The physiological role of the adenosine A 3 receptor is being investigated using newly synthesized, selective ligands. Recently, in addition to agonists, selective antagonists have been developed that belong to three distinct, non-purine chemical classes: flavonoids, 1,4-dihydropyridine derivatives (e.g. MRS1191, which is 1300-fold selective for human adenosine A 3 vs A 1 /A 2A receptors, with a K i value of 31 nM) and the triazoloquinazolines (e.g. MRS1220, which has a K i value of 0.65 nM). The A 3 receptor has proven enigmatic in terms of antagonist ligand specificity, coupling to second messengers, and biological effects in the CNS, inflammatory system and cardiovascular system. A 3 receptors are also potentially involved in apoptosis. It appears that intense, acute activation of A 3 receptors acts as a lethal input to cells, while low concentrations of A 3 receptor agonists protect against apoptosis. Here, Kenneth Jacobson describes how A 3 receptor agonists might be useful in treating inflammatory conditions, possibly through their inhibition of tumour necrosis factor α (TNF-α) release, which has been shown in macrophages. A 3 receptor antagonists might be useful in treating asthma or acute brain ischaemia. Recently, the versatility of A 3 receptor agonists, administered either before or during ischaemia, in eliciting potent cardioprotection has been shown.Adenosine has been shown to be a critical modulator of a vast array of physiological functions, through activation of one or more of the four known receptor subtypes: A 1 , A 2A , A 2B and A 3 (Refs 1, 2). The adenosine A 1 and A 2A receptors, pharmacologically well characterized through the use of selective ligands, generally have a protective role, i.e. in decreasing energy demand and increasing energy supply, respectively, under conditions of stress. Relatively recently identified through cloning 1,2 , the A 3 receptor (Fig. 1) has provided a new challenge to medicinal chemists in search of selective ligands 3 and to pharmacologists in defining its role in vivo. With the recent availability of selective agonists and antagonists, both protective and lethal effects of A 3 receptor activation have been discovered.In humans, A 3 receptors are found in the lungs, liver, heart and kidneys, with a lower density being found in the brain and testes 2 . A 3 receptors are found in both neurones 4 and astrocytes 5 . Although the density of A 3 receptors in the brain is possibly too low for mapping using either autoradiography with a high-affinity agonist, [ 125 I]N 6 -(4-aminobenzyl)-adenosine-5′-N-methyluronamide {[ 125 I]I-AB-MECA} (Fig. 2) 6,7 , or in situ hybridization 8 , a role for this subtype in the CNS has been proposed 9,10 .The A 3 receptors are under scrutiny in relation to potential therapeutic approaches for treating inflammatory and neurodegenerative diseases, asthma and cardiac ischaemia [10][11][12][13][14][15][16][17] . A 3 receptor ligands are protective in cerebral ischaemia models in gerbils 10 . In the heart, both A 1 and A 3 recepto...