High-affinity desensitization (HAD) by nanomolar agonists was described to shape the ability of P2X 3 receptors for mediating pain sensation. These receptors are activated by micromolar ATP, but nanomolar ATP is sufficient to effectively desensitize them. The mechanism behind HAD is still obscure. It has been suggested (J Neurosci 25: 7359 -7365, 2005) that HAD can happen only if the receptor has previously been activated and desensitized by high agonist concentrations. It was not clear, however, whether the high-affinity site was different from the conventional binding site and which mechanism led to its exposure during desensitization. A subsequent article (Mol Pharmacol 70:373-382, 2006) argued that HAD could also occur without preceding desensitization, because even resting receptors expose high-affinity binding sites. To support this hypothesis, a kinetic model was proposed that could reproduce all major phenomena observed experimentally. We attempted to improve this model and used it to simulate the agonist-induced formation of the high-affinity binding site. We collected electrophysiological data using HEK 293 cells expressing human P2X 3 receptors and fitted simulated currents to experimentally acquired currents. A simple allosteric kinetic model in which only triliganded receptors could open failed to reproduce receptor behavior; introduction of an additional diliganded open state was necessary. Simulation with this model gave results that were in good agreement with experimental data. By using simulations and experiments, we analyzed the process of highaffinity binding site formation upon agonist exposure and propose an explanation, which helps to resolve the apparent conflict regarding the mechanism of HAD.Rapid desensitization (within ϳ100 ms) and very slow recovery from desensitization (requiring several minutes) are the hallmark of P2X 3 [and also of P2X 1 (Rettinger and Schmalzing, 2003)] receptors (North, 2002). In the study of this phenomenon, it has been shown that agonists compete for the same binding sites, and the recovery rate will be determined by the type of agonist occupying the binding sites of the receptors at the beginning of washout (Sokolova et al., 2004). Extremely low concentrations of agonists were found to be able to effectively inhibit agonist-evoked currents, presumably by inducing desensitization of the receptors. No detectable currents were evoked at these low concentrations; in fact, a ϳ80-to 800-fold difference was found between IC 50 and EC 50 values of the same agonist.The ability of low nanomolar agonist concentrations to induce desensitization was questioned by an elegant study of Pratt et al. (2005), where the ability of agonists to prevent recovery from desensitization was compared with their ability to induce desensitization. Intriguingly, and in contrast to previous results, no inhibition by nanomolar agonists was found without previous activation and desensitization.Dealing with a mechanism in which agonists cannot induce desensitization but, once it is at...