Abstract
Shortage of oxygen and nutrients in the brain induces the release of glutamate and ATP that can cause excitotoxicity and contribute to neuronal and glial damage. Our understanding of the mechanisms of ATP release and toxicity in cerebrovascular diseases is incomplete. This review aims at summarizing current knowledge about the participation of key elements in the ATP-mediated deleterious effects in these pathologies. This includes pannexin-1 hemichannels, calcium homeostasis modulator-1 (CALHM1), purinergic P2X7 receptors, and other intermediaries of CNS injury downstream of ATP release. Available data together with recent pharmacological developments in purinergic signaling may constitute a new opportunity to translate preclinical findings into more effective therapies in cerebrovascular diseases.
Introduction
Cerebrovascular diseases (CVDs) are referred to as a group of conditions that eventually lead to a reduction of blood supply to the brain as a consequence of a blockage (thrombosis or atherosclerosis), malformation (aneurysm), hemorrhage, or transient ischemia. In all instances, a decrease in oxygenation and nutrient supply ultimately leads to brain damage. Cerebrovascular diseases, principally stroke, constitute the second leading cause of death in adults worldwide and are major contributors to disability and reduced quality of life (Truelsen et al., ), so it is important to know the mechanisms behind this damage to reduce their consequences with the design and use of therapies against these diseases.
At the cellular level, damaged neurons and glial cells during and after stressful events in CVDs release glutamate into the extracellular space, which finally induces cytosolic Ca2+ overload and excitotoxicity (Braun et al., ; Jurányi et al., ; Melani et al., ; Takeuchi et al., ; for reviews, see also Rossi et al., ; Yenari et al., 2010). More recently, ATP was also defined as a potent excitotoxic signal to oligodendrocytes and neurons (Matute et al., ; Domercq et al., ; Cisneros-Mejorado et al., ). In addition to ATP being among the molecules that are released by cell damage, recent evidence suggests that ATP acts as a damage-associated molecular pattern (DAMP) to initiate the innate immune response, induce pro-inflammation, and contribute to progressive neurological injury (Braun et al., ). Moreover, the massive increase in the cytosolic concentration of Ca2+ is due in part to the overactivation of P2X7 receptors, a nonselective ligand-gated cation channel expressed at the cell surface of various cell types and activated by extracellular ATP. In this review, we summarize the state of the art regarding the P2X7 receptor role in cerebrovascular damage and its possible use as a therapeutic target. In addition, we discuss its relationship with other molecular agents, such as pannexins (Panxs) and calcium-permeable channels, representing all together a pathological orchestrated cluster that can contribute to the onset of tissue damage and its propagation in CVDs.
P2X7 Receptors Are Major Mediators of Tissue Damage in Cerebrovascular Diseases
Energy deprivation after stroke causes anoxic and irreversible depolarization. These events subsequently lead to massive release of excitatory neurotransmitters, including glutamate and ATP (Braun et al., ; Jurányi et al., ; Melani et al., ; Rossi et al., ), the latter causing neuronal and glial cell death through P2X7 receptor activation (Matute et al., ; Domercq et al., ; Arbeloa et al., ). However, the mechanisms of deleterious ATP release during brain ischemia are only partially known (Dale and Frenguelli, 2009; Cisneros-Mejorado et al., ). Thus, during ischemia, the lack of oxygen causes a reduction in ATP production with an ensuing failure of plasma membrane ion pumps and loss of ion concentration homeostasis, all of which can finally lead to activation of Panx1 and calcium homeostasis modulator-1 (CALHM1) and the subsequent release of ATP (Cisneros-Mejorado et al., ). These events lead to sustained activation of P2X7 receptors and pore formation with ensuing further ATP release that together creates a vicious circle, resulting in enhanced ATP-mediated excitotoxicity (Cisneros-Mejorado et al., ). Indeed, pharmacological blockade or gene ablation of P2X7, Panx1, and CALHM1 results in substantial delayed post-anoxic depolarization following oxygen-glucose deprivation (OGD) and reduced brain tissue damage after transient middle cerebral artery occlusion (MCAO; Cisneros-Mejorado et al., , ; Figure 1).
Figure 1
In addition to neuronal and oligodendroglial excitotoxicity, activation of P2X7 receptors triggers the formation of the inflammasome, a multiprotein complex that mediates the release of cytokines, such as IL-1β, IL-18, and IL-33 (Giuliani et al.,
P2X7 receptors are expressed in neurons and glia (see Table 1). Neurons express P2X7 receptors (Yu et al.,
Table 1
| Cell type | Preparation | Techniques | References |
|---|---|---|---|
| Neuron | Mouse brain | Ca2+ imaging, IHH, | Díaz-Hernández et al. ( |
| qPCR, WB | Miras-Portugal et al. ( | ||
| Rat Brain | in situ hybridization | Yu et al. ( | |
| Oligodendrocyte lineage | Rat forebrain OPCs in vitro | WB, Ca2+ imaging | Agresti et al. ( |
| Rat optic nerve OLs in situ | Ca2+ imaging | James and Butt ( | |
| Rat brain OLs | qPCR | Yu et al. ( | |
| Rat and human optic nerve OLs | IHH, WB, Ca2+ imaging, electrophysiology | Matute et al. ( | |
| Microglia | Rat and mice brain | WB, IHH, in situ hybridization | Collo et al. ( |
| Rat brain in vitro | Ca2+ imaging, electrophysiology | Visentin et al. ( | |
| Rat brain in vitro | Cytokine reléase, fluorimetry | Hide et al. ( | |
| Rat brain in vitro | IHH, fluorimetry | Verderio and Matteoli ( | |
| Mouse brain in vitro | Electrophysiology, fluorimetry | Chafke et al. ( | |
| Astrocytes | Rat brain in vitro | Ca2+ imaging | Ballerini et al. ( |
| Astrocyte cell line | Ca2+ imaging | Sun et al. ( | |
| Rat brain in vitro | IHH, chemokine signaling | Panenka et al. ( | |
| Rat brain after lesion | IHH | Franke et al. ( | |
| Rat brain | IHH | Kukley et al. ( | |
| Rat optic nerve in situ | Ca2+ imaging | James and Butt ( | |
| Rat spinal cord | Ca2+ imaging, ATP release | Suadicani et al. ( |
P2X7 receptor expression in the central nervous system.
IHC, immunohistochemistry; OL, oligodendrocyte; OPCs, oligodendrocyte progenitor cells; qPCR, quantitative PCR; WB, western blot.
On the other hand, microglia express P2X7 receptors (Ferrari et al.,
Together, these data indicate that activation of P2X7 receptors can activate deleterious signals after ischemia by altering Ca2+ homeostasis and promoting the release of pro-inflammatory cytokines as well as causing oxidative stress. Accordingly, P2X7 blockade reduces tissue damage in experimental models of CVDs. Thus, Brilliant Blue G (BBG), a P2X7 selective antagonist, attenuates the extent of brain damage following transient MCAO (Arbeloa et al.,
Table 2
| Antagonist | Model | Effects | References |
|---|---|---|---|
| Brilliant Blue G | OGD, MCAO | Decreases infarct size | Arbeloa et al. ( |
| Protects from neuronal death | Chu et al. ( | ||
| Relieves neurological symptoms | Cisneros-Mejorado et al. ( | ||
| in vitro, EAE | Promotes oligodendrocyte survival, protects myelin, ameliorates neurological symptoms | Matute et al. ( | |
| OGD in vitro and in situ | Promotes oligodendrocyte survival, protects myelin | Domercq et al. ( | |
| Perinatal hypoxia-ischemia | Reduces white matter injury | Wang et al. ( | |
| experimental subarachnoid hemorrhage | Ameliorates function and reduces neuronal apoptosis | Chen et al. ( | |
| A0438079 | MCAO | Relieves neurological symptoms | Chu et al. ( |
| increase survival rates | |||
| Attenuate inflammation | |||
| OGD in slices and culture | reduce postanoxic depolarization | Cisneros-Mejorado et al. ( | |
| OxATP | MCAO | Reduces mortality | Chu et al. ( |
| in vitro, EAE | Promotes oligodendrocyte survival, Protects myelin, ameliorates neurological symptoms | Matute et al. ( | |
| Nanobodies | in vivo glomerulonephritis | Ameliorates experimental glomerulonephritis in mice | Danquah et al. ( |
Protective effects of blocking of P2X7 receptors.
EAE, experimental autoimmune encephalomyelitis; MCAO, transient middle cerebral artery occlusion; OGD, oxygen-glucose deprivation.
Activation and Biophysical Properties of P2X7 Receptors in Neurons and Glia
P2X7 receptors have two possible states of conductance. First, low concentrations of agonist (ATP or BzATP) induce activation of a nonselective monophasic conductance allowing monovalent (Na+, K+) and divalent (Ca2+) cation influx and plasma membrane depolarization (North,
P2X7 Receptors Are Involved in Ischemic Pre- and Post-Conditioning Effects
Brief, non-harmful, ischemic preconditioning can confer tolerance and protection from subsequent cerebrovascular damage. Thus, preconditioning attenuates damage in models of cerebral ischemia associated with oxidative stress and glutamate excitotoxicity (Jachova et al.,
In addition, hypoxic preconditioning protects cultured neurons against hypoxic stress via tumor necrosis factor-α; TNF-α; Jie Liu et al.,
The above data argues in favor of a dual role of P2X7 receptors in CVDs with a protective edge during mild ischemia (preconditioning) and a deleterious excitotoxic role in more severe ischemia. This duality adds further complexity to the development of effective therapies to prevent ischemic injury by promoting, for example, preconditioning with P2X7 receptor agonists and/or allosteric modulators while having at hand antagonists as neuroprotectants to limit the extension of the ischemic core into the penumbra once stroke occurs. To define the parameters that limit this double-edged behavior of P2X7 receptors constitutes a major challenge in experimental ischemia as a previous step for an effective translation into CVDs patients.
On the other hand, ischemic post-conditioning may be more amenable and effective for therapeutic use. Thus, repetitive short periods of OGD alternated with reperfusion after prolonged OGD attenuates neuronal apoptosis by increasing Bcl-2 expression while reducing Bax levels and overexpressing heat-shock protein 70 (HSP70; Zhao et al.,
Therapeutic Potential of P2X7 Receptor in Cerebrovascular Diseases
All the above evidence suggests that P2X7 receptor activation or blockade is involved in the onset and propagation of tissue damage as well as in neuroprotection and neuroinflammation in CVDs. Therefore, a thorough understanding of the upstream events leading to P2X7 receptor activation along with subsequent downstream signaling cascades they trigger will eventually allow identifying new cellular and molecular targets amenable for the design of novel drugs to use in clinical studies.
P2X7 receptor agonists may facilitate ischemia preconditioning by promoting the release of protective factors and signals in neurons and glia that ultimately attenuate major damage (Hirayama et al.,
In addition to agonists and antagonists, other P2X7 receptor ligands may have therapeutic value. This includes positive allosteric modulators, such as clemastine, an anti-allergy drug, which binds extracellularly to P2X7 receptors and potentiates their ATP-sensitivity while it increases the release of IL-1β; from lipopolysaccharide-primed macrophages, thus modulating native immune responses (Nörenberg et al.,
Discovering new uses for approved drugs acting at P2X7 may provide the quickest possible transition from bench to bedside in CVDs. Thus, A-740003 (N-(1-[(cyanoimino)(5-quinolinylamino) methyl] amino-2,2-dimethylpropyl)-2-(3,4-dimethoxyphenyl)acetamide), a competitive antagonist of P2X7 receptors, produces significant antinociception in animal models of neuropathic and inflammatory pain (Honore et al.,
Another interesting approach in the development of biologics targeting P2X7 receptors are antibodies and nanobodies that antagonize or potentiate gating of P2X7. Their potential advantages over small-molecule drugs include high specificity, lower off-target effects, and tunable in vivo half-life (for a recent review see Koch-Nolte et al.,
Conclusions
The present review provides an outlook about the role of P2X7 receptors in CVDs and their dual function as a cationic channel and as a precursor of large pore formation. It summarizes a wealth of evidence demonstrating that inhibition of P2X7 receptors promotes neuron and glia protection against brain injury and that they can be essential for the release of cell-supporting factors. At the same time, these receptors are also relevant to preconditioning and post-conditioning and, therefore, emerge as possible targets to attenuate tissue damage in CVDs and modulate neuroinflammation to constrain the expansion of the core lesion into the penumbra.
