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Neuropsychopharmacology: The Fifth Generation of Progress |
Purinergic Mechanisms in Nervous System Function and Disease States
Michael F. Jarvis and Michael Williams
The role of the purine nucleoside, adenosine and its
nucleotides, AMP, ADP and ATP, in intercellular signaling processes originated
with the report of Drury and Szent-Gyorgi in 1929 (25) that adenosine (ADO)
(Fig. 1) and AMP could reduce cardiac contractility,
increase coronary vasodilatation, inhibit intestinal contraction and elicit
CNS sedation in guinea pigs. These findings were rapidly followed by the evaluation
of the therapeutic potential of ADO as an antihypertensive agent. However, the short half life of ADO (2- 10 s) precluded further
interest in the utility of the purine as a potential drug although this shortcoming
proved to be an advantage in the subsequently approved use of ADO for the treatment
supraventricular tachycardia some 60 years later (19).
It was not until the late 1940s that interest in the
role of purines as extracellular messenger molecules re-emerged, culminating
in the 1970s with Burnstock’s now seminal hypothesis of purinergic transmission
that proposed the existence of distinct P1 (adenosine) and P2 (ATP) receptors
(73). The P2 receptor family was then further subdivided on the basis of pharmacological
data into P2X, P2Y and P2T and P2Z receptors.
With the exception of the P2T receptor, molecular clones of all the
receptors proposed from these pharmacological studies have been identified.
Extracellular levels of ATP (Fig.
2)and ADO are increased as the result of tissue trauma, particularly ischemia
and hypoxia (4,92) ADO thus acts as an autocrine homeostatic agent to conserve
tissue function under adverse conditions (91). The widely consumed psychoactive
drug, caffeine produces its CNS stimulatory actions by antagonizing the sedative,
sleep inducing actions of endogenous ADO acting via the A2A receptor
(55) indicating that the purine nucleoside is normally present in the extracellular
environment.
ATP has neuromodulatory actions in amoeba, annelids,
molluscs, coelenterates, crustacea and various insects (8) and are thought to
precede neuropeptides as an intercellular messenger in evolutionary terms
Like the neuropeptides, the
purines, ADO and ATP are also primary cellular constituents that are involved
in nearly all aspects of cell function acting as metabolic cofactors, the building
blocks for nucleic acids and proteins and as key molecules involved in the storage
and production of cellular energy. The concept that ADO and ATP could function
as neuromodulator agents via their presence in the synaptic cleft has been the
subject of considerable debate focusing on why such a “uniquely valuable small
molecule to the cell” (10) would be released to the extracellular milieu. However,
the body can synthesize its own weight in ATP per day (66), the nucleotide being
formed as fast as it is required (10). Thus the amounts of ATP, ADO and their
various intermediates that are involved in neurotransmission/neuromodulation
processes appear inconsequential compared
to the total amounts available. In addition to their role as signalling molecules,
ATP and ADO may also have the potential to alter the cellular energy charge
(2) distal to their site of release. ATP may also act as a substrate for synaptic
membrane phosphorylation events (10).
Abundant evidence now exists to show that ADO has both pre and postsynaptic
effects on neurotransmission processes (6) while ATP has excitatory actions
both centrally and peripherally (90).
Four distinct ADO receptors
and 11 different receptors sensitive to purine and pyrimidine nucleotides, (Tables
1, 2,
and 3; 36, 51, 67, 73) have been
cloned and characterized providing a diversity of cellular targets through which
purines can elicit effects on tissue function.
Purinergic
Receptor Dynamics, Interactions, and the Purinergic Cascade
The metabolic pathways that link ATP, ADP, AMP and
ADO and the potential for each of these purines to elicit receptor-mediated
effects on cell function forms the basis of a potentially complex physiological
cascade that is comparable to those involved blood clotting and complement activation.
Thus ATP released synaptically as a co-transmitter leads to the sequential formation
of ADP, AMP and ADO (Fig. 3). The ATP in the extracellular space can activate
the various classes of P2 receptors and its actions are terminated by receptor
desensitization or dephosphorylation. The latter occurs via group of some 11 enzymes that metabolize ATP, diadenosine
polyphosphates like Ap4A (Fig. 2), and NAD
(99). Ecto-ATPases preferentially hydrolyze ATP to ADP and ecto-apyrases convert
both ATP and ADP to AMP. Ecto-5’-nucleotidase converts AMP to ADO. The activity
of this enzyme class is dynamic. In
myeloid leukocytes, ecto-apyrase and ecto-5’-nucleotidase show stage specific
transient expression (16, 40) while in guinea-pig vas deferens, soluble nucleotidase
are released from neurons together with ATP and norepinephrine (87) suggesting
that the ATP released by nerve activity can undergo increased inactivation as
a result of the same nerve activity that results in its release.
The term inactivation is however a misnomer since the
products of ATP breakdown their own functional activities, some of which are
mutually antagonistic to ATP, and thus comprise a purinergic cascade (Figure
2). ATP can antagonize the actions of ADP on platelet aggregation and ADO-elicited
sedation in the CNS activity contrasts with the excitatory actions of ATP on
nerve cells (73). Furthermore, in the broader framework of ATP-modulated proteins,
ATP-sensitive potassium channels (KATP) can also be activated when
intracellular ATP levels are reduced (32). Thus as P2 receptor mediated responses
are attenuated as a result of ATP hydrolysis to adenosine, P1 mediated responses
and KATP -mediated responses become enhanced. ADP activates platelet
P2T receptors and can also
enhances its own availability while ADO activates members of the P1 receptor
family. Activation of A1 or A2A receptors can inhibit
ATP availability (49) while activation of hippocampal A3 receptors
can desensitize A1 receptor-mediated inhibition of excitatory neurotransmission
(6). For UTP, while high concentrations of uracil have been reported to modulate
CNS dopaminergic systems in animals, there is currently no pharmacological evidence
for a uracil equivalent of the P1 receptor (91).
The purinergic cascade is an
elegant and complex system for the regulation of cell to cell communication
that in physiological terms will be dependent on the dynamics of the local milieu in which ATP is made available
thus reflecting the purinoceptor phenotype of the tissue, ectonucleotidase activities
and ADA, AK and nucleoside transporter activity.
More recently, electrophysiological
studies on P2X and nicotinic receptor-mediated responses have led to the suggestion
(80) that these two ligand gated ion channels interact with one another with
each receptor containing a inhibitory binding site for agonists active at the
other receptor. If this hypothesis proves to be correct, then nicotinic agonist
may function as P2X receptor antagonists. This is particularly interesting inasmuch
as ATP, acting via the P2X receptor is a nociceptive agent while neuronal nicotinic
receptor agonists like ABT-594 are potent analgesic agents (3)
Purine
Availability and Modulation
The factors governing the extracellular availability
of ADO and ATP in nervous tissue have been and remain a controversial issue.
Basal levels of ADO in the extracellular space in the CNS are thought to be
in the 30 -300 nM range. Under conditions of tissue hypoxia or ischemia or in
seizure activity, extracellular ADO levels can approach micromolar levels (28,96) Similarly, extracellular ATP levels can also reach millimolar concentrations
in the local environment either through release as a co-transmitter or following
cellular perturbation (73). ATP is released together with other neurotransmitters
including acetylcholine, norepinephrine, glutamate, GABA and neuropeptide Y
(83) depending on the transmitter repertoire of the neuron.
Under basal conditions, ADO
levels in the extracellular milieu are tightly regulated by ongoing metabolic
activity. Bi-directional nucleoside transporters and the enzymes, ADO deaminase
(ADA) and ADO kinase (AK), regulate the removal of ADO from the extracellular
space (Fig. 4; 35, 42, 52). ADO can also
be formed intracellularly from ATP and transported to the extracellular milieu
via nucleoside transporters thus representing a major source of extracellular
ADO (35).
Under conditions of hypoxia
or ischemia, ADO levels in the extracellular space are markedly increased in
response to increased metabolic demand with the purine acting to regulate the
energy supply / demand balance in a given tissue in response to changes in blood
flow and energy availability (4, 92). Reductions in oxygen or glucose availability
due to tissue trauma such as that that occurs during stroke, epileptogenic activity
and reduced cerebral blood flow lead to the breakdown of ATP with the sequential
formation of ADP, AMP and ADO. Thus the normal homeostatic role of extracellular
ADO can be locally amplified several fold resulting in an enhanced protective
role to prevent further traumatic insult to affected tissues (76).
Studies with a limited number
of ADA and AK inhibitors have shown that inhibition of AK is physiologically
more relevant in increasing extracellular ADO availability than ADA inhibition
(47, 97). AK inhibitors are also more effective in enhancing the neuroprotective
actions of endogenous ADO as compared to inhibitors of ADA or ADO transport
(47,97). Compounds that act to potentiate
the actions of endogenous ADO have effects that are limited to those areas where
tissue insult results in increased production of extracellular ADO, e.g in stroke,
reperfusion injury and epilepsy (Fig. 3).
Such compounds have been termed "site and event specific" agents (29).
The adenosine or P1 receptor family is activated by
adenosine and its many analogs and, with the exception of the rat A3
receptor, is selectively blocked by methyl and arylxanthines derived from caffeine
and theophylline e.g. CPX (Fig. 5) and by
a number of other novel heterocyclic molecules that include CGS 15943A, SCH
58261, ZM 241385, MRS 1067, MRS 1191, MRS 1220 and MRS 1222 (43, 44, 73;Table
1; Fig. 5).
ATP and related purine and pyrimidine nucleotides activate
the P2 receptor family (Tables 2
and 3). However, the selectivity
of the various agonists is extremely dependent on the tissue preparation(s)
used, the species and the experimental protocol. As a result, the functional
characterization of P2 receptors has been limited by a paucity of potent, selective
and bioavailable ligands, both agonists and antagonists (43, 44). All P2 agonist ligands known are closely
related to ATP, UTP, ADP etc. (Fig. 2) and,
irrespective of their degree of chemical modification, show varying degrees
of susceptibility to degradation and intrinsic activity (48). There are also
very few studies where a systematic evaluation of the selectivity of P2 receptor
agonists has been carried out. As a result, their use as probes for the functional
characterization of the various P2 receptor subtypes has been limited. For example,
BzATP is widely used as an agonist for the P2X7 receptor active where
it is active in the micromolar range being 13-times more potent than ATP in
activating this receptor P2X7 receptor (EC50 = 18 mM). It is however, far more
potent at transfected rat and human P2X1 (EC50 = 1.9 nM)
and P2X3 (EC50 = 98 nM) receptors (5)
Evolution
of Receptor Nomenclature
While the nomenclature for P1 receptors is straightforward
from both a pharmacological and a molecular perspective, that for P2 receptors
has evolved in a somewhat haphazard manner reflecting both the complexity of
this superfamily and the limited pharmacological tools available for receptor
characterization. Thus the P2X, P2Y , P2T and
P2Z nomenclature was followed by the identification of various pharmacologically
defined receptors designated P2D, P2U, P3, P4, P2YAp4A
etc. (73) Since ATP was known to produce
its receptor -mediated effects via either ion channels or G protein -coupled
receptors, P2 receptors were divided into two main classes, P2X that are ligand-gated
ion channels and P2Y which are GPCRs. With the cloning of the members of the
P2X and P2Y families, the previous nomenclature systems have been replaced with
P2Xn and P2Yn designations (73). For
the P2X receptor family, these receptors are sequentially numbered 1
through 7 (P2X1 - P2X7) For the P2Y family, receptors
designated P2Y1, P2Y2, P2Y4,
P2Y6, and P2Y11 have been cloned and shown to have functional
activity (51,73; Table 3)
This unusual numbering reflects
the fact that at least six other putative P2Y receptors have been identified
based on putative sequence homology which are either non-mammalian homologues
or receptors for which nucleotides are not the preferred agonists (51, 73).
For example, the putative P2Y7 receptor (1) proved to be a
leukotriene B4 receptor (94). For those receptors that are not valid
members of the P2Y receptor family but have been cloned, lower case is used
to define the receptor. Thus what would be the P2Y3 receptor is designated
as p2y3. For those receptors that have been pharmacologically defined but not
cloned, italics and subscripts are used, e.g. P2T
and P2D.
