-The concept of a purinergic signalling system, using purine nucleotides and nucleosides as extracellular messengers, was first proposed over 30 years ago. After a brief historical review and update of purinoceptor subtypes, this article focuses on the diverse physiological roles of adenosine triphosphate, adenosine diphosphate, uridine triphosphate and adenosine. These molecules mediate short-term (acute) signalling functions in neurotransmission, secretion and vasodilation, and long-term (chronic) signalling functions in development, regeneration, proliferation and cell death. Plasticity of purinoceptor expression in pathological conditions is frequently obser ved, including an increase in the purinergic component of parasympathetic nervous control of the human bladder in interstitial cystitis and outflow obstruction, and in sympathetic cotransmitter control of blood vessels in hypertensive rats. The antithrombotic action of clopidogrel (Plavix), a P2Y 12 receptor antagonist, has been shown to be particularly promising in the prevention of recurrent strokes and heart attacks in recent clinical trials (CAPRIE and CURE). The role of P2X 3 receptors in nociception and a new hypothesis concerning purinergic mechanosensory transduction in visceral pain will be considered, as will the therapeutic potential of purinergic agonists or antagonists for the treatment of supraventricular tachycardia, cancer, dry eye, bladder hyperactivity, erectile dysfunction, osteoporosis, diabetes, gut motility and vascular disorders. KEY WORDS: purinoceptors, interstitial cystitis, thrombosis, visceral pain, cancer, osteoporosis, peripheral vascular disease, cystic fibrosis, Parkinson' s disease, kidney failure Purinergic signalling: history and receptor subtypes A seminal paper by Drury and Szent-Györgi in 1929 described the potent actions of purine nucleotides and nucleosides, adenosