Purinergic signalling : therapeutic potential * GEOFFREY BURNSTOCK

The concept of a purinergic signalling system, using purine nucleotides and nucleosides as extracellular messengers, was first proposed over 30 years ago. After a brief introduction and update of purinoceptor subtypes, this article focuses on the diverse pathophysiological roles of ATP, ADP, UTP and adenosine. These molecules mediate short-term (acute) signalling functions in neurotransmission, secretion and vasodilatation and long-term (chronic) signalling functions in development, regeneration, proliferation and cell death. Plasticity of purinoceptor expression in pathological conditions is frequently observed, including an increase in the purinergic component of parasympathetic nervous control of the human bladder in interstitial cystitis and outflow obstruction, and in sympathetic cotransmitter control of blood vessels in hypertensive rats. The antithrombotic action of clopidogrel, a P2Y12 receptor antagonist, has been shown to be particularly useful in the prevention of recurrent strokes and heart attacks in recent clinical trials. The role of P2X3 receptors in nociception and a novel hypothesis about purinergic mechano-sensory transduction in visceral pain will be considered, as well as the therapeutic potential of purinergic agonists or antagonists for the treatment of supraventricular tachycardia, cancer, dry eye, bladder hyperactivity, erectile dysfunction, osteoporosis, diabetes, gut motility, respiratory and vascular