New, groundbreaking research on therapeutic targeting on P2X7 receptors is constantly being made available. A notable example is the relatively recent discovery of a structural basis for subtype-specific inhibition, which provides novel mechanistic insights to facilitate the development of P2X7-specific drugs for treating human diseases (Karasawa and Kawate,
In summary, P2X7 receptors contribute to neurotransmission and glia signaling using Ca2+ as a key second messenger (Figure 2) although the precise mechanisms mediating their effects in neurons and glial cells are still unclear. In mild CVDs, P2X7 receptors are involved directly or indirectly in preconditioning or post-conditioning by conditions by promoting the release of protective factors, such as HIF-1 (Hirayama et al.,
Figure 2

Upstream and downstream events of P2X7 receptor activation in brain cells. ATP release through Panx1 or CALHM1 activates P2X7 receptors, which induces influx of Ca2+. The prolonged stimulation of P2X7 receptors induces pore formation and further ATP release. Brief depolarization during mild cerebrovascular diseases (CVDs) may promote the release of protective factors, such as hypoxia-inducible factor (HIF)-1, that confer cellular protection against subsequent ischemic stimuli. In contrast, severe CVDs trigger a sustained P2X7 receptor depolarization and the release of pro-inflammatory cytokines that cause apoptosis or lysis.
Statements
Author contributions
AC-M and CM conceived and described the initial draft of the manuscript. AC-M prepared graphic material. AP-S, MD, RA, MG, and FK-N contributed numerous comments and suggestions to the final manuscript.
Funding
This study was supported by grants from CONACYT-México No. 252121 and PAPIITUNAM-México No. IN203519 to ROA laboratory; by Spanish Ministry of Education and Science/FEDER (SAF2016-75292-R), Basque Government (IT1203/19), CIBERNED, Eranet-Neuron and Universidad del País Vasco to CM’s laboratory. AC-M is a researcher from Cátedras-CONACYT commissioned at Instituto de Neurobiología at Universidad Nacional Autónoma de México (UNAM).
Acknowledgments
We thank Dr. Edith Garay and Saioa Marcos for technical assistance.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Summary
Keywords
ATP, pannexin-1, ischemia, neuron, oligodendrocyte
Citation
Cisneros-Mejorado AJ, Pérez-Samartín A, Domercq M, Arellano RO, Gottlieb M, Koch-Nolte F and Matute C (2020) P2X7 Receptors as a Therapeutic Target in Cerebrovascular Diseases. Front. Mol. Neurosci. 13:92. doi: 10.3389/fnmol.2020.00092
Received
01 March 2020
Accepted
05 May 2020
Published
18 June 2020
Volume
13 - 2020
Edited by
Miguel Diaz-Hernandez, Complutense University of Madrid, Spain
Reviewed by
Francesco Di Virgilio, University of Ferrara, Italy; Juan C. Saez, Pontificia Universidad Católica de Chile, Chile; Robson Coutinho-Silva, Federal University of Rio de Janeiro, Brazil
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© 2020 Cisneros-Mejorado, Pérez-Samartín, Domercq, Arellano, Gottlieb, Koch-Nolte and Matute.
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*Correspondence: Abraham J. Cisneros-Mejorado abraham.cisneros.mejorado@gmail.com Carlos Matute carlos.matute@ehu.es
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