Signalling complex involving purine nucleosides and their receptors
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Receptors for adenosine (called P1) and for ATP and ADP (called P2) were distinguished in 1978. Later, the P2 receptors were subdivided into P2X and P2Y families based on their different mechanisms. In the early 1990s, when the receptors to purines and pyrimidines were cloned and characterized, numerous subtypes of P1 and P2 receptors were discovered.[3]
The purinergic signalling complex of a cell is sometimes referred to as the “purinome”.[4]
Background
Evolutionary origins
Purinergic receptors, represented by several families, are among the most abundant receptors in living organisms and appeared early in evolution.[6]
The primitive P2X receptors of unicellular organisms often share low sequence similarity with those in mammals, yet they still retain micromolar sensitivity to ATP. The evolution of this receptor class is estimated to have occurred over a billion years ago.[10]
Molecular mechanisms
Generally speaking, all cells have the ability to release nucleotides. In neuronal and neuroendocrinal cells, this mostly occurs via regulated exocytosis.[1] Released nucleotides can be hydrolyzed extracellularly by a variety of cell surface-located enzymes referred to as ectonucleotidases. The purinergic signalling system consists of transporters, enzymes and receptors responsible for the synthesis, release, action, and extracellular inactivation of (primarily) ATP and its extracellular breakdown product adenosine.[11] The signalling effects of uridine triphosphate (UTP) and uridine diphosphate (UDP) are generally comparable to those of ATP.[12]
Purinergic receptors
Purinergic receptors are specific classes of membrane receptors that mediate various physiological functions such as the relaxation of gut smooth muscle, as a response to the release of ATP or adenosine. There are three known distinct classes of purinergic receptors, known as P1, P2X, and P2Y receptors. Cell signalling events initiated by P1 and P2Y receptors have opposing effects in biological systems.[13]
The extracellular concentration of adenosine can be regulated by NTs, possibly in the form of a feedback loop connecting receptor signaling with transporter function.[14]
Ectonucleotidases
Released nucleotides can be hydrolyzed extracellularly by a variety of cell surface-located enzymes referred to as ectonucleotidases that control purinergic signalling. Extracellular nucleoside triphosphates and diphosphates are substrates of the ectonucleoside triphosphate diphosphohydrolases (E-NTPDases), the ectonucleotide pyrophosphatase/phosphodiesterases (E-NPPs) and alkaline phosphatases (APs). Extracellular AMP is hydrolyzed to adenosine by ecto-5'-nucleotidase (eN) as well as by APs. In any case, the final product of the hydrolysis cascade is the nucleoside.[15][16]
Pannexins
The Pannexin-1 channel (PANX1) is an integral component of the P2X/P2Y purinergic signaling pathway and the key contributor to pathophysiological ATP release.[17] For example, the PANX1 channel, along with ATP, purinergic receptors, and ectonucleotidases, contribute to several feedback loops during the inflammatory response.[18]
Purinergic signalling in humans
Circulatory system
In the human heart, adenosine functions as an autacoid in the regulation of various cardiac functions such as heart rate, contractility, and coronary flow. There are currently four types of adenosine receptors found in the heart.[19] After binding onto a specific purinergic receptor, adenosine causes a negative chronotropic effect due to its influence on cardiac pacemakers. It also causes a negative dromotropic effect through the inhibition of AV-nodal conduction.[20] From the 1980s onwards, these effects of adenosine have been used in the treatment of patients with supraventricular tachycardia.[21]
The regulation of vascular tone in the endothelium of blood vessels is mediated by purinergic signalling. A decreased concentration of oxygen releases ATP from erythrocytes, triggering a propagated calcium wave in the endothelial layer of blood vessels and a subsequent production of nitric oxide that results in vasodilation.[22][23]
During the blood clotting process, adenosine diphosphate (ADP) plays a crucial role in the activation and recruitment of platelets and also ensures the structural integrity of thrombi. These effects are modulated by the P2RY1 and the P2Y12 receptors. The P2RY1 receptor is responsible for shape change in platelets, increased intracellular calcium levels and transient platelet aggregation, while the P2Y12 receptor is responsible for sustained platelet aggregation through the inhibition of adenylate cyclase and a corresponding decrease in cyclic adenosine monophosphate (cAMP) levels. The activation of both purinergic receptors is necessary to achieve sustained hemostasis.[24][25]
