Role of purinergic P2X receptors in the control of liver homeostasis


  • Michel Fausther,

    1. Division of Gastroenterology & Hepatology, Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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  • Emmanuel Gonzales,

    1. INSERM, Université Paris-Sud, UMR-S757, Orsay Cedex, France
    2. CHU Bicêtre Assistance Publique—Hôpitaux de Paris, Hépatologie Pédiatrique, Le Kremlin Bicêtre Cedex, France
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  • Jonathan A. Dranoff

    Corresponding author
    1. Division of Gastroenterology & Hepatology, Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
    • Division of Gastroenterology & Hepatology, Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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This article is corrected by:

  1. Errata: Erratum: Role of purinergic P2X receptors in the control of liver homeostasis Volume 1, Issue 6, 829, Article first published online: 9 July 2012


It is now accepted that extracellular ATP and other nucleotides are potent signaling molecules, akin to neurotransmitters, hormones, and lipid mediators. In the liver, several clues support a significant role for extracellular ATP-induced signaling pathways in the control of tissue homeostasis. First, ATP and other nucleotides are physiologically detected in extracellular fluids within the liver, including sinusoidal blood and intraductular bile, in various mammalian species including human and rodents. Moreover, finely tuned mechanisms of ATP release by different liver cell types have been described, under physiological cellular changes. In addition, most hepatic cells constitutively express, at the membrane level, several ATP-metabolizing ectoenzymes and ATP-sensitive receptors that modulate and transduce these mediator signals, respectively. Finally, hepatic cells also express numerous membrane transporters that actively contribute to purinergic salvage pathways. Once released in the extracellular medium, unmetabolized ATP molecules can bind to purinergic P2X and P2Y receptors, and subsequently trigger various intracellular signal transduction pathways collectively referred to as purinergic signaling. In the liver, purinergic signaling has been shown to regulate key basic cellular functions, such as glucose/lipid metabolism, protein synthesis and ionic secretion, and homeostatic processes, such as cell cycle, inflammatory response, and immunity. While the functional relevance of P2Y receptors in liver physiology has been well documented, limited information is available regarding the potential role of hepatic P2X receptors in the modulation of liver homeostasis. WIREs Membr Transp Signal 2012,1:341–348. doi: 10.1002/wmts.32

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Identification and Cloning of P2XRs

In 1972 Burnstock advanced the concept of purinergic signaling, hypothesizing that extracellular ATP acts as a signaling molecule, such as neurotransmitters adrenaline and acetylcholine, based on early studies on excitable tissues by Szent-Györgyi and Drury, Holton et al. as well as his own work.1 Before long, surface-located membrane receptors called purinoreceptors including adenosine-activated P1 and ATP-activated P2 receptor classes were described for the first time as receptors that mediate purinergic signaling in tissues.2 In 1985, a new classification system (using functional criteria, such as structure, pharmacology, and mechanism of action) for purinergic receptors was proposed, wherein P2 receptors were divided into ionotropic P2X and metabotropic P2Y receptors.3 In the mid 1990s, P2X1 and P2X2 were the first P2X family members identified by cDNA cloning in rat species.4,5 Hitherto, the P2XR gene family comprises seven distinct genes P2RX1-7, each encoding for P2X1–7 protein subunits and found in various mammalian species including human and rodents.6

Molecular Structure of P2XRs

P2XRs are nonselective ligand-gated ion channels that are activated by extracellular ATP. Each P2X channel is formed by the hetero-/oligomeric assembly of three P2X protein subunits.7 This long-debated minimal trimeric stoichiometry was recently confirmed by a study describing the solved crystal structure of zebrafish P2XR4 ion channel in closed state.8 The basic P2X subunit is a protein 379 (P2X6) to 595 (P2X7) amino acids long, with the following structural topology: intracellular N and C-termini, two transmembrane spanning regions that delimits a large ectodomain.9 This extracellular loop contains the so-called ATP-binding domain of 10 conserved cysteine residues forming disulfide bonds, and several phosphorylation, glycosylation, and palmitoylation sites likely involved channel activity modulation.6 Biochemical and biophysical studies in heterologous expression systems, such as Xenopus oocytes or mammalian HEK293 and 1321N1 cell lines, have shown that all P2XRs can form both heteromeric and homomeric channels. Accordingly, all seven homomeric channels: P2X1–7 and, at least, a dozen heteromeric channels have been identified and pharmacologically characterized.9–13 However, additional functional evidences from studies in native tissues as well as genetically modified mouse models are needed to determine or confirm the existence and physiological relevance of the combinations identified in biochemical studies. This is well illustrated by the debate surrounding the existence of native homomeric P2X6 receptors,14,15 although functional highly glycosylated P2X6 receptors have been described upon transient transfection of HEK293 cells with recombinant rat P2X6 receptor cDNA.11 Also, unknown are the factors influencing the stoichiometry of each partner P2X subunit for a given heteromeric channel.13,14

