The neuronal nicotinic acetylcholine receptor alpha 4 beta 2 forms pentameric proteins with two alternate stoichiometries. The high-sensitivity receptor is related to (alpha 4)(2)(beta 2)(3) stoichiometry while the low-sensitivity receptor to (alpha 4)(3)(beta 2)(2) stoichiometry. Both subtypes share two binding sites at the alpha 4((+))/beta 2((-)) interface with high affinity for agonists. (alpha 4)(3)(beta 2)(2) has an additional binding site at the alpha 4((+))/alpha 4((-)) interface with low affinity for agonists. We investigated activation kinetics of both receptor subtypes by patch-clamp recordings of single-channel activity in the presence of several concentrations of acetylcholine (0.5 to 300 mu M). We used kinetic software to fit these data with kinetic models. We found that the high-sensitivity subtype correlates with the low-conductance channel (g(-70) = 29 pS) and does not activate with high efficacy. On the contrary, the low-sensitivity subtype correlated with a high-conductance channel (g(-70) = 44 pS) and exhibited higher activation efficacy. Opening events of individual nAChRs at high agonist concentrations occurred in clusters, which allowed us to determine kinetic constants for the activation of the triliganded receptor. Our kinetic modeling identified an intermediate state, between resting and open conformation of the receptor. Binding of the third molecule increases the efficacy of receptor activation by favoring the transition between resting and intermediate state around 18 times. The low rate for this transition in the diliganded receptor explains the action of acetylcholine as partial agonist when it binds to the high-affinity sites. The presence of the third binding site emerges as a potent modulator of nicotinic receptor alpha 4 beta 2 activation which may display different functions depending on agonist concentration. (C) 2016 Elsevier B.V. All rights reserved.