a concerted rotation of the external vestibule.

Animals↗
PubMed2003

[mRNA expression alteration of two-pore potassium channels in the brain of beta-amyloid peptide25-35-induced memory impaired rats].

AIM: To study mRNA expression alteration of two-pore potassium channels in the brain of beta-amyloid peptide25-35 (beta-AP25-35)-induced memory impaired rats. METHODS: Memory impairments induced in rats by single icv injection of beta-AP25-35 (2 mmol.L-1) 5 microL were assessed in the Morris water maze test. The mRNA expression levels of three two-pore potassium channels TREK-1, TREK-2 and TRAAK were detected in rat cerebral cortex and hippocampus by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: In the Morris water maze test, the escape latencies of the beta-AP25-35-treated rats were longer than those of the control group in 1st, 2nd and 4th training day, suggesting that the memory of beta-AP25-35-treated rats was obviously impaired. Compared with the control group, the mRNA levels of TREK-1, TREK-2 and TRAAK in the hippocampus of the beta-AP25-35-treated rats were increased by 40.0%, 27.9% and 18.9%, respectively; while no significant change of TREK-1, TREK-2 and TRAAK mRNA levels was observed in the cortex. CONCLUSION: The mRNA expression levels of two-pore potassium channels were increased significantly in the brain of beta-AP25-35-induced memory impaired rats.

Amyloid beta-Peptides↗
PubMed1993

A voltage-dependent and a voltage-independent potassium channel in brown adipocytes of the rat.

Single-channel recordings of a voltage-dependent potassium channel in brown adipocytes of the rat confirm recordings of macroscopic currents. Single-channel conductance (gamma) is 8 pS at 20 degrees C in KF solution inside vs. a modified Ringer's solution outside. With KCl solution outside, gamma is 17 pS for outward currents and 21 pS for inward currents. The majority of the channels inactivate with a time constant around 200 ms; deactivation occurs within milliseconds. The channel is blocked by tetraethylammonium (TEA) with an inhibiting constant of 1.8 mM. The type of block is fast. Selectivity sequence for monovalent cations is K+ > Rb+ >> NH4+ >> Li+ > or = Na+ approximately Cs+. Cs+ at the outside causes a voltage-dependent block of inward currents. This channel is remarkably similar to the delayed rectifier of the F-type in the node of Ranvier. Occasionally, an additional K+ channel was found. This channel is voltage-insensitive, not blocked by 10 mM TEA, and has not been recorded in brown adipocytes before. Physiological relevance of this channel could be the steady-state membrane potential.

Adipocytes↗
PubMed1992

Potassium channel openers, NIP-121 and cromakalim, enhance the relaxation induced by sodium nitroprusside in the guinea-pig isolated trachea.

1. The effect of the potassium channel openers, NIP-121 and cromakalim, on agonist-induced relaxation of the guinea-pig isolated trachea was investigated and the results were compared with those in the epithelium-denuded trachea. 2. Tracheal strips were incubated with a potassium channel opener or vehicle for 30 min in the presence of 5 microM indomethacin and then contracted with 30 nM leukotriene D4 (LTD4). Relaxant agents were added to the organ bath after the LTD4-elicited contraction had reached a plateau. 3. In epithelium-intact trachea, NIP-121 0.1 microM and cromakalim 1 microM, which did not modify the LTD4 (30 nM)-induced contraction, significantly enhanced the sodium nitroprusside (SNP)-induced relaxation. This enhancement of relaxation was not seen in the case of relaxation induced by the cyclic AMP-dependent bronchodilators isoprenaline, vasoactive intestinal peptide or prostaglandin E2. The enhancement of SNP-induced relaxation by NIP-121 and cromakalim was abolished in the presence of the ATP-sensitive potassium channel blocker, glibenclamide (1 microM). NIP-121 and cromakalim did not produce any significant changes in the relaxation induced by 8-bromoguanosine-cyclic monophosphate (8-Br-cyclic GMP), a cyclic GMP analogue. 4. In epithelium-denuded trachea, SNP-induced relaxation alone was significantly enhanced but that induced by 8-Br-cyclic GMP was not changed. Neither NIP-121 nor cromakalim enhanced SNP-induced relaxation in denuded trachea.5. These results suggest that in the presence of an intact epithelium the enhancement by NIP-121 and cromakalim of the relaxation of guinea-pig tracheal smooth muscle induced by SNP may be associated with the opening of glibenclamide-sensitive potassium channels.