Digestive system
In the liver, ATP is constantly released during homeostasis and its signalling via P2 receptors influences bile secretion as well as liver metabolism and regeneration.[26]P2Y receptors in the enteric nervous system and at intestinal neuromuscular junctions modulate intestinal secretion and motility.[27]
Autocrine purinergic signalling is an important checkpoint in the activation of white blood cells. These mechanisms either enhance or inhibit cell activation based on the purinergic receptors involved, allowing cells to adjust their functional responses initiated by extracellular environmental cues.[29]
Like most immunomodulating agents, ATP can act either as an immunosuppressive or an immunostimulatory factor, depending on the cytokine microenvironment and the type of cell receptor.[30] In white blood cells such as macrophages, dendritic cells, lymphocytes, eosinophils, and mast cells, purinergic signalling plays a pathophysiological role in calcium mobilization, actinpolymerization, release of mediators, cell maturation, cytotoxicity, and apoptosis.[31] Large increases in extracellular ATP that are associated with cell death serve as a "danger signal" in the inflammatory processes.[32]
In neutrophils, tissue adenosine can either activate or inhibit various neutrophil functions, depending on the inflammatory microenvironment, the expression of adenosine receptors on the neutrophil, and the affinity of these receptors for adenosine. Micromolar concentrations of adenosine activate A2A and A2B receptors. This inhibits the release of granules and prevents oxidative burst. On the other hand, nanomolar concentrations of adenosine activate A1 and A3 receptors, resulting in neutrophilic chemotaxis towards inflammatory stimuli. The release of ATP and an autocrine feedback through P2RY2 and A3 receptors are signal amplifiers.[33][34]Hypoxia-inducible factors also influence adenosine signalling.[21]
In the peripheral nervous system, Schwann cells respond to nerve stimulation and modulate the release of neurotransmitters through mechanisms involving ATP and adenosine signalling.[37] In the retina and the olfactory bulb, ATP is released by neurons to evoke transient calcium signals in several glial cells such as Muller glia and astrocytes. This influences various homeostatic processes of the nervous tissue including volume regulation and the control of blood flow. Although purinergic signaling has been connected to pathological processes in the context of neuron-glia communication, it has been revealed, that this is also very important under physiological conditions. Neurons possess specialised sites on their cell bodies, through which they release ATP (and other substances), reflecting their "well-being". Microglial processes specifically recognize these purinergic somatic-junctions, and monitor neuronal functions by sensing purine nucleotides via their P2Y12-receptors. In case of neuronal overactivation or injury, microglial processes respond with an increased coverage of neuronal cell bodies, and exert robust neuroprotective effects.[38] These purinergic somatic-junctions have also been shown to be important for microglia to control neuronal development. [39]Calcium signaling evoked by purinergic receptors contributes to the processing of sensory information.[40]
During neurogenesis and in early brain development, ectonucleotidases often downregulate purinergic signalling in order to prevent the uncontrolled growth of progenitor cells and to establish a suitable environment for neuronal differentiation.[41]
Purinergic signalling, and in particular tissue-injury induced ATP-release is very important for the rapid and robust phenotype changes of microglia. [42]
ATP and adenosine are crucial regulators of mucociliary clearance.[45] The secretion of mucin involves P2RY2 receptors found on the apical membrane of goblet cells.[45] Extracellular ATP signals acting on glial cells and the neurons of the respiratory rhythm generator contribute to the regulation of breathing.[46]
Skeletal system
In the human skeleton, nearly all P2Y and P2X receptors have been found in osteoblasts and osteoclasts. These receptors enable the regulation of multiple processes such as cell proliferation, differentiation, function, and death.[47] The activation of the adenosine A1 receptor is required for osteoclast differentiation and function, whereas the activation of the adenosine A2A receptor inhibits osteoclast function. The other three adenosine receptors are involved in bone formation.[48]
Pathological aspects
Alzheimer's disease
