A1 receptors are implicated in sleep promotion by inhibiting wake-promoting cholinergic neurons in the basal forebrain.[6] A1 receptors are also present in smooth muscle throughout the vascular system.[7]
The adenosine A1 receptor has been found to be ubiquitous throughout the entire body.[citation needed]
This receptor has an inhibitory function on most of the tissues in which it rests. In the brain, it slows metabolic activity by a combination of actions. At the neuron's synapse, it reduces synaptic vesicle release.[citation needed]
In the heart, A1 receptors play roles in electrical pacing (chronotropy and dromotropy), fluid balance, local sympathetic regulation, and metabolism.[9]
Collectively, these mechanisms lead to an myocardial depressant effect by decreasing the conduction of electrical impulses and suppressing pacemaker cells function, resulting in a decrease in heart rate. This makes adenosine a useful medication for treating and diagnosing tachyarrhythmias, or excessively fast heart rates. This effect on the A1 receptor also explains why there is a brief moment of cardiac standstill when adenosine is administered as a rapid IV push during cardiac resuscitation.[citation needed] The rapid infusion causes a momentary myocardial stunning effect.
In normal physiological states, this serves as protective mechanisms. However, in altered cardiac function, such as hypoperfusion caused by hypotension, heart attack or cardiac arrest caused by nonperfusing bradycardias, adenosine has a negative effect on physiological functioning by preventing necessary compensatory increases in heart rate and blood pressure that attempt to maintain cerebral perfusion.[citation needed]
Metabolically, A1AR activation by endogenous adenosine across the body reduces plasma glucose, lactate, and insulin levels, however A2aR activation increased glucose and lactate levels to an extent greater than the A1AR effect on glucose and lactate.[21] Thus, intravascular administration of adenosine increases the amount of glucose and lactate available in the blood for cardiac myocytes. A1AR activation also partially inhibits glycolysis, slowing its rate to align with oxidative metabolism, which limits post-ischemic damage through reduced H+ generation.[22]
In the state of myocardial hypertrophy and remodeling, interstitial adenosine and the expression of the A1AR receptor are both increased. After transition to heart failure however, overexpression of A1AR is no longer present.[23] Excess A1AR expression can induce cardiomyopathy, cardiac dilatation, and cardiac hypertrophy.[24] Cardiac failure may involve increased A1AR expression and decreased adenosine in physical models of cardiac overload and in dysfunction induced by TNFα.[25] Heart failure often involves secretion of atrial natriuretic peptide to compensate for reduced renal perfusion and thus, secretion of electrolytes. A1AR activation also increases secretion of atrial natriuretic peptide from atrial myocytes.[26][27]
^"Human PubMed Reference:". National Center for Biotechnology Information, U.S. National Library of Medicine.
^"Mouse PubMed Reference:". National Center for Biotechnology Information, U.S. National Library of Medicine.
^Townsend-Nicholson A, Baker E, Schofield PR, Sutherland GR (March 1995). "Localization of the adenosine A1 receptor subtype gene (ADORA1) to chromosome 1q32.1". Genomics. 26 (2): 423–425. doi:10.1016/0888-7543(95)80236-F. PMID7601478.
^Tawfik HE, Schnermann J, Oldenburg PJ, Mustafa SJ (March 2005). "Role of A1 adenosine receptors in regulation of vascular tone". American Journal of Physiology. Heart and Circulatory Physiology. 288 (3): H1411–H1416. doi:10.1152/ajpheart.00684.2004. PMID15539423. S2CID916788.
^Romagnoli R, Baraldi PG, IJzerman AP, Massink A, Cruz-Lopez O, Lopez-Cara LC, et al. (September 2014). "Synthesis and biological evaluation of novel allosteric enhancers of the A1 adenosine receptor based on 2-amino-3-(4'-chlorobenzoyl)-4-substituted-5-arylethynyl thiophene". Journal of Medicinal Chemistry. 57 (18): 7673–7686. doi:10.1021/jm5008853. PMID25181013.
^Gottlieb SS, Brater DC, Thomas I, Havranek E, Bourge R, Goldman S, et al. (March 2002). "BG9719 (CVT-124), an A1 adenosine receptor antagonist, protects against the decline in renal function observed with diuretic therapy". Circulation. 105 (11): 1348–1353. doi:10.1161/hc1102.105264. PMID11901047. S2CID14866962.
^Greenberg B, Thomas I, Banish D, Goldman S, Havranek E, Massie BM, et al. (August 2007). "Effects of multiple oral doses of an A1 adenosine antagonist, BG9928, in patients with heart failure: results of a placebo-controlled, dose-escalation study". Journal of the American College of Cardiology. 50 (7): 600–606. doi:10.1016/j.jacc.2007.03.059. PMID17692744. S2CID37858957.
^Givertz MM, Massie BM, Fields TK, Pearson LL, Dittrich HC (October 2007). "The effects of KW-3902, an adenosine A1-receptor antagonist,on diuresis and renal function in patients with acute decompensated heart failure and renal impairment or diuretic resistance". Journal of the American College of Cardiology. 50 (16): 1551–1560. doi:10.1016/j.jacc.2007.07.019. PMID17936154.
^Cotter G, Dittrich HC, Weatherley BD, Bloomfield DM, O'Connor CM, Metra M, et al. (October 2008). "The PROTECT pilot study: a randomized, placebo-controlled, dose-finding study of the adenosine A1 receptor antagonist rolofylline in patients with acute heart failure and renal impairment". Journal of Cardiac Failure. 14 (8): 631–640. doi:10.1016/j.cardfail.2008.08.010. PMID18926433.
^Lorbar M, Chung ES, Nabi A, Skalova K, Fenton RA, Dobson JG, et al. (November 2004). "Receptors subtypes involved in adenosine-mediated modulation of norepinephrine release from cardiac nerve terminals". Canadian Journal of Physiology and Pharmacology. 82 (11): 1026–1031. doi:10.1139/y04-108. PMID15644943.
"Adenosine Receptors: A1". IUPHAR Database of Receptors and Ion Channels. International Union of Basic and Clinical Pharmacology. Archived from the original on 2020-09-20. Retrieved 2007-10-25.