Animals↗
PubMed1995

Activation of the cGMP-dependent protein kinase mimics the stimulatory effect of nitric oxide and cGMP on calcium-gated potassium channels.

Nitric oxide (NO) is an endogenous vasodilator and inhaled NO is a promising therapeutic agent for the treatment of pulmonary hypertension. However, NO's mechanism of action is not completely understood. Previous studies have shown that NO increases intracellular levels of cyclic guanosine 3',5'-monophosphate (cGMP) and that leads to activation of calcium-gated potassium channels in vascular smooth muscle cells. Resulting cell membrane hyperpolarization causes vasorelaxation. The potassium channel activation by NO is inhibited by a blockade of cyclic nucleotide-dependent protein kinases, suggesting a key role of these enzymes in NO-induced vasodilation. To further examine this mechanism, we tested the hypothesis that pharmacological stimulation of the cGMP-dependent protein kinase will simulate the activating effect of NO on potassium channels. Indeed, we found that (Sp)-guanosine cyclic 3',5'-phosphorothioate (1 microM), a selective activator of the cGMP-dependent protein kinase, dramatically increased potassium currents measured by the whole-cell patch clamp technique in freshly dispersed pulmonary artery smooth muscle cells. These currents were inhibited by an inhibitor of calcium-gated potassium channels, charybdotoxin. Our results support the hypothesis that the effect of NO on potassium channels is mediated by the cGMP-dependent protein kinase.

Animals↗
PubMed1995

Chemical synthesis and characterization of ShK toxin: a potent potassium channel inhibitor from a sea anemone.

ShK-toxin, a 35 residue peptide isolated from the sea anemone Stichodactyla helianthus, was synthesized using an Fmoc strategy and successfully folded to the biologically active form containing three intramolecular disulfide bonds. The ability of synthetic ShK toxin to inhibit specific [125I]-dendrotoxin I binding to rat brain membranes slightly exceeded (was more potent than) that of the natural ShK toxin sample, but was comparable with previously reported data for ShK toxin. The peptide toxin inhibited [125I]-charybdotoxin binding to Jurkat T lymphocytes with an IC50 value of 32 pM. In addition, Jurkat T lymphocytes Kv1.3 potassium channels were inhibited with an IC50 value of 133 pM. Owing to their unique structure and high affinity for at least some potassium channels, ShK toxin and related sea anemone potassium channel toxins may become useful molecular probes for investigating potassium channels.

Amino Acid Sequence↗
PubMed2001

Localization of two high-threshold potassium channel subunits in the rat central auditory system.

The firing pattern of auditory neurons is determined in part by the type of voltage-sensitive potassium channels expressed. The expression patterns for two high-threshold potassium channels, Kv3.1 and Kv3.3, that differ in inactivation properties were examined in the rat auditory system. The positive activation voltage and rapid deactivation kinetics of these channels provide rapid repolarization of action potentials with little effect on action potential threshold. In situ hybridization experiments showed that Kv3.3 mRNA was highly expressed in most auditory neurons in the rat brainstem, whereas Kv3.1 was expressed in a more limited population of auditory neurons. Notably, Kv3.1 mRNA was not expressed in neurons of the medial and lateral superior olive and a subpopulation of neurons in the ventral nucleus of the lateral lemniscus. These results suggest that Kv3.3 channels may be the dominant Kv3 subfamily member expressed in brainstem auditory neurons and that, in some auditory neurons, Kv3.1 and Kv3.3 may coassemble to form functional channels. The localization of Kv3.1 protein was examined immunohistochemically. The distribution of stained somata and neuropil varied across auditory nuclei and correlated with the distribution of Kv3.1 mRNA-expressing neurons and their terminal arborizations, respectively. The intensity of Kv3.1 immunoreactivity varied across the tonotopic map in the medial nucleus of the trapezoid body with neurons responding best to high-frequency tones most intensely labeled. Thus, auditory neurons may vary the types and amount of K(+) channel expression in response to synaptic input to subtly tune their firing properties.