Activation Mechanism of P2XRs

The basic activation mechanism of P2XR involves conformational changes of the ion channel from a ‘closed’ to an ‘open’ state, upon binding of (at least) three ATP molecules.7 These structural changes lead to the opening of a pore with an increased permeability to Ca2+, Na+, K+, and Cl ions. The changes in P2X ion channel permeability trigger a fast membrane depolarization, which is followed by the generation of cellular Ca2+ (and to a less extent Na+) influxes that activate still poorly understood downstream intracellular coupling mechanisms. P2XR are characterized by different pharmacological properties. First, the potency of ATP ligand for P2XR is ranging from nanomolars (e.g., P2X1) to millimolars (e.g., P2X7).6,16 Second, prolonged exposure to ATP leads to a desensitization phase of P2XRs that varies from fast (ms for P2X1) to fairly sustained (more than 20 seconds for P2X2–4 and P2X7).6 Third, pharmacokinetics of P2XRs can be distinguished using various synthetic ATP analogs that act as agonists (e.g., α,β-MeATP; ATPγS) or antagonists (e.g., TNP-ATP; PPADS)15,17. For instance, both P2X1 and P2X3 receptors are selectively activated by α,β-MeATP and inhibited by TNP-ATP. Finally, P2XR channel activity can be affected by physiological parameters, such as extracellular pH, divalent ions (e.g., Zn2+, Cu2+, Hg2+, Ni2+ or Cd2+) and interactions with other membrane receptors. For example, the activation of the P2X2 receptor is potentiated by Zn2+ and blocked by Ca2+.15

Now that the reader is hopefully more familiar with the P2XR pharmacology, the following section will recapitulate the existing data about the liver distribution of these receptors.


All P2XRs are expressed in the liver, with P2X4 and P2X7 being the most widely distributed proteins.18,19 The distribution of hepatic P2XRs is summarized in Table 1. Parenchymal cells or hepatocytes express all P2XR subtypes, except P2X5 and P2X6. Nonparenchymal cells including cholangiocytes, liver fibroblasts, endothelial cells, immune cells, and smooth muscle cells express also multiple P2XRs. To the best of our knowledge, there are no data available in the current literature regarding the expression of P2XRs in liver stem or precursor cells (including hepatoblasts and oval cells). It is interesting to note the expression of multiple P2XRs in various functionally specialized hepatic cells, which suggests that ATP-mediated signaling pathways through P2XRs likely modulate different aspects of liver physiology.

Table 1. Pharmacology and Liver Distribution of P2X Receptors (P2XRs)
ReceptorAgonists1Antagonists1Modulators1Transduction Mechanism1Hepatic Distribution2
  • N.D., not determined; IP5I, diinosine pentaphosphate; IP4I, diinosine tetraphosphate; PPADS, 6-azophenylpyridoxal 5-phosphate, 2′,4′-disulphonic acid isomer; isoPPADS, 6-azophenylpyridoxal 5-phosphate, 2′,5′-disulphonic acid isomer; 5-BDBD, 5-(3-bromophenyl)-1,3-dihydro-2H-benzofuro[3,2-e]-1,4-diazepin-2-one; BBG, brilliant blue G; TNP-ATP, 2′,3′-O-(2,4,6-Trinitrophenyl)adenosine-5′-triphosphate; oATP, oxidized ATP.