Four P1 receptors designated A1, A2A,
A2B and A3 (Table
1) have been cloned and pharmacologically characterized (67). All four are
members of the G protein -coupled receptor (GPCR) superfamily and are heterogeneously
distributed in a variety of mammalian tissues including heart, smooth muscle,
kidney, testis, platelets, leukocytes, adipocytes in addition to the
central nervous system (CNS)
The A1 receptor
has a wide distribution in the CNS and is functionally coupled to inhibition
of cAMP formation, stimulation of potassium conductance, inhibition of N-channel-mediated
calcium conductance, stimulation of phospholipase C production and modulation
of nitric oxide production (73). Selective agonists for A1 receptors
are ADO analogs substituted in the N6-position and include cyclohexyl
(CHA), cyclopentyl (CPA; A1 Ki = 0.6 nM)and 2-chlorocyclopentyl (CCPA; Ki =
0.6 nM) ADO (Fig. 1) that are 780- and 1500-
fold selective for the A1 receptor as compared to other P1 receptors
(44). Agonist effects at the A1 receptor are selectively blocked
by 8 - phenyl substituted xanthines including BIIP-20 (Ki = 15 nM) and cyclopentylxanthine
(CPX; Ki = 0.46 nM) that are 180- and 740-fold selective for the A1
receptor, respectively (Fig. 5). Pharmacologically,
the A1 receptor shows distinct species differences at the receptor
level (91). Like other GPCRs, the A1 receptor can be allosterically
modulated by compounds that do not directly interact with the agonist binding
site of the receptor. The thiophenes, PD 81,723 and RS 74513 (Fig. 5) can selectively enhance
A1 receptor binding and function (7, 58) by stabilizing an agonist
preferring conformation of the A1 receptor independent of an interaction
of G proteins (60).
Two molecular and pharmacologically
distinct subtypes of the A2 receptor exist that are linked to activation
of adenylate cyclase (67). The A2A high affinity receptor may also
utilize N- and P-type Ca2+ channels as signal transduction mechanisms.
This receptor is localized in the striatum, nucleus accumbens and olfactory
tubercule regions of mammalian brain. The lower affinity A2B receptor
is more ubiquitously distributed throughout the CNS and periphery. CGS 21680
(Ki A2A = 15 nM; Fig. 1) is an
2-substituted ADO analog that is 39- and 173-fold selective for the A2A
receptor versus A3 and A1 receptors in vitro. The xanthine
antagonists, KF 17837 (Ki A2A = 24 nM; Fig.
5) and CSC (8 -(3-chlorylstyryl) caffeine (Ki A2A = 9 nM) are
108- and greater than 3000-fold selective for A2A receptors versus
other members of the P1 receptor family (43). SCH 58261 (Ki A2A = nM) and ZM241385 (Ki A2A = x nM;
Fig. 5) are novel and potent non-xanthine
antagonists that are 60 - 1000- and 6800-fold selective, respectively for the
A2A receptor (43). The A2B receptor has proven considerably
more difficult to characterize due to a paucity of selective agonist and antagonist
ligands. Responses mediated by the non -selective ADO agonist, 5’N6-ethylcarboxamido
adenosine (NECA) and not by other A1, A2A or A3
receptor selective agonists can however, be attributed to A2B receptor
activation.
The A3 receptor
is a relatively new member of the P1 receptor family that is linked to inhibition
of adenylate cyclase and elevation of cellular IP3 levels and intracellular
Ca2+ and also shows distinct species-dependent pharmacology. The
human A3 receptor is sensitive to xanthine blockade while the rat
receptor is not (67, 91). The A3 receptor shows wide spread distribution
with low levels in brain. IB-MECA (Ki = 1nM) and its 2-chloro analog (Ki = 0.3
- 0.7 nM; Fig. 1) are potent and selective
A3 receptor agonists, the latter being 2500- and 1400-fold selective
for A3 versus A1 and A2A receptors, respectively.
Efforts to identify non-xanthine A3 receptor antagonists have been
unusually successful with the flavonoid
MRS 1067, the dihydropyridine, MRS 1191, the triazolonaphthyridine, L-249313
and the thiazolopyrimidine, L-268605 having been recently identified (43). A3
receptors are involved in mast cell function, eosinophil apoptosis and
the phenomenon known as preconditioning in ischemic reperfusion (61).
The P2 receptor family is divided into two major subclasses;
P2X (Table 2) receptors that are
ligand-gated ion channel (LGIC) receptors specific for ATP and P2Y (Table
3) receptors that are members of the GCPR superfamily (26, 73). While the
initial classification of P2 receptors was based on the rank order
potency in vitro of a limited series
of agonists related to ATP in native tissues, the majority of these receptors
have subsequently been cloned and functionally characterized in various heterologous
expression systems (51, 73).
P2X Receptors.
P2X receptor subunits share a common motif of two transmembrane spanning
regions, a large extracellular domain with both the N and C termini being located
intracellularly in a manner similar to that
of the amiloride-sensitive epithelial Na+ channel (73). As noted by Ralevic and Burnstock (73),
the subunits by themselves are not functional entities. The functional receptor
channel, a non-selective pore permeable to calcium, potassium and sodium and
mediates rapid (~ 10 ms) neurotransmission processes (Fig.
6), is formed by multimeric combinations of the various P2 receptor subunits.
When a given receptor is discussed below, unless stated otherwise, it will refer
to a homomeric functional LGIC. The homomeric and heteromeric combinations and
their proportions in the functional receptor(s) is unclear with evidence for
three, five (65) and four (74) subunit combinations. Seven functional members
of the P2X receptor family, P2X1 - P2X7 have been cloned
and characterized (Table 2). These
have been grouped into three major classes based on agonist efficacy (27). Group
1 includes P2X1 and P2X3 receptors that have high affinity
for ATP (EC50 = 1 mM) and are rapidly activated
and desensitized; Group 2 includes P2X2, P2X4, P2X5
and P2X6 receptors that have lower affinity for ATP (EC50
= 10 mM) and
show a slow desensitization and sustained depolarizing currents; and Group 3
that is represented by the P2X7 LGIC that has very low affinity for
ATP (EC50 = 300 -400 mM), shows little or no desensitization and in
addition to functioning as an ATP-gated ion channel, also functions as a non-selective
ion pore. The physiological significance
of P2X receptor desensitization remains to be determined but clearly reflects
one mechanism by which to terminate the actions of ATP, another being degradation
of the nucleotide to ADO.