Animals↗
PubMed1996

Effect of the class III antiarrhythmic agent E-4031 on the ATP-sensitive potassium channel in rabbit ventricular myocytes.

The class III antiarrhythmic drug E-4031, a known blocker of the delayed rectifier potassium channel (IK), might also be capable of blocking the ATP-sensitive potassium channel (IKATP). We examined this possibility by studying the effect of E-4031 on single IKATP channels in membrane patches excised from ventricular myocytes that were obtained by standard enzymatic dissociation techniques from New Zealand white rabbits. In inside-out patches, E-4031 caused a dose-dependent block of IKATP with an EC50 of 31 +/- 1 microM, Hill coefficient of 0.89 +/- 0.24 and no effect on channel conductance. Open dwell-time kinetics were fitted by two exponential components, with E-4031 causing reduction of the longer time constant. In outside-out patches, the concentration of E-4031 required to produce blockade was much higher. We conclude that E-4031 blocks the ATP-sensitive potassium channel and that it does so from within the cytoplasm, with one-to-one channel binding stoichiometry. Single channel conductance is unchanged, but the longer time constant for the open state is reduced, which suggests that E-4031 may be an open channel blocker of intermediate to slow time course.

Adenosine Triphosphate↗
PubMed1997

Screening for novel drug effects with a microphysiometer: a potent effect of clofilium unrelated to potassium channel blockade.

Changes in cellular metabolism in response to pharmacological compounds can be detected using a biosensor known as a microphysiometer, which measures the rate at which cells release acidic metabolites. We have applied this technique to screen for effects of cation channel blockers on the metabolism of a variety of human and murine cell lines. At concentrations sufficient for cation channel blockade, most of these drugs have little or no effect on cellular metabolism as measured by acid release. In contrast, the potassium channel blocker clofilium triggers sustained increases in acid release at low (> or = 3 microM) concentration. Acid release persists in media containing high (150 mM) extracellular potassium. This release is not triggered by chemically similar potassium channel blockers. Thus these metabolic effects reflect a potent and specific function of clofilium which is unrelated to potassium channel blockade. Attempts to identify physiological correlates to this response revealed that low concentrations of clofilium but not other potassium channel blockers cause lymphoma apoptosis. These findings demonstrate that effects of clofilium found in other studies may not be due to changes in plasma membrane potassium conductance.

Adrenergic beta-Antagonists↗
PubMed2001

Characterization of KCNQ5/Q3 potassium channels expressed in mammalian cells.

Heteromeric KCNQ5/Q3 channels were stably expressed in Chinese Hamster ovary cells and characterized using the whole cell voltage-clamp technique. KCNQ5/Q3 channels were activated by the novel anticonvulsant, retigabine (EC(50) 1.4 microM) by a mechanism that involved drug-induced, leftward shifts in the voltage-dependence of channel activation (-31.8 mV by 30 microM retigabine). KCNQ5/Q3 channels were inhibited by linopirdine (IC(50) 7.7 microM) and barium (IC(50) 0.46 mM), at concentrations similar to those required to inhibit native M-currents. These findings identify KCNQ5/Q3 channels as a molecular target for retigabine and raise the possibility that activation of KCNQ5/Q3 channels may be responsible for some of the anti-convulsant activity of this agent. Furthermore, the sensitivity of KCNQ5/Q3 channels to linopirdine supports the possibility that potassium channels comprised of KCNQ5 and KCNQ3 may make a contribution to native M-currents.

