Activation of A 2A receptors has been shown to protect neurons in the hippocampus from damage caused by excitotoxins or from cerebral insults such as ischaemia. For example, the A 2A agonist 2-p-(2-carboxyethyl)phenethylamino-5′-N-ethylcarboxamidoadenosine hydrochloride (CGS 21680) protects the hippocampus at concentrations which are only partially blocked by the centrally acting adenosine A 1 receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (CPX), suggesting that protection is mediated largely by the A 2A receptor. However, selective antagonists at the A 2A receptor, such as 4-(2-[7-amino-2-{2-furyl}{1,2,4}triazolo{2,3-a}{1,3,5}triazin-5-yl-amino]ethyl)phenol (ZM 241385), also show protection against neuronal death produced by ischaemia or excitotoxicity. In addition, A 2A receptor antagonists can reduce damage produced by combinations of subthreshold doses of the endogenous excitotoxin quinolinic acid and free radicals. The TdT-mediated dUTP-biotin nick end labeling (TUNEL) method has revealed that, after systemic kainic acid administration, staining was apparent in the CA1 region of the hippocampus only, even though damage was present in both the CA1 and CA3a areas. In animals injected intrahippocampally, both apoptosis and damage were limited to the CA3 region. Intrahippocampal co-injection of kainate together with ZM 241385 did not induce apoptosis even though damage was apparent. This suggests that the adenosine A 2A receptor may play a role in the route by which cells die during excitotoxicity. Overall, A 2A receptor antagonists appear to be promising candidates as new drugs for the prevention of neuronal damage and death in the central nervous system. Drug Dev. Res. 52:323-330, 2001.