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FIGURE 48–2. Molecular basis of cholinergic neurotransmission.Acetylcholine (ACh) is synthesized in the nerve terminal cytoplasm and is incorporated into synaptic vesicles via the vesicular acetylcholine transporter (VAChT). Upon nerve impulse, cholinergic vesicles release ACh into the synaptic cleft, where the transmitter binds to pre- and postsynaptic muscarinic and nicotinic receptor subtypes. Transmission is terminated by the rapid hydrolysis of ACh by acetylcholinesterase (AChE). The degradation product choline is recycled into the terminal by the high-affinity choline transporter (CHT). This reuptake process is a key regulated and rate-limiting step in ACh synthesis. AcCoA = acetyl coenzyme A.

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