Animals↗
PubMed1998

Abnormal function of potassium channels in platelets of patients with Alzheimer's disease.

BACKGROUND: Reports of abnormalities of potassium-channel function in various cultured cells of Alzheimer's disease patients led us to attempt to characterise the pharmacological characteristics of the abnormal channel. METHODS: We studied platelets from 14 patients with Alzheimer-type dementia and 14 non-demented controls matched for age and sex. The effects of specific inhibitors of K+ channels on the efflux of rubidium-86 ions, a radioactive analogue of K+, from the platelets were measured. FINDINGS: Normal platelets contain three types of K+ channel, sensitive to the inhibitory actions of apamin (small-conductance calcium-dependent potassium channels), charybdotoxin (of less specificity, but probably intermediate-conductance calcium-dependent K+ channels), and alpha-dendrotoxin (voltage-sensitive K+ channels). However, 8Rb+ efflux from the platelets of patients with Alzheimer-type dementia was not inhibited by either apamin or charybdotoxin. By contrast, inhibition by alpha-dendrotoxin did occur. INTERPRETATION: Our results suggest that calcium-dependent K+ channels in platelets are selectively impaired in Alzheimer's disease. A similar abnormality in neurons could contribute to the pathophysiology of the disorder.

Aged↗
PubMed1997

Different effect of anticholinergic agents and potassium channel openers on urinary bladder response to pelvic nerve stimulation in anaesthetized dogs.

1. Effects of the anticholinergic agents atropine, oxybutynin, and terodiline, and the potassium channel openers YM934 (2-(3,4-dihydro-2,2-dimethyl-6-nitro-2H-1,4-benzoxazin-4-yl) pyridine N-oxide) and cromakalim were examined on urinary bladder response to pelvic nerve stimulation in pentobarbital-anaesthetized dogs. 2. Pelvic nerve stimulation (PNS) produced a frequency-dependent increase in intravesical pressure in anaesthetized dogs. The response to PNS was abolished by topical tetrodotoxin, and markedly inhibited by intravenous hexamethonium, suggesting a neurogenic origin for the in vivo contractile response. 3. Atropine (0.3-3 mg kg-1 i.v.) and the anti-neurogenic bladder agents, oxybutynin (1-10 mg kg-1 i.v.) and terodiline (1-10 mg kg-1 i.v.) dose-dependently decreased the amplitude of the peak intravesical pressure response to PNS. At either frequency of PNS, these agents inhibited the response to a similar degree. 4. The potassium channel openers YM934 (1-10 micrograms kg-1 i.v.) and cromakalim (3-30 micrograms kg-1 i.v.) dose-dependently decreased the amplitude of the peak intravesical pressure response to PNS. The inhibitory effects of these drugs were more potent at lower than at higher frequencies of PNS. 5. These data suggest that the inhibitory effects of potassium channel openers on urinary bladder response to PNS are different from those of anticholinergic agents. The preferential inhibitory effect of potassium channel openers on detrusor smooth muscle contraction at lower frequencies of PNS may represent new potential for the treatment of neurogenic bladder.

Anesthesia↗
PubMed1989

Cardiohemodynamic effects of cromakalim and pinacidil, potassium-channel openers, in the dog, special reference to venous return.