Known P2 receptor antagonists include PPADS, DIDS,
various blue dyes that include Evans, trypan and reactive blue-2 and suramin,
the usefulness of which is limited by their lack of selectivity, potency and
bioavailability, not only for the different subtypes of the P2 receptor but
also for other classes of neurotransmitter receptors, G proteins and various
enzymes (43,44,91). In addition, these compounds may also inhibit the enzymes
responsible for the breakdown of ATP and related nucleotides thus further confounding
receptor characterization (48). The lack of any reliable binding assays for
P2 receptor subtypes together with species nuances in receptor pharmacology
(13,14,41) has tended to limit the discovery of improved compounds.
More recent P2X selective antagonists
have been described that have reduced ectonucleotidase activity:
Examples a DIDS analog NH01 and the suramin analogs, NF023 and NF 279
(Fig. 7; 43). A series of trinitrophenyl (TNP) substituted
nucleotides have been reported as noncompetitive, reversible antagonists at
P2X1 and P2X3 receptors (88). TNP-ATP(Fig.
7) which has antagonist activity in the 1 nM range has being characterized
as an allosteric modulator has weak activity at P2X4 and P2X7
receptors. The ATP analogs, A3P5PS and A3P5P (Fig.1) are partial agonists/ competitive
antagonists at the turkey erythrocyte P2Y1 receptor (43) and a derivative,
MRS 2179 (Fig. 7) is a full P2Y1
receptor antagonist (IC50 =330 nM; 11). ARL 67085 (57) is 2-alkylthio
substituted bioisostere of ATP that is a selective antagonist at the ADP-sensitive
P2T/P2YAC receptor involved in platelet aggregation
(21).
P2X1 receptors are activated by 2meSATP,
ATP and ab-meATP, exhibit rapid desensitization kinetics and are present in the
dorsal root, trigeminal and celiac ganglia and in spinal cord and brain. The
P2X1/5 receptor heteromeric polymers display slow desensitization
kinetics and reduced affinity for ab meATP.
The P2X2 receptor is activated by 2MeSATP
and ATPgS but is insensitive to ab-meATP and bg-meATP. This receptor desensitizes
slowly to agonist activation and P2X2-3R splice variants are
present on the endolymphatic surface of the cochlear endothelium, an area associated
with sound transduction (37).
The P2X3 receptor has a rank order of activation
where 2meSATP >> ATP > ab-meATP. This receptor is localized to a subset
of sensory neurons that includes the dorsal root, trigeminal and nodose ganglia.
The P2X3 receptor has similar properties to the P2X1 subtype
including ab-meATP sensitivity and rapid desensitization kinetics. P2X2
and P2X3 subunits can form functional heteromeric receptors in vivo Functionally, the P2X2/3
heteromeric receptor appears to combine the pharmacological properties of P2X3
(ab-meATP
sensitivity) with the kinetic properties of P2X2 (slow desensitization)
thereby facilitating its detection in
situ or in heterologous expression systems (73).
The P2X4 receptor is activated by 2MeSATP
and is only weakly activated by ab meATP. The human P2X4 receptor is
weakly sensitive, and the rat P2X4 receptor insensitive to putative
P2X receptor antagonists. This receptor is present in rat hippocampus, superior
cervical ganglion, spinal cord, bronchial epithelium, adrenal gland, testis
and human brain and can form functional heteromers
with P2X6 subunits in vitro
(54).
The P2X5 receptor shows an activation profile
of ATP > 2MeSATP > ADP with ab meATP being inactive (17). The P2X5
receptor does not exhibit rapid desensitization kinetics but is blocked by suramin
and PPADS. Message for the P2X5 receptor is present in the central
horn of the cervical spinal cord and in trigeminal and dorsal root ganglia neurons.
The P2X5 receptor is found in the brain only in the mesencephalic
nucleus of the trigeminal nerve (17,73)
and can form heteromers with P2X1 subunits.
The P2X6 is present in the superior cervical
ganglion, cerebellar Purkinje cells, spinal motoneurons of lamina IX of the
spinal cord and the superficial dorsal horn neurons of lamina II. It is also
present in trigeminal, dorsal root and celiac ganglia (17). In vivo,
neither the P2X5 nor the P2X6 receptor appear to exist
as homomers but form functional heteromers with other P2X receptor subunits.
The P2X7 receptor, known as the P2Z
receptor before it was cloned (84), is an atypical member of the P2X receptor
family that has been extensively studied in mast cells and macrophages (22,
26). This receptor has a long (240 amino acid) intracellular C-terminal region
that confers a unique phenotype of forming a large non-selective cytolytic pore
upon prolonged or repeated agonist stimulation (22, 26). Application of agonists
to the P2X7 receptor for brief periods (1-2 sec) results in transient
pore opening that is thought to be involved in intercellular signaling processes.
Prolonged P2X7 receptor activation can trigger apoptosis (programmed
cell death), a complex intracellular process that is important in both embryogenesis
and in removing cancerous, infected and dying cells from tissues (15). The P2X7
receptor can be partially activated by saturating concentrations of ATP, but
it is fully activated by the synthetic ATP analog, BzATP (34). The physiological
function of the P2X7 receptor remains unclear since its involvement
in apoptotic events would suggest that its presence within a cell is designed,
under conditions where there are high local concentrations of ATP (300 - 400
mM; 27) leads to the elimination
of the cell.
In the immune system, hemopoetic cell differentiation
and activation are modulated by P2 receptors (27) and IFN-g and LPS can upregulate P2X7 receptor expression (39,40)
an accompanying decrease in ecto-ATPase activity which makes them more susceptible
to the cytolytic actions of extracellular ATP. ATP can induce cytolysis in macrophages that
are infected with mycobacterium via P2X7 receptor - mediated apoptotic
and necrotic events (53). This novel antimicrobial activity of ATP while having
potential utility in the treatment of tuberculosis may also provide a more basic
understanding of P2X7 receptor- mediated apoptotic events than that
can be derived from more complex mammalian cell systems. The P2X7
receptor is found in the SCG and spinal cord (84) and cerebral artery occlusion
results in an increase in P2X7 immunoreactive cells in the penumbral
region around the stroke (17).The release and maturation of IL-1b from
macrophages can be stimulated by ATP acting via P2X7 receptor-mediated
mechanisms (22, 68) that involve activation of the cysteine protease/ caspase,
interleukin -1b convertase (ICE) that is involved in the initiation
of apoptosis (86).
KN-62 is an isoquinoline inhibitor of calcium-calmodulin
dependent protein kinase-II (CamK-II) with an IC50 value of 900 nM.