In Alzheimer's disease (AD), the expression of A1 and A2A receptors in the frontal cortex of the human brain is increased, while the expression of A1 receptors in the outer layers of hippocampal dentate gyrus is decreased.[41]
Asthma
In the airways of patients with asthma, the expression of adenosine receptors is upregulated. Adenosine receptors affect bronchial reactivity, endothelial permeability, fibrosis, angiogenesis and mucus production.[49]
The release of ATP increases adenosine levels and activates nitric oxide synthase, both of which induces the relaxation of the corpus cavernosum penis. In male patients with vasculogenic impotence, dysfunctional adenosine A2B receptors are associated with the resistance of the corpus cavernosum to adenosine. On the other hand, excess adenosine in penile tissue contributes to priapism.[56][57]
Following tissue injury in patients with Graft-versus-host disease (GVHD), ATP is released into the peritoneal fluid. It binds onto the P2RX7 receptors of host antigen-presenting cells (APCs) and activates the inflammasomes. As a result, the expression of co-stimulatory molecules by APCs is upregulated. The inhibition of the P2X7 receptor increases the number of regulatory T cells and decreases the incidence of acute GVHD.[60]
Therapeutic interventions
Current
Acupuncture
Mechanical deformation of the skin by acupuncture needles appears to result in the release of adenosine.[62][63] A 2014 Nature Reviews Cancerreview article found that the key mouse studies that suggested acupuncture relieves pain via the local release of adenosine, which then triggered close-by A1 receptors "caused more tissue damage and inflammation relative to the size of the animal in mice than in humans, such studies unnecessarily muddled a finding that local inflammation can result in the local release of adenosine with analgesic effect."[64] The anti-nociceptive effect of acupuncture may be mediated by the adenosine A1 receptor.[65][66][67]Electroacupuncture may inhibit pain by the activation of a variety of bioactive chemicals through peripheral, spinal, and supraspinal mechanisms of the nervous system.[68]
Several herbs used in Traditional Chinese medicine contain drug compounds that are antagonists of P2X purinoreceptors.[72] The following table provides an overview of these drug compounds and their interaction with purinergic receptors.
Purinergic signalling is an important regulatory mechanism in a wide range of inflammatory diseases. It is understood that shifting the balance between purinergic P1 and P2 signalling is an emerging therapeutic concept that aims to dampen pathologic inflammation and promote healing.[13] The following list of proposed medications is based on the workings of the purinergic signalling system:
In the 1960s, the classical view of autonomicsmooth muscle control was based upon Dale's principle, which asserts that each nerve cell can synthesize, store,
and release only one neurotransmitter. It was therefore assumed that a sympathetic neuron releases noradrenaline only, while an antagonisticparasympathetic neuron releases acetylcholine only. Although the concept of cotransmission gradually gained acceptance in the 1980s, the belief that a single neuron acts via a single type of neurotransmitter continued to dominate the field of neurotransmission throughout the 1970s.[86]
Beginning in 1972, Geoffrey Burnstock ignited decades of controversy after he proposed the existence of a non-adrenergic, non-cholinergic (NANC) neurotransmitter, which he identified as ATP after observing the cellular responses in a number of systems exposed to the presence of cholinergic and adrenergic blockers.[87][88][89]
Burnstock's proposal was met with criticism, since ATP is an ubiquitous intracellular molecular energy source[90] so it seemed counter-intuitive that cells might also actively release this vital molecule as a neurotransmitter. After years of prolonged scepticism, however, the concept of purinergic signalling was gradually accepted by the scientific community.[1]
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^Sperlagh B, Csolle C, Ando RD, Goloncser F, Kittel A, Baranyi M (December 2012). "The role of purinergic signaling in depressive disorders". Neuropsychopharmacologia Hungarica. 14 (4): 231–8. PMID23269209.
^Kukulski F, Lévesque SA, Sévigny J (2011). "Impact of ectoenzymes on p2 and p1 receptor signaling". Pharmacology of Purine and Pyrimidine Receptors. Advances in Pharmacology. Vol. 61. pp. 263–99. doi:10.1016/B978-0-12-385526-8.00009-6. ISBN9780123855268. PMID21586362.
^McIntosh VJ, Lasley RD (March 2012). "Adenosine receptor-mediated cardioprotection: are all 4 subtypes required or redundant?". Journal of Cardiovascular Pharmacology and Therapeutics. 17 (1): 21–33. doi:10.1177/1074248410396877. PMID21335481. S2CID544367.