  • 1

    Data obtained from pharmacological and functional studies in native tissues, primary and/or immortalized cell lines.6,7,12,15,29–40

  • 2

    Data obtained from mRNA and/or protein expression studies using native tissues, primary and/or immortalized cell lines.11,19–29

P2X1ATP, α,β-MeATP, 2-MeSATPIP5I, MRS2159, NF023, NF279, NF449, PPNDSCd2+, Gd2+, Zn2+Ion channel (Ca2+ and Na+)Hepatocytes, Kupffer cells, lymphocytes, portal vein myocytes smooth muscle cells
P2X2ATP, ATPγS, AP4AisoPPADS, NF279, NF770, RB2, SuraminCa2+, Gd2+, Hg2+, Zn2+Ion channel (Ca2+)Cholangiocytes, hepatocytes, lymphocytes, mesenteric artery cells
P2X3ATP, α,β-MeATP, 2-MeSATP, AP5AIP4I, NF110, RO-3, RO-85, Spinorphin, TNP-ATPCibracon blue, ethanol, Zn2+Intrinsic ion channelCholangiocytes, hepatocytes, portal vein myocytes, smooth muscle cells
P2X4ATP, α,β-MeATP, BzATP, CTP5-BDBD, Coomassie blue, oATP, paroxetine, NF023Cd2+, Hg2+, hydrogen peroxide, tolueneIon channel (Ca2+ and Na+)Cholangiocytes, cyst epithelial cells, dendritic cells), hepatic stellate cells, hepatocytes (apical and basolateral membranes, Kupffer cells, lymphocytes, portal fibroblasts, portal vein myocytes, smooth muscle cells, vascular endothelium
P2X5ATP, α,β-MeATP, ATPγSBBG, Coomassie blue, PPADS, SuraminZn2+Intrinsic ion channel (Cl)Portal vein myocytes, smooth muscle cells
P2X6ATP, BzATPisoPPADS, TNP-ATPN.D.Intrinsic ion channelCholangiocytes, Kupffer cells
P2X7ATP, BzATP, β,γ-MeATP, ATPγSA740003, AZ11645373, KN62, MRS2427, MRS2159, oATPCalmodulin, Mg2+, Zn2+Intrinsic ion channel (Ca2+) and poreCholangiocytes, dendritic cells, hepatic stellate cells, hepatocytes, lymphocytes, mesenteric artery cells, portal fibroblasts, smooth muscle cells, vascular endothelium

Finally, the next section will address the contribution of P2XR signaling pathways to liver homeostasis.


Bile Formation

Several lines of evidence have supported a role for extracellular ATP in the regulation of bile formation by hepatocytes and cholangiocytes.41–43 First, studies have shown that extracellular ATP is detectable in bile samples collected downstream at the common bile duct level in human and rodents as well as in the supernatants of primary and/or immortalized cholangiocytes, as mentioned above. For instance, a recent study using primary mouse intrahepatic bile duct units showed evidence of ATP release by these cells, when subjected to mechanosensitive (e.g., fluid flow) stimulation.20 Interestingly, measurements of nucleotide release by small cholangiocytes (located upstream along the biliary tree) were greater than by large ones (located downstream) following stimulation. These findings suggest that purinergic signaling triggered in cholangiocytes can be actively involved in bile formation and that biliary ATP release mechanism is differently regulated by morphologically and functionally distinct cholangiocytes. Second, ATP stimulation induces in both primary and immortalized murine cholangiocytes Cl currents that are essential to both alkalinization and bile formation processes. The P2X4 receptor has been recently identified as key regulator of this mechanism in cholangiocytes.20 Finally, numerous ectoenzymes and transporters that can modify greatly extracellular ATP bioavailability are expressed in the canalicular membrane domain of hepatocytes.44,45 However, there has been, thus far, no direct evidence of canalicular ATP release by parenchymal cells, as bile sample collection in the lumen of bile canaliculi is technically challenging. Yet, because of the anatomic continuity between hepatocytes and intrahepatic bile duct cells, it is reasonable to hypothesize that unmetabolized ATP upon release in the canalicular lumen by hepatocytes could possibly stimulate downstream purinergic P2X and P2Y receptors expressed apically in cholangiocytes and regulate their physiological functions, for instance bile formation. While the contribution of potent mediator secretin and metabotropic P2Y246 and P2Y12 receptors47 to bile formation process has been established, the role of P2XRs in this important hepatic function needs to be further investigated (Box 1).



