The P2X 7 plasma membrane receptor is an intriguing molecule that is endowed with the ability to kill cells, as well as to activate many responses and even stimulate proliferation. Here, the authors give an overview on the multiplicity and complexity of P2X 7 -mediated responses, discussing recent information on this receptor. Particular attention has been paid to early and late signs of apoptosis and necrosis linked to activation of the receptor and to the emerging field of P2X 7 function in carcinogenesis.P2X 7 : From an elusive receptor to an ATP-gated channel/pore The P2X 7 receptor (P2X 7 R) for extracellular ATP is expressed by a variety of cell types as different as neurons, macrophages, dendritic and microglial cells, fibroblasts, lymphocytes, and endothelial cells. At least a subpopulation of human osteoblasts also express P2X 7 [1]. Expression of the receptor has been demonstrated in human fibroblasts [2,3] and epithelia from the human bladder [4,5], human and rat uterus [6,7], male genital organs of the rats [8], human fetal keratinocytes [9] and mouse parotid acinar and duct cells [10].Although interest in this molecule has increased exponentially since the late 1990s, initial observations on its peculiar biochemical properties go back to the 1970s, when Cockcroft and Gomperts reported that extracellular ATP caused degranulation and striking morphological changes in rat mast cells [11]. These authors also hypothesized that cell responses triggered by ATP, such as histamine secretion and phosphatidyl inositol formation, were due to activation of an as yet unknown receptor (the FATP receptor_) activated by the fully dissociated ATP form (ATP 4j ) [12]. Based on its intriguing ability to cause a reversible permeabilization of the plasma membrane, this receptor was also referred to as the Fpermeabilizing ATP receptor_ later named P2Z [13]. P2Z was described not only in rat mast cells but also in mouse macrophages [14,15]. Following these early observations, the peculiar pharmacological and biochemical properties of the P2Z receptor were recognized in many other cells such as human macrophages, human B lymphocytes, mouse microglial cells, mouse and human monocyte-derived dendritic cells.The permeabilizing ATP receptor was cloned in 1996 from a rat brain library and named P2X 7 for its homology with the other P2X receptors [16]. P2X 7 is a 595 AA protein with a predicted structure comprising two transmembrane domains and a bulky extracellular cysteine rich region, with conserved lysine and glycine residues and several potential N-linked glycosylation sites, followed by a long stretch (from Phe 188 to Val 321 ) forming six putative antiparallel b sheets. The amino and carboxyl-terminal domains are both cytoplasmic. Similarities have been found between the b sheets region and the catalytic domains of class II aminoacylYtRNA synthetases [17]. These b sheets are likely to include residues comprising the ATP-binding site, since substitution of two aminoacids comprised in this region, Lys 193 and Lys 311...