The compound is also a potent, non-competitive antagonist of the human P2X7
receptor (IC50 = 9 -13 nM; 34). KN-62 was inactive at the transfected
rat P2X7 receptor (41) highlighting species related responses. The
novel anti-inflammatory, tenidap, a putative ICE inhibitor can enhance ATP activation
of P2X7 receptors in mouse macrophages (77).
P2Y
Receptors. The P2Y receptors are
all members of the GPCR superfamily and are activated by both purine and pyrimidine nucleotides (18, 36,
51). While 13 P2Y-like receptors have
been cloned (51) only five mammalian subtypes designated P2Y1, P2Y2,
P2Y4, P2Y6, and P2Y11 have been cloned and
shown to have functional activity (Table
3; 51). All five are coupled to Gq11 and receptor activation
results in stimulation of PLC and IP3 activation and subsequent release
of calcium from intracellular stores (36).
The P2t
receptor in platelet is distinguished from other P2 receptors in that ADP is
the preferred agonist and ATP can function as a competitive antagonist P2t and P2Y1 receptors
share a similar agonist pharmacology leading to the proposal that they are the
same molecular entity although it has yet to be cloned. This is however, controversial
and there is now a body of evidence showing that purine responses in platelets
are mediated via multiple P2 receptor subtypes including a putative P2t
receptor (21).
The
P2Y1 receptor is preferentially activated by adenine nucleotides
with 2MeSATP being the most potent agonist. Uridine nucleotides (e.g. UTP, UDP)
are inactive at this receptor. Suramin,
PPADS and cibacron blue can antagonize P2Y1 receptor activation.
The ADO-bisphosphate analogs, A3P5PS, A3P5P and MRS 2179 (Fig.
1 & Fig. 7) are competitive antagonists
at this receptor (11,43)
The P2Y2 receptor
is activated by both ATP and UTP, with diphosphate nucleotides are inactive.
The efficacy of UTP at this receptor provided molecular evidence for the concept
of pyrimidinergic transmission. P2 receptor
antagonists like suramin and are less efficacious at the P2Y2 receptor.
UTP is the preferred agonist at the P2Y4 receptor with ATP
and the nucleotide diphosphates being inactive. The latter are more active at
the P2Y6 receptor as compared to nucleoside triphosphates. The P2Y6
receptor can thus be classified as a UDP-preferring receptor. The P2Y11
receptor (18) is unique in regard to other P2Y receptors in that only ATP serves
as a agonist for this receptor.
The
diadenosine polyphosphates represent an additional group of purine based signalling
molecules that can modulate cell function via activation of cell surface receptors
(38). A pharmacologically defined Ap4A receptor in nervous tissue can modulate
neurotransmitter release. However, it is unclear whether the actions of the
diadenosine polyphosphates involve unique receptor subtypes since these purines
non- selectively interact with other cloned P2 receptors (73). No distinct receptors
for the diadenosine polyphosphates have yet been cloned.
Therapeutic
Potential of Purinoceptor Ligands in Nervous Tissue
ADO
is a potent inhibitor of dopamine, GABA, glutamate, acetylcholine, serotonin
and norepinephrine release acting via presynaptic A1 receptors (6).
These effects of ADO occur preferentially on excitatory as opposed to inhibitory
neurotransmitter release data (71, 95) implying a degree of specificity in regard
to its effects on brain function. Postsynaptically, ADO can modulate excitability
acting via both A1 and A2A receptors causing hyperpolarization
of the postsynaptic membrane.
In the past 25 years there
have been many studies suggesting that ADO systems in both the CNS and PNS are
involved in the actions of a wide variety of CNS active drugs that include analgesics,
antipsychotics, antidepressants, anxiolytics, nootropics / cognition enhancers
and the various agents effective in stroke related CNS damage. These studies
have involved test paradigms in which either the effects of CNS drugs on ADO
responses have been evaluated or, alternatively, the effects of ADO agonists
or antagonists on the effects of prototypic CNS agents were assessed. In many
instances single, somewhat high, concentrations of a limited number of compounds
were used to draw conclusions related to a complete class of psychotherapeutic
agent, often with no negative control data thus representing a somewhat reductionistic
approach to delineating the role of the purine in drug actions.
Thus, while ADO has been implicated in the actions of a wide variety
of CNS active agents, much of this data must be viewed as interesting in the
absence of more rigorous evaluation. For P2 receptors where the absence of ligands,
either agonists and antagonists, limit the functional characterization of the
various receptor subtypes, the delineation
of a role(s) for P2 receptors in CNS pathology has been postulated largely on
the basis of in situ localization of the mRNAs encoding the different
P2 receptor subtypes.
One way to circumvent these
limitations is the use of mice made deficient in a targeted receptor by gene
disruption, the phenotype of which will provide information on the role of the
receptor. In A2A receptor knockout mice, caffeine no longer acts
as a stimulant but depresses exploratory activity. These mice which were insensitive
to the effects of the A2A agonist, CGS 21680, were more anxious,
more aggressive, had higher nociceptive thresholds and increases in blood pressure
and heart rate (55)
Compounds that produce their
effects via purinoceptor systems, either P1 or P2 receptors, comprise three
distinct classes - i) conventional agonists, partial agonists or antagonists;
ii) allosteric modulators of receptor function and ii) modulators of the endogenous
systems that regulate the extracellular availability of ATP, ADO, UTP and their
respective nucleotides. This latter group includes the various ecto-ATPases,
adenosine deaminase, adenosine kinase and the bi-directional member transporter
systems (35, 42, 52) that remove ADO from the extracellular environment (Fig.
4).
Efforts over the last 25 years
to develop directly acting P1 receptor agonists and antagonists as therapeutic
agents (91) have been unsuccessful due to a combination of the choice of disease
states in which other therapeutic modalities have been successful and the side-effects
associated with global receptor modulation. The identification of partial agonists
that may have enhanced tissue specificity (42), allosteric modulators (7, 34)
or of novel modulators of ADO and ATP metabolism may result in the discovery
of clinically useful agents with greater therapeutic indices (35, 52).
