Purinergic (P2) Receptor Control of Lower Genitourinary Tract Function and New Avenues for Drug Action: An Overview

Micturition, penile erection, contraction of prostatic smooth muscle, peristalsis of the male excurrent duct system and lumbosacral spinal cord neurotransmission all require adenosine 5'-triphosphate (ATP) activity and this likely involves purinergic (P2) receptors. P2 receptors are categorized as either ligand-gated ionotropic P2X or metabotropic G-protein-coupled P2Y subtypes. In the urinary bladder, purinergic receptor mechanisms are involved in both motor and sensory function. In the prostate, P2X1-receptors, which mediate contraction, are present in the fibromuscular stroma while G protein-coupled P2Y purinoceptors have a wide range of actions in prostate cancer. In the excretory ducts of the testis (ductus epididymidis, vas deferens and its associated seminal vesicles), heavy immunostaining for P2X1 and P2X2 subtypes is detected in the membranes of smooth muscle, suggesting their role in sperm transport and ejaculation. In the penis, intense P2X1 and weak P2X2 immunoreactivity are observed in smooth muscle of blood vessels and the corpus cavernosum, implying their participation in detumescence. Human corporal cavernosum stimulation induces relaxation of P2Y purinoceptors. Targeting of extracellular or intracellular P2X and/or P2Y receptor signaling pathways holds promise in affecting the lower genitourinary tract system. Our advancing knowledge about purine agonists and their pharmacologic benefits in erectile, ejaculatory, urinary bladder and prostatic hyperplasia may service clinical problems in the near future.