Institute of Pharmacology, Untversity of Ztirich, Gloriastrasse 32, CH-8006 Zurtch, Switzerland Introduction The aims of pharmacology include understanding the mechanisms underlying successful therapeutic interventions on the molecular level as well as laying down a rationale for use as a basis for new approaches. The recent and, one might safely say, major advances in our know- ledge of the central role of Ca 2÷ in the regu- lation of muscle activity have revealed a variety of interconnected pathways. These in turn help to explain the flexibility shown by different muscle tissues in their re- sponses to the natural neural and hormonal control as well as to pharmacological probes. In this short review we focus on selected topics arising from more recent progress in both the biochemical and phar- macological fields. We find, however, that the basic emphasis on these topics becomes two-fold as a result of the natural division between (1) skeletal muscles, where Ca2÷-control of contraction functions com- pletely within the cell and (2) smooth and cardiac muscles, where the extracellular Ca2*-supply is importanP. The first class presents us with the process of neuromuscu- lar transmission as the main area open to pharmacological intervention, whereas the latter offers many possibilities as a result of the polyfunctional control system existing within the cell. Levels of drug action It is now generally recognized that cytosolic-free Ca 2÷ is the messenger re- sponsible for initiating a wide range of cellu- lar activities, which cease to function as soon as its concentration falls below a cer- tain critical limit (around 10 -7 M). Besides contraction these activities include secre- tion, mitosis, various metabolic enzyme systems, membrane transports, microtubuli assembly-disassembly, phosphorylation reactions and many others. The extracellu- lar concentration of Ca 2+ is in the millimolar range, so that for a cell at rest an outside-to- inside ratio exceeding 104 must be estab- lished. The extremely low level of cytosolic free Ca ~ is maintained by Ca2+-pumps located in the cell outer membranes of heart and smooth muscles, in the endoplasmic reticulum system of smooth muscle cells 2'3 and in the sarcoplasmic reticulum (SR) sys- tem of sarcomeric muscles. Furthermore, Ca ~+ is extruded from the cell by a Na ~- Ca2+-exchange carrier under the control of the ion gradient established by the Na +- K+-pump in the outer membrane. All these pumps require energy to work against the ionic gradients. For contractile activity to begin, Ca ~ must flow from outside through the membrane via the voltage- dependent Ca2+-channels, reversal of the Na+-CaZ+-exchange carder and transfer by passive diffusion, or the release from the intracellular reticulum systems. Overflood- ing of the cytosolic space, however, leads to cell death. If the free Ca 2 t-concentration rises above 10 -4 M, the mitochondria begin to absorb it. In this function they play the role of a Ca2+-sink and are not usually con- sidered to be actively involved in regulation under normal conditions. Although the molecular mechanism by which actin and myosin bring about con- traction is thought to be the same in differ- ent types of muscles, and even in non- muscle cells, the way it is regulated by the Ca2+-messenger varies from tissue to tis- suek However, at the first step of the regu- lation process, i.e. the intracellular Ca 2+- target sites, we do find marked similarities. Evolution has produced a family of phylogenetically related proteins capable of binding Ca 2+ reversibly with high affinity (affinity constant around 106 M 1). They include calmodulin, troponin-C, myosin P-light-chain and parvalbumin, have molecular weights ranging from 12 000 to 19 000 and are found exclusively within the celP. Troponin-C is directly involved in triggering contraction in sarcomeric muscles whereas binding of Ca 2÷ to cal- modulin m smooth muscles stimulates cer- tain protein phosphorylation reactions and thus leads indirectly to contraction as dis- cussed earlier a. In addition, calmodulin is involved in the intracellular processes enu- merated above. It was found to be increased in all transformed tumorous cells. A clear picture of how parvalbumin functions has not yet emerged but it is found in appre- ciable amounts in fast contracting muscle fibres as well as nerve cells which use the" transmitter y-aminobutyric acid ~. It may act as a scavenger for available free Ca 2÷ and so enable cells, which are switched on by a pulse of Ca 2+ to a state of high activity, to be rapidly returned to rest. Thus parvalbu- min could function as a soluble cytosolic relaxing factor by depleting the triggering sites of their bound Ca 2+ faster than the ions are eventually removed from the cytosol by the membrane pumps. In short, one can say there are two main levels at which drugs may act. First, we have the level of the membranes, whether at the cell surface or ~ntemally on the intra- cellular reticuhim systems. Because mem- branes contain various specific constituents such as ionic pumps, channels and hormone receptors, they offer a diversity of targets for drug interference. Nevertheless, the effects must be ultimately on the concentra- tions of cytosolic ions, in particular the Ca2+-messenger. Second, drug action can be directed at the level of Ca2+-binding proteins themselves. Furthermore, in some tissues these two levels are interconnected, e.g. hormone receptor proteins in the mem- brane on the one hand and calmedulin the other play a decisive role in cyclic nucleotide metabolism. In this case, drug action on one level may have its effects extended to the other. Some specific drug effects on contraction in different muscle types will now be discussed. Skeletal muscles The voluntary striated skeletal muscles are under the control of neural activity. Their fibres are surrounded by excitable membranes which can respond specifically to that activity and at the same time shield the interior from extracellular electrolytic changes. All Ca 2~ needed for triggering internal activity is contained in the well developed SR system. Isolated skeletal muscles can perform hundreds of succes- sive contractions without any extracelhi- larly originated Ca 2+. The regulation of con- traction