In
hypoxia (92)and focal ischemia (76) there is rapid extracellular accumulation
of ADO supporting the role of the purine as a homeostatic neuroprotective function
of endogenous ADO (52, 91). In support of this concept, directly acting ADO
receptor agonists can reduce cerebral ischemic damage while, in contrast, ADO
receptor antagonists exacerbate ischemic brain damage in animal models of focal
and global cerebral ischemia (98). The neuroprotective effects of ADO are mediated
by several distinct but complementary mechanisms (76). ADO A1 receptor
activation stabilizes neuronal membrane potential, inhibiting neuronal excitability
and excitatory amino acid (EAA) release (76). Blockade of EAA release thus prevents
the neurotoxic sequalae associated with activation on NMDA receptor.
ADO also hyperpolarizes astrocyte membranes, limiting extracellular
glutamate and potassium accumulation and modulates local cerebral blood flow
and local inflammatory responses such as platelet aggregation and neutrophil
recruitment and adhesion acting via
the A2A receptor (31)
A1 receptor agonists
like CHA can reduce stroke related cell death and hippocampal neurodegeneration
(76) while ADO antagonists increase ischemic damage by enhancing glutamate release.
The prototypic AK inhibitor, 5’d-5IT is also neuroprotective (52, 63) Expression
of P2X7 receptor mRNA is upregulated on microglial cells in the ischemic
penumbral region 24 hr following middle cerebral artery occlusion in the rat (17) suggesting that cytolytic pore formation and inflammatory cytokine
release (22) are events associated with neural trauma and neurodegeneration
Seizure activity
is associated with rapid and marked increases in brain ADO concentrations in
both animals (50) and in epileptic patients with spontaneous onset seizures
(28). ADO agonists reduce seizure activity induced by a variety of chemical
and electrical stimuli in animal models (23) acting via A1 receptors
(50) In electrically kindled seizure
models, ADO agonists reduce seizure severity and duration without significantly
altering seizure threshold (50). The anticonvulsant effects of ADO agonists
are blocked by doses of methylxanthines that, when given alone, have no observable
effect on seizure activity (50).
The direct administration
of the AK inhibitors, 2’-deoxycoformycin, NH2dADO and 5-IT (Fig.
1) into rat brain reduced bicuculline methiodide-induced seizures (97).
AK inhibitors were more effective than either ADA inhibitors(2’-deoxycoformycin)
or nucleoside transport inhibitors (dilazep) in this model.
5’d-5IT given systemically was more potent in reducing PTZ-induced seizures
in mice as compared to NH2dADO and 5-IT in agreement with the rank
order of potency of these AK inhibitors in inhibiting ADO phosphorylation in
intact cells. (52) These effects appear to be centrally mediated as the peripherally
active ADO receptor antagonist, 8-(p-sulfophenyl)theophylline
(8-PST) was unable to antagonize the anticonvulsant actions of 5’d-5IT while
the A1-selective antagonist, 8-cyclopentyl-1,3-dimethylxanthine (CPT),
completely block PTZ-induced seizures in mice (50). Other AK inhibitors like
GP515, GP683, and GP3269 also have enhanced in vivo potency as compared to NH2dADO in reducing PTZ
and maximal electroshock seizures in mice (52, 63).
The
role of ATP as an excitatory neurotransmitter coupled with the finding of reduced
ecto-ATP activity in situations of increased seizure sensitivity suggests that
ATP may participate in pathological neuronal hyperexcitability. Recent studies
have shown that ATP agonists potent induced generalized seizures following direct
infusion into the prepiriform cortex (50). Interestingly, direct administration
of 8-PST was shown to potentiate the proconvulsant effects of ATP in this brain
region further supporting a specific and discrete role for ATP in the excitatory
neurotransmission events associated with seizure generation.
It
is widely accepted that the neuronal hyperexcitability associated with ischemia,
hypoxia and epilepsy also underlies the neurodegenerative processes associated
with aging. Thus the toxicity following
excessive glutamate release and the resultant changes in calcium homeostasis
that lead to nerve cell death may reflect an acute manifestation of more subtle,
long term changes that are associated with Alzheimer's and Parkinson's Disease.
ADO antagonists like caffeine and theophylline are potent CNS stimulants
and enhance cognition in animal models acting by blocking the actions of endogenous
ADO. For instance, the 8 - substituted
xanthine, BIIP 20 ((+)-8 - (3-oxocyclopentyl)- 1, 3- dipropylxanthine; Fig.
1) has been clinically evaluated as a cognition enhancing agent with potential
utility in the treatment of Alzheimer's and other age-related dementias (91).
The
utility of ADO ligands in addressing the processes underlying neurodegeneration
is bifunctional. Agonists reduce EAA-induced neurotoxicity while antagonists
enhance cognition by disinhibition of the inhibitory effects of ADO on excitatory
neurotransmission. If CNS - selective purinoceptor ligands are to be effective
agents for the amelioration of the cognitive decline associated with aging,
a functional equilibrium will need to be established between the neuroprotective
and CNS stimulatory actions of the purine. In this context, P1 receptor partial
agonists may represent useful entities (42).
Amyloid-b-protein (Ab) may elicit nerve cell death
in Alzheimer's Disease via activation of the classical complement cascade via
an immunoglobulin-independent mechanism and epidemiological data that indicates
that aged patients with rheumatoid arthritis who consume large quantities of
traditional anti-inflammatory agents have a reduced incidence of Alzheimer's
disease has underlined a role for inflammation in he onset of this disease.
ADO agonists are potent anti-inflammatory agents (31) acting to inhibit free
radical production and may thus provide
additional benefit in AD over and above direct effects on neurotransmitter -
mediated neuronal events.
In nervous tissue, trophic factors ensure neuronal
viability and regeneration (64). Increases in the polypeptide growth factors
e.g. fibroblast growth factors, epidermal growth factor and platelet-derived
growth factor are increased following neural injury (64). ATP can act in combination
with various growth factors to stimulate astrocyte proliferation ,contributing
to the process of reactive astrogliosis, a hypertrophic/hyperplastic response
that is frequently associated with brain trauma, stroke/ischemia, seizures and
various neurodegenerative disorders.In reactive astrogliosis, astrocytes undergo
process elongation and express GFAP (glial fibrillary acidic protein), an astrocyte
specific intermediate filament protein. ATP increases GFAP and AP-1 complex
formation in astrocytes (64) in a manner quantitatively similar to that seen
with bFGF. In addition, ATP as well as GTP can induce trophic factor (NGF, NT-3,
FGF) synthesis in astrocytes and neurons.
ADO
DOPAMINE INTERACTIONS: Parkinson's Disease and Psychosis
A
detailed body of behavioral and biochemical data supports a functional interaction
between central dopaminergic and purinergic systems (30). Methylxanthines like
caffeine stimulate rotational behavior and potentiate the effects of dopamine
(DA) agonists in rats with unilateral striatal lesions. Conversely, ADO agonists
can blocked the behavioral effects of DA via A2A receptor activation
(75). Interestingly, in mouse A2A receptor knockouts, exploratory
motor activity was reduced relative to controls and caffeine was able to further
reduced this activity, an effect opposite to its well characterized psychomotor
stimulant effects (55).
ADO A2A receptors
are highly localized in striatum, nucleus accumbens and olfactory tubercule,
brain regions that also have high densities of DA D1 and D2
receptors. Furthermore, mRNAs for ADO
A2A receptors and DA D2 receptors are co-localized in
GABAergic- enkephalin striatopallidal neurons in the basal ganglia (Fig.
8) that represent the so-called “indirect' pathway from the striatum to
the globus pallidus. Dysfunction of this pathway may be involved in the etiology
of Huntingtons' chorea as well as the movement disorders associated with Parkinson's
disease (PD; 30). The indirect pathway originates from striatal GABA - enkephalinergic
neurons and via GABAergic relays interacts with a glutaminergic pathway arising
in the subthalamic nucleus (Fig. 8). The
latter can activate the internal segement of the
pars reticulata which relays through a pars reticulata thalamic GABAergic
pathway to inhibit the thalmic/ cortical glutaminergic pathway (Fig.
9a).
A
direct pathway also exists that originates in the striatum from GABA - Substance
P - dynorphinergic neurons which,acting via a GABAergic pathway also inhibits
the internal segment of the pars reticulata to disinhibit the ascending thalamic
glutaminergic pathway (Fig. 8 & Fig.
9b). The balance between these direct (cortical activating) and indirect
(cortical inhibiting) striatal dopaminergic pathways
tonically regulates normal motor activity. Dopaminergic inputs arising
from the pars compacta can facilitate motor activity,
inhibiting the indirect pathway by activation of D2 receptors and
activating the direct pathway via D1 receptor activation.
These
findings have led to the hypothesis that striatal ADO systems, specifically
those involving A2A receptors, may play a pivotal role in neurological
disorders involving basal ganglia malfunction like PD. Intrastriatal administration
of the A2A agonist, CGS 21680 attenuates rotational behavior produced
by both direct and indirect DA agonists in unilaterally lesioned rats. Radioligand
binding studies have shown an increased efficacy of CGS 21680 in reducing the
binding affinity of supersensitive D2 receptors, a mechanistic finding
that supports the increased sensitivity of animals with supersensitive DA receptors
to CGS 21680. Repeated administration of the DA antagonist, haloperidol can
upregulate the density of both DA D2 and ADO A2A receptors
in rat striatum. The modulatory influence of ADO on dopaminergic neurotransmission
is thus enhanced in situations of increased DA receptor sensitivity (30, 75).
The
modulatory relationship between ADO and DA extends to the ADO A1
receptor, activation of which can reduce the high affinity state of striatal
DA D1 receptors {30). Functionally,
the A1 selective agonist, CPA blocks DA D1 receptor-mediated
locomotor activation in reserpinized mice. Similarly, the non- selective ADO
agonist, NECA can attenuate perioral dyskinesias induced by selective DA D1
activation in rabbits..
ADO
acting at both striatal A2a and A1 receptors directly
modulates DA receptor -mediated effects on striatal GABA-enkephalinergic neurons
and DA D1 receptors on striatal GABA-Substance P neurons (Fig.
5). While the exact mechanisms by
which ADO agonists modulate the binding of dopaminergic agonists at the D1
and D2 receptors is currently unknown, these interactions appear
to be independent of G protein coupling and an intramembrane modulatory mechanism
has been proposed (30).
This dynamic inter-relationship
between dopaminergic and purinergic systems in the neurochemistry of psychomotor
function offers new possibilities for the amelioration of dopaminergic dysfunction
via ADO receptor modulation. Selective adenosine A2A receptor antagonists
like KW 17837 have been evaluated as novel treatments for PD in MPTP lesioned
marmosets(75). Aa related analog, KW-6002 potentiates the antiparkinsonian effects
of L-dopa without producing dyskinesia in this model (46)
As
would be predicted, ADO agonists mimic the biochemical and behavioral actions
of DA antagonists in animal models, an effect mediated via A2A receptors.
ADO agonists inhibit DA release and synthesis and attenuate DA transductional
processes effects that contribute to a diminution in dopaminergic neurotransmission.
ADO receptor agonists thus act as functional DA antagonists (30).
The
lack of a clear dose-dependent effect for the A2A selective agonist
CGS 21680 to induce catalepsy illustrates the possibility that activation of
A2A receptors can produce favorable antipsychotic activity
without untoward motor impairment (30,62).
One ADO agonist, CI -936 was advanced to the clinic over a decade ago
as a novel antipsychotic but was terminated in Phase II trials due to undisclosed
side effect liabilities.
The
hypnotic and sedative effects of ADO are well known as are the central stimulant
activities of the various xanthine ADO antagonists that include caffeine (45).
Direct administration of ADO into the brain elicits an EEG profile similar to
that seen in deep sleep, manifested as an increase in REM sleep with a reduction
in REM sleep latency that results in an increase in total sleep (12) Caffeine,
on the other hand, suppresses REM sleep and decreases total sleep time. Sleep
deprivation can increase ADO A1 receptor density in the cortex and
corpus striatum (12). In vivo microdialysis
studies have shown that extracellular ADO concentrations increase in basal forebrain
in proportion to periods of sustained wakefulness and declined during sleep
(70) suggesting that ADO functions as a endogenous sleep regulator. Infusion
of the A2A agonist, CGS 21680 into the subarachnoid space associated
with the ventral surface of the rostral basal forebrain, an area defined as
the prostaglandin D2-sensitive sleep promoting zone increased slow
wave (SWS) and paradoxical (PS) sleep, effects blocked by the A2A
antagonist, KW 17837 (78). The A1 selective agonist, CHA, suppressed
SWS and PS prior to eliciting an increase in SWS.
Application of ATP to sensory afferents
results in hyperexcitability and the perception of intense pain. The nucleotide
can also induce nociceptive responses at local sites of administration and can
facilitate nociceptive responses to other noxious stimuli (79). P2 receptor
antagonists like suramin and PPADS reduce nociceptive responses in animal models
of acute and persistent pain (24).
The pronociceptive actions of ATP
are mediated via P2X receptors present on sensory afferents and in the spinal
cord. Homomeric P2X3 and heteromeric P2X2/3 receptors
are highly localized the sensory nerves
that specifically transmit nociceptive signals (20). ATP is released from a
number of cell types (e.g. sympathetic nerves, endothelial cells, visceral smooth
muscle) in response to trauma (9) and there is a substantive body of evidence
that activation of P2X3 receptors may initiate and contribute to
the peripheral and central sensitization associated with visceral nociception
(9). P2X3 receptor expression is upregulated in sensory afferents
and spinal cord following damage to peripheral sensory fibers (90).Thus the
development of selective, bioavailable P2X3 receptor antagonists
may be anticipated to provide novel compounds for the treatment of pain.
While ATP acts to facilitate
nociceptive sensory information processing, ADO has opposite effects, inhibiting
nociceptive processes in the brain and spinal cord. Intrathecal
ADO, ADO receptor agonists and AK inhibitors provide pain relief in a
broad spectrum of animal models (e.g. mouse hot plate test, mouse tail flick
assay, rat formalin test, mouse abdominal constriction assay (47, 52, 69, 79).
These effects are blocked by systemic or intrathecal ADO receptor antagonist
administration. ADO agonists are also effective in relieving neuropathic pain
in rat models (56).
ADO receptor agonists also inhibit pain behaviors elicited
by spinal injection of substance P and the glutamate agonist, NMDA .Glutamate
is a key mediator of the abnormal hyperexcitability of spinal cord dorsal horn
neurons (central sensitization) that is associated with clinical pain states
(93) A1 agonists inhibit the spinal cord glutamate release and also
reduce cerebrospinal fluid levels of substance P in rat, another key mediator
of nociceptive responses (79, 81,82). Electrophysiological studies have shown
both pre- and post-synaptic actions of ADO on synaptic transmission from primary
afferent fibers to neurons of the substantia gelatinosa of the spinal dorsal
horn (59). Thus a combination of peripheral and supraspinal mechanisms contribute
to ADO modulation of nociception. The ADO agonists, CHA, R-PIA and NECA, were
10 to 1000-fold more potent in inhibiting acetylcholine-induced writhing in
mice when administered i.c.v than orally, suggesting a supraspinal site of action
(52). ATP can also modulate nociceptive transmission processes in the spinal
cord (59). The ability of ADO to inhibit neurotransmitter release (6) and inflammatory
processes (31) may contribute to the blockade of peripheral sensitization which
is a feature of the pain resulting from tissue injury and inflammation (92). ADO agonists have also shown utility in relieving human pain (82).
Spinal administration of the A1 agonist, R-PIA relieved allodynia
in a neuropathic pain patient without affecting normal sensory perception and
ADO infusion (at doses without effect on the cardiovascular responses) improved
pain symptoms in clinical pain models reducing spontaneous pain, ongoing hyperalgesia
and allodynia in patients with neuropathic pain. In addition, low dose infusions
of perioperative ADO during surgery
reduced the requirement for volatile anesthetic and for postoperative opioid
analgesia (33, 81).
AK inhibitors are also active in a variety of animal
pain models (52). As noted in animal seizure models, NH2dADO was
a more effective antinociceptive agent than the ADO deaminase inhibitor, deoxycoformycin
(47). The effects of NH2dADO were blocked by intrathecal co- administration
of theophylline. NH2dADO, and two other AK inhibitors, 5'd-5IT and 5IT
were also active when given systemically in the mouse hotplate test (52).
Challenges
in the Development of CNS Selective Therapeutic Agents
In the past decade, the field
of purinergic pharmacology has undergone significant growth as the complexity
of the receptor families and the various enzymes involved in purine metabolism
have been cloned. Progress in delineating
bona fide targets for therapeutic intervention and the development of selective
compounds that may represent drugs has continued to be slow. One theme that
has emerged however, is the complex interactions of P1 and P2 receptor systems
and their ligands. A wide spectrum of ligands have been developed for P1 receptors
over the past 30 years. Interestingly, the majority of these were developed
in the compete absence of information regarding the molecular structure of these
receptors and without the advantages of high throughput screening to identify
novel structures. In contrast, the search for P2 receptor ligands with improved
potency, selectivity and bioavailability is occurring in a very different era
of drug discovery with the molecular structure of the targets firmly established
coupled with the ability to functionally characterize these receptors in transfected
cell systems..
Efforts to develop therapeutics
based on the modulation of purine receptor responses for CNS disorders have
not been very successful. CI-936 has already been mentioned while the potential
use of ADO antagonists as cognition enhancers/CNS stimulants has been investigated
with compounds like BIIP 20 with no results are available on any clinical utility.
The extensive research efforts at the Karolinska Institute on the interrelationships
between A2A receptors and D2 receptors in the basal ganglia
offer a novel approach to the treatment of PD and KF 17837 and KW 6002 have
already shown positive results in predictive animal models of this disease (46,
75). Direct acting ADO agonists have shown problems with tolerance and a lack
of tissue selectivity (44, 91) However, novel AK inhibitors have shown potential
to enhance the endogenous neuroprotective actions of ADO in epilepsy, stoke,
and chronic pain (52).
While much less is currently
known regarding the P2 receptor families in CNS function, the discrete localization
of the P2X3 receptor on sensory nociceptive neurons (20)
together with the nociceptive actions of P2 agonists (9, 24) suggests
that antagonists for this receptor may have
potential as novel analgesic agents. Finally, the emerging role of the P2X7
receptor in apoptotic events and its increase in ischemic tissues (17) suggests
that this receptor may be as a key mediator of the molecular events related
to neurodegeneration as extracellular ATP levels are increased under conditions
of neuronal trauma including hypoxia/ischemia, neuropathic pain and viral load.
The development on novel ligands for these receptors coupled with genetic analysis
of tissues from various disease states may be anticipated to provide a wealth
of novel targets to aid in the understanding on CNS disease states and their
amelioration.
Acknowledgements: The authors would like to thank Ed Burgard and Wende Niforatos for providing the information in Fig. 6. They would also like to acknowledge the extensive work of their colleagues in the purine research area whose work, for reasons of space limitations, could not be cited.
published 2000