Cholinergic stimulation of adrenal medulla is essential for the granulicytopoietic response to lithium.

Granulocytopoietic response to lithium carbonate (Li+) in rat was eliminated completely by N-cholinergic blocking agent, and independently by alpha-1-adrenergic antagonist. A link between these two contradictory events is explained by release of acetylcholine from the cholinergic preganglionic nerve endings in adrenal medulla triggered by Li+, and subsequent discharge of catecholamines (CA) from medullar chromaffin cells, which on their part activate adrenergic receptors of alpha-1 class on hematopoietic progenitor cells. Respectively, granulocytopoietic response to Li+ is blocked by cholinergic N-blocking agent at the level of adrenal medulla, and by the alpha-adrenergic blocking agent at the level of the hematopoietic cells proper. The stimulatory action of Li+ on granulocytopoietic cells is indirect, while is mediated by CA release from adrenal chromaffine cells. At the initial stages of leukocyte restitution in the acute myelotoxic leucopenia relative increase in "large" lymphocyte fraction (Lge) preceding the increment in granulocyte counts is evident. In this fraction of lymphocytes peripheral blood progenitor cells (PBPC) are expected.