In the liver, there are various identified sources of extracellular ATP, the natural ligand for P2XRs. Because of their central role in metabolism, nucleotides are found virtually in every cell.48 For instance, in hepatocytes, the intracellular ATP concentration is estimated between 3 and 5 mM.42 Thus, any active (e.g., cell apoptosis)49 or passive (e.g., tissue injury)50 process leading to loss of cell membrane integrity will cause the release of large amounts of ATP in the extracellular medium. A number of studies have also shown that various hepatic physiological fluids contain nucleotides and derivatives. For instance, biochemical analyses of normal bile samples collected from human, pig, and rat donors detected the presence of physiologically relevant ATP, ADP, and AMP nucleotides levels.51 In the same study, the authors estimated that the ATP concentration in human bile was 5.2 ± 0.9 µM. In another study using the isolated perfused rat liver model, ATP levels were measured in the nanomolar range in sus-hepatic venous blood.52 Moreover, several studies have reported that nanomolar concentrations of ATP can be measured in the supernatants of various hepatic primary cells (isolated hepatocytes; isolated bile duct units) or immortalized cell lines (HTC, hepatoma; Mz-ChA-1, cholangiocarcinoma), consistent with a constitutive release of ATP.25,50–55 On the other hand, hepatic cells can liberate ATP molecules in the extracellular medium upon stimulation and several examples of this mechanism have been reported in studies using pharmacological (e.g., purinergic antagonist PPADS) and/or biochemical (e.g., apyrase) approaches. Mechanical pressure (isolated hepatocytes; WB-F344 liver epithelial cell line; HTC),56–58 hypo-osmotic shock (isolated hepatocytes; Mz-ChA-1; NRC, isolated normal rat cholangiocytes),53,59 fluid flow (Mz-ChA-1; NRC; isolated mouse cholangiocytes)20,60 and exposure to biologically potent endogenous molecules such as bile acids (isolated hepatocytes)61 can trigger the release of ATP molecules in the extracellular milieu. Thus, all these studies indicate that ATP release by hepatic cells is a fine-tuned mechanism and clearly support a second messenger role for extracellular ATP in different liver compartments.

Glucose Metabolism

Early studies using the isolated perfused liver model showed that infusion of exogenous ATP and UTP nucleotides stimulates hepatic glycogenolysis and glucose release by rat hepatocytes,62,63 suggesting a role for P2 receptor signaling in hepatic glucose metabolism. A more recent study has shown that exposure to P2X-selective BzATP agonist causes decreases in glycogen contents in isolated rat and human hepatocytes.64 In the same study, an interesting observation showed that P2X4 mRNA expression is increased in glycogen-rich hepatocytes from carbohydrate-activated transcription factor (ChREBP)-deficient mice, suggesting a functional link between P2X4 and glucose metabolism in hepatocytes. Another recent study has shown that, upon a glucose tolerance test, plasma glucose levels are higher in ectonucleotidase CD39/NTPDase1-deficient (Cd39−/–) mice (wherein extracellular ATP hydrolysis is considerably diminished) than in wild-type mice.65 Interestingly, increases in plasma glucose levels could also be induced in wild-type mice by preadministration of ecto-ATPase inhibitor ARL-67156 or administration of exogenous nucleotide ATP (but not of ADP, UTP or UDP) species, suggesting functional involvement of P2XR-mediated signaling in glucose homeostasis.

Inflammation and Immunity

Immune cell functions within the liver are also modulated by P2XRs. In developing postnatal rat livers, intraperitoneal injection of lipopolysaccharide causes increases of P2X6 gene transcriptional activity in resident Kupffer cells, suggesting that extracellular ATP-induced signaling mediates immune functions in this cell type.21 In a mouse concavalin A-induced hepatitis model, P2X7 receptor signaling exacerbates pro-inflammatory activities in natural killer T (NKT) cells.66 In the same model of hepatitis, genetic deletion of ectoenzyme CD39 is associated with reduced liver injury, because of increased NKT cell apoptosis resulting from unimpeded activation of P2X7 expressed on these cells.67 A role for purinergic signaling in the modulation of liver anti-viral response has been recently uncovered by a number of studies showing that pharmacological antagonism of P2X7 receptors with synthetic compounds, such as suramin and brilliant blue G causes reduced hepatitis B and/or D virus infection, in human primary and immortalized hepatocytes.68,69 Also, reduced parasite burden and necrotic areas are observed in livers of mice with functional P2X7 receptors, following Toxoplasma gondii infection.70

