Gergs U, Boknik P, Schmitz W, Simm A, Silber RE, Neumann J. A positive inotropic effect of ATP in the human cardiac atrium. Am J Physiol Heart Circ Physiol 294: H1716-H1723, 2008. First published February 8, 2008 doi:10.1152/ajpheart.00945.2007.-We studied contractile effects in isolated electrically driven (1 Hz) atrial preparations from patients undergoing cardiac bypass surgery. ATP concentration dependently (10, 30, and 100 M) and rapidly decreased force of contraction (negative inotropic effect, NIE) and thereafter more slowly increased force of contraction. The maximum positive inotropic effect (PIE) at 100 M ATP amounted to 152% of the predrug value (n ϭ 9) and was stable and could be washed out fast and completely. The PIE did not affect time parameters of contraction (time to peak tension and time of relaxation). Moreover, a similar NIE and PIE were noted with adenosine 5Ј-O-(2-thiotriphosphate) (100 M). In contrast 2-methyl-thio-ATP did not exert a NIE but only a PIE. In a second set of experiments, preparations were first incubated for 30 min with purinoreceptor antagonists and, in their continuous presence, 100 M ATP was applied. However, the PIE and NIE of ATP could neither be blocked with suramin (100 and 500 M), pyridoxalphosphate-6-azophenyl-2Ј,4Ј-disulfonic acid (50 M), nor reactive blue 2 (30, 100, and 500 M), which are known blockers for subtypes of P2 receptors, or 1,3-dipropyl-cyclopentvl-xanthine (1 and 10 M), a subtype (A 1 adenosine) P1 receptor blocker. Likewise, the inhibitor of phospholipase C (PLC) activity (U-73122) and the inhibitor of adenylate cyclase activity (SQ-022563) (10 M each) failed to affect the NIE and the PIE of ATP. We tentatively suggest that the PIE of ATP might be mediated via P2X4-like receptors. In summary, we describe a novel biphasic effect of ATP on force contraction in the isolated human atrium. It is conceivable that ATP plays a physiological role in the human heart, for instance, after cardiac injury to sustain contractility. human heart; right atrium; adenosine 5Ј-triphosphate; purinoceptor; inotropy SOON AFTER DISCOVERY of ATP, Drury and Szent-Györgyi reported on cardiac effects of the compound: a negative chronotropic effect and a decrease in blood pressure (19). Berne suggested that the vasodilatory effect of ATP may be mediated by its degradation product adenosine (5). This led to extensive studies on the effects of adenosine in the cardiovascular system. Only later on was interest in ATP itself renewed. This was in part driven by the suggestion that ATP may be a cotransmitter in nonadrenergic and noncholinergic nerves (13). In fact, ATP can be released from nerve terminals as a cotransmitter with norepinephrine and acetylcholine (14).Extracellular ATP was found to exert many effects in the cardiovascular system. These include negative (NIE) and positive (PIE) inotropic effects (species dependent), negative chronotropic and dromotropic as well as antihypertrophic effects (for review, see Ref. 62). A number of additional physiological effects of ATP in ...