Adenosine receptor agonists have potent antinociceptive effects in diverse preclinical models of chronic pain. In contrast, the efficacy of adenosine or adenosine receptor agonists at treating pain in humans is unclear. Two ectonucleotidases that generate adenosine in nociceptive neurons were recently identified. When injected spinally, these enzymes have long-lasting adenosine A 1 receptor (A 1 R)-dependent antinociceptive effects in inflammatory and neuropathic pain models. Furthermore, recent findings indicate that spinal adenosine A 2A receptor activation can enduringly inhibit neuropathic pain symptoms. Collectively, these studies suggest the possibility of treating chronic pain in humans by targeting specific adenosine receptor subtypes in anatomically defined regions with agonists or with ectonucleotidases that generate adenosine.Keywords adenosine monophosphate; preemptive analgesia; prostatic acid phosphatase; PAP; ecto-5'-nucleotidase; CD73
Adenosine as a therapeutic agent for painAdenosine is a purine nucleoside that can signal through four distinct receptors (A 1 R, A 2A R, A 2B R and A 3 R; also known as ADORA1, ADORA2A, ADORA2B and ADORA3). Of these receptors, A 1 R has received the greatest attention in pain-related studies. A 1 R is a G i/ocoupled receptor that is expressed in nociceptive (pain-sensing) neurons, spinal cord neurons and other cells of the body [1][2][3][4]. Agonists of this receptor have well-studied antinociceptive (see Glossary) effects in rodents when injected intrathecally, including antihyperalgesic and antiallodynic effects [5]. Furthermore, intrathecal adenosine reduces allodynia and hyperalgesia in patients with chronic pain [6]. In some instances, these pain-relieving effects in humans persist for days to months [7,8].Although adenosine has antinociceptive effects in humans [5] and is being studied clinically (Table 1), adenosine and adenosine receptor agonists are not currently used to treat chronic pain in patients. There are several possible reasons for this. For one, there is uncertainty as to whether adenosine or adenosine receptor agonists treat spontaneous pain, a common symptom of chronic pain. In addition, adenosine has limited efficacy in patients (at the doses