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Summary of the Sequence of Events Underlying Synaptic Transmission at the Skeletal Neuromuscular Junction the normal EPP is due to the simultaneous release of more than 100 packages of ACh, each containing 104 molecules and each quanta producing a potential change by itself of 0.4 mV. Calcium ions appear to be the critical step in causing the release of the vesicles. In low extracellular Ca2+, an action potential in the presynaptic terminal results in a small amount of Ca2+ influx and a small number of vesicles released. When the extracellular Ca2+ concentration is high, a large amount of Ca2+ flows into the terminal and causes a larger number of vesicles to be released (and therefore a larger EPP). The Ca2+ that enters the cell promotes the binding of vesicles with the inside membrane of the presynaptic terminal to promote exocytosis (Fig. 18). Considerable progress has been made in identifying the specific proteins involved in the docking, fusion, and regulation of vesicular release.

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