(ACh), an ester of choline and acetic acid that is the transmitter (neurotransmitter) substance at many neural, or nerve, synapses and at the motor end plate of vertebrate muscles (see end-plate potential). When a nerve impulse arrives at the nerve ending, ACh, which is stored there in vesicles, is released and combines with a receptor molecule in the postsynaptic membrane or the end-plate membrane (end-plate potential) of a muscle fibre. This bonding changes the permeability of the membrane, and a change in the nature of a generator potential results. The effects of successive nerve impulses accumulate if they arrive at a sufficiently high frequency. The ACh is destroyed by an enzyme, acetylcholinesterase, and thus is effective only briefly. Inhibitors of the enzyme, however, prolong the lifetime of ACh itself.

ACh affects a number of body systems including the cardiovascular system by acting as a vasodilator, by decreasing cardiac rate, and by decreasing cardiac contraction; the gastrointestinal system by such activities as increasing peristalsis in the stomach and by increasing the amplitude of digestive contractions; and the urinary tract by such actions as decreasing the capacity of the bladder and increasing the voluntary voiding pressure. It also affects the respiratory system and stimulates secretion by all glands that receive parasympathetic nerve impulses.

ACh is also known to play an important role in memory and learning and is in abnormally short supply in the brains of those with Alzheimer's disease (Alzheimer disease).