Ionic Secretion

A number of pharmacological studies have shown that P2XR stimulation can regulate ionic secretion in hepatocytes and cholangiocytes. In murine and human hepatocytes, activation of P2X4 and P2X7 receptors leads to increased Ca2+ and Na+ influxes.22,64 In rat hepatoma HTC cells, P2X4 activation modulates cellular regulatory volume decrease response by controlling the opening of volume-sensitive rectifying outwardly Cl channels.56 P2XRs are also involved in the control of ionic secretion by biliary epithelium. In Mz-ChA-1 cholangiocytes, BzATP-induced Clcurrents can be inhibited by addition of Cu2+ions in the extracellular medium, suggesting ionic secretion is mediated, at least in part, by P2X4 receptors.23

Liver Cell Proliferation and Death

In liver, purinergic signaling plays an important role in the maintenance of organ cell mass, by modulating both cellular growth and apoptosis mechanisms. Functional studies in vitro and in vivo have demonstrated that proliferation of liver cell types, such as hepatocytes and liver sinusoidal cells is mainly mediated by ATP/UTP-sensitive P2Y receptors.50,71–73 On the other hand, programmed cell death in hepatic cells, such as hepatocytes and NKT cells, is mediated by ionotropic P2X7 receptor. In primary rat hepatocytes, the purinergic P2Z receptor, now known as P2X7 receptor, mediates Ca2+-dependent cell death induced by extracellular adenosine triphosphate.74 Another functional study has reported that isolated rat hepatocytes exposed to high concentrations of P2X4/P2X7-selective agonist BzATP exhibit several classical hallmarks of apoptosis: membrane blebbing and pore formation.22 In addition, these mechanisms could be inhibited by addition of P2XR antagonist oxidized ATP in the medium, suggesting these mechanisms are regulated by P2X7 receptors expressed on hepatocytes. Moreover, in livers from Cd39−/− mice, resulting prolonged ATP exposure leads to an increased activation of P2X7 receptors expressed on tumor cells and causes reduced tumor progression, when compared to wild-type animals.75


The role of P2XRs in the modulation of liver vasculature function(s) has not been addressed extensively. Using pharmacological and genetic approaches, a number of studies have demonstrated that extracellular ATP signaling, mainly through P2X1 receptor activation, modulates adrenergic-mediated control of vascular tone in both rat hepatic artery and portal vein systems.24,76,77 Also, it has been recently shown that ATP stimulation increases portal vein pressure in Cd39−/− mice upon administration of nitric oxide (NO) inhibitor L-NG-Nitroarginine, suggesting a P2X-dependent vasoconstrictive effect, in absence of P2Y-mediated NO release.78


The contribution of purinergic signaling to liver homeostasis is now well established. This notion is supported by the identification in most hepatic cells of functional components of purinergic signaling: first, mechanisms involving constitutive and/or regulated release of nucleotides and nucleosides; second, cell surface ectoenzymes and membrane transporters that are involved in the metabolism of nucleotides and salvage pathways of nucleosides; third and finally, membrane receptors that transduce signals induced by extracellular nucleotides and nucleosides. Among the latter, ATP-gated P2XR ion channels are emerging as new potential players in modulating liver functions. Indeed, the expression of all seven P2XRs has been described in the liver and their involvement in the modulation of several key hepatic functions, such as glucose metabolism, bile formation, cell proliferation, apoptosis, inflammation and immunity has been demonstrated.18,19 Yet, future investigations will be required to fully understand the involvement of P2XR signaling in liver homeostasis and, as a result, develop innovative and effective treatments of liver diseases. In that respect, the development of new potent pharmacological compounds30,79,80 and molecular tools81 targeting P2XRs will be essential in achieving these goals.


The authors would like to acknowledge DaShawn Hickman for helping with table preparation. This work was supported by the National Institutes of Health (NIH/NIDDK R01 DK076735 and R01 DK070849 to J.A.D.). M.F. has been recently awarded the ‘2011 American Liver Foundation Roger L. Jenkins, MD’ postdoctoral research fellowship award. E.G. is the recipient of studentships from INSERM (poste d'accueil INSERM), SANOFI and the ‘Groupe Francophone d'Hépatologie Gastro-Entérologie et Nutrition Pédiatriques.’