^Mustafa SJ, Morrison RR, Teng B, Pelleg A (2009). "Adenosine Receptors and the Heart: Role in Regulation of Coronary Blood Flow and Cardiac Electrophysiology". Adenosine Receptors in Health and Disease. Handbook of Experimental Pharmacology. Vol. 193. pp. 161–88. doi:10.1007/978-3-540-89615-9_6. ISBN978-3-540-89614-2. PMC2913612. PMID19639282.
^Arulkumaran N, Turner CM, Sixma ML, Singer M, Unwin R, Tam FW (1 January 2013). "Purinergic signaling in inflammatory renal disease". Frontiers in Physiology. 4: 194. doi:10.3389/fphys.2013.00194. PMC3725473. PMID23908631. Extracellular adenosine contributes to the regulation of GFR. Renal interstitial adenosine is mainly derived from dephosphorylation of released ATP, AMP, or cAMP by the enzyme ecto-5′-nucleotidase (CD73) (Le Hir and Kaissling, 1993). This enzyme catalyzes the dephosphorylation of 5′-AMP or 5′-IMP to adenosine or inosine, respectively, and is located primarily on the external membranes and mitochondria of proximal tubule cells, but not in distal tubule or collecting duct cells (Miller et al., 1978). ATP consumed in active transport by the macula densa also contributes to the formation of adenosine by 5- nucleotidase (Thomson et al., 2000). Extracellular adenosine activates A1 receptors on vascular afferent arteriolar smooth muscle cells, resulting in vasoconstriction and a reduction in GFR (Schnermann et al., 1990).
^Antonioli L, Blandizzi C, Pacher P, Haskó G (December 2013). "Immunity, inflammation and cancer: a leading role for adenosine". Nature Reviews. Cancer. 13 (12): 842–57. doi:10.1038/nrc3613. PMID24226193. S2CID13224098.
^Mortaz E, Folkerts G, Nijkamp FP, Henricks PA (July 2010). "ATP and the pathogenesis of COPD". European Journal of Pharmacology. 638 (1–3): 1–4. doi:10.1016/j.ejphar.2010.04.019. PMID20423711.
^Esther CR, Alexis NE, Picher M (2011). "Regulation of Airway Nucleotides in Chronic Lung Diseases". Purinergic Regulation of Respiratory Diseases. Subcellular Biochemistry. Vol. 55. pp. 75–93. doi:10.1007/978-94-007-1217-1_4. ISBN978-94-007-1216-4. PMID21560045.
^Berman BM, Langevin HM, Witt CM, Dubner R (July 2010). "Acupuncture for chronic low back pain". The New England Journal of Medicine. 363 (5): 454–61. doi:10.1056/NEJMct0806114. PMID20818865. Acupuncture also has effects on local tissues, including mechanical stimulation of connective tissue, release of adenosine at the site of needle stimulation, and increases in local blood flow
^Sawynok J (2013). "Adenosine and Pain". In Masino S, Boison D (eds.). Adenosine. New York, NY: Springer. p. 352. doi:10.1007/978-1-4614-3903-5_17. ISBN978-1-4614-3903-5. in an elegant series of experiments, adenosine has been implicated as a mediator of acupuncture analgesia{{cite book}}: |work= ignored (help)
^ abLiang S, Xu C, Li G, Gao Y (December 2010). "P2X receptors and modulation of pain transmission: focus on effects of drugs and compounds used in traditional Chinese medicine". Neurochemistry International. 57 (7): 705–12. doi:10.1016/j.neuint.2010.09.004. PMID20863868. S2CID21358206.
^Burnstock G (March 2006). "Pathophysiology and therapeutic potential of purinergic signaling". Pharmacological Reviews. 58 (1): 58–86. CiteSeerX10.1.1.623.4370. doi:10.1124/pr.58.1.5. PMID16507883. S2CID12337865. Tetramethylpyrazine, a traditional Chinese medicine used as an analgesic for dysmenorrhea, was shown to block P2X3 receptor signaling
^Burnstock G, Di Virgilio F (December 2013). "Purinergic signalling and cancer". Purinergic Signalling. 9 (4): 491–540. doi:10.1007/s11302-013-9372-5. PMC3889385. PMID23797685. Chrysophanol, a member of the anthraquinone family that is one of the components of a Chinese herb including rhubarb recommended for the treatment of cancer, induces necrosis of J5 human liver cancer cells via reduction in ATP levels
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