The cardiohemodynamic effects of the potassium-channel openers, cromakalim and pinacidil, were studied by the use of the closed-loop method (for both drugs) and the cardiopulmonary bypass technique (for cromakalim only) in anesthetized, open-chest dogs. In closed-loop preparations, both drugs (cromakalim, 3 to 100 micrograms/kg; pinacidil, 10 to 300 micrograms/kg) administered intravenously decreased systemic blood pressure and increased venous return (sum of the flow through the inferior and the superior vena cava) and cardiac output (CO). With the highest doses of both drugs, venous return and CO decreased in some preparations in which right atrial pressure rose, and the maximum rate of rise of left ventricular pressure (LV dP/dt max) diminished. Except such preparations, right atrial pressure, heart rate, and atrioventricular conduction time remained virtually unchanged. The fall in systemic blood pressure produced by intermediate doses of pinacidil was greater in the preparations in which baroceptor reflexes were eliminated (denervated preparations) than in those with the reflexes left intact (nerve-intact preparations). The increases in venous return and CO, however, were not different when comparing the nerve-intact and the denervated preparations. In cardiopulmonary-bypass preparations, higher doses of cromakalim increased venous return while producing a fall in systemic blood pressure, suggesting that the decreased venous return and CO seen with higher doses of the potassium-channel openers in the closed-loop preparations were secondary to the decreased cardiac contractility. The potassium-channel openers should be characterized as vasodilators, which preferentially reduce afterload and increase venous return.

Animals↗
PubMed1993

Effect of potassium channel modulators on the release of glutamate induced by ischaemic-like conditions in rat hippocampal slices.

The effects of the potassium channel openers lemakalim, RP 52891 and galanin and the potassium channel blockers glibenclamide and gliquidone were evaluated by the release of endogenous glutamate from rat hippocampal slices subjected to a brief period of ischaemia (2-10 min). Ischaemia was mimicked by incubating slices in a glucose free medium equilibrated with 95% N2/5% CO2. These conditions evoked a release of glutamate which was insensitive to tetrodotoxin and Ca2+ indicating a non-vesicular origin. The release of glutamate evoked by a 6- or 8-min period of ischaemia was reduced by 25-40% in the presence of lemakalim (10 microM), RP 52891 (10 microM) or galanin (0.3 microM), whereas it was enhanced by 60 to 100% in the presence of glibenclamide (1 microM) and gliquidone (2 microM). These observations suggest that cellular damage resulting from ischaemia induced excessive release of glutamate in the hippocampus may be partly reduced by potassium channel openers, and conversely increased by sulfonylureas.

Animals↗
PubMed1996

The effect of the potassium channel activator, cromakalim, on antidepressant drugs in the forced swimming test in mice.

The forced swimming test (FST) is a widely used behavioural model to predict potential antidepressant (AD) action of compounds in humans. It has been previously shown that pretreatment with lithium, quinine and clonidine had additive effects on AD drugs in the FST, an effect proposed to be a result of potassium channel blockade. It is possible that pretreatment with potassium channel openers may induce opposite effects to those seen following pretreatment with potassium channel blockers in the FST. Pretreatment with cromakalim (CROM) (1 mg/kg, intraperitoneally [i.p.]) antagonized the anti-immobility effect of the mixed noradrenaline (NA)/5-hydroxytryptamine (5-HT) reuptake inhibitors imipramine and amitriptyline (P < 0.05). CROM administration (0.06 and 1 mg/kg, i.p.) also blocked the AD-like effects of the specific NA reuptake inhibitor, desipramine, and the selective serotonin reuptake inhibitor, paroxetine (P < 0.05 and P < 0.01, respectively). Pretreatment with CROM via gavage (1 mg/kg) antagonized the AD-like effects of imipramine, amitiptyline, desipramine and paroxetine. CROM treatment (via i.p. route or gavage) did not have any significant effect on the anti-immobility activity of the atypical AD mianserin at any of the doses employed. Another potassium channel opener, minoxidil (MINOX), which does not cross the blood-brain barrier, was also tested to eliminate the possibility that CROM may be acting via peripheral/local mechanisms. MINOX (32 mg/kg) failed to antagonize anti-immobility effects of any of the AD tested. In conclusion, the results of the present study suggest that CROM is only acting on drugs involved with neurotransmitter uptake inhibition.

Amitriptyline↗