P arkinson's disease (PD) is a chronic, progressive neurologicaldisease that affects âŒ1% of the population over the age of 65. 1 It is characterized by progressive impairment in motor function that is often accompanied by disturbances in mood and cognitive function. The majority of motor impairments of PD are caused by a gradual loss of dopamine (DA) producing neurons in the ventral midbrain and concomitant loss of DA input to forebrain (striatal) motor structures. 2,3 The loss of DA input to the neostriatum leads to dysregulation of striatal function and the classic motor symptoms of PD, such as resting tremor, muscular rigidity, and bradykinesia.The majority of treatments aim to restore dopamine signaling and thereby reduce the severity of the motor symptoms. Dopamine replacement therapy using L-DOPA, the precursor to dopamine, remains the gold-standard treatment for PD. Other approaches include inhibition of DA turnover using monoamine oxidase type B (MAO-B) inhibitors, 4 catechol O-methyl-transferase (COMT) inhibitors, 5 and inhibition of dopamine reuptake 6 or direct agonists 7 of postsynaptic dopamine receptors. Although the dopamine targeted therapies work well to address the PD related motor disturbances, they all produce undesirable side effects (dyskinesia, hallucinations, onĂoff effects) that become more severe and problematic with continued treatment. Also, the aforementioned therapies typically show reduced efficacy as motor functions deteriorate and the disease progresses. Moreover, these treatments do not alter disease progression and do not address the mood, postural instability, or cognitive disturbances that frequently accompany PD.The dopamine replacement agents have significant limitations which influenced researchers to find nondopamine based treatments for PD. One nondopaminergic approach that has received considerable attention is modulation of adenosine receptors which is the topic highlighted in this Review. 8 Adenosine is a neuromodulator that coordinates responses to dopamine and other neurotransmitters in areas of the brain that are responsible for motor function, mood, and learning and memory. 9 Adenosine comprises four distinct receptor subtypes designated A 1 , A 2A , A 2B , and A 3 belonging to the G protein-coupled receptor superfamily. 10 Adenosine A 1 and A 3 receptors are coupled to inhibitory G proteins, while A 2A and A 2B receptors are coupled to stimulatory G proteins. Autoradiography studies in rodents showed that the greatest densities of A 2A receptors are found in the striatum 11 which closely matches the distribution in humans based on PET imaging. 12 As described above, loss of dopamine input into the neostriatum is a hallmark of PD and causes many of the cardinal motor symptoms of this disorder. In the striatum adenosine A 2A receptors colocalize and physically associate with dopamine D 2 receptors. ABSTRACT: This Review summarizes and updates the work on adenosine A 2A receptor antagonists for Parkinson's disease from 2006 to the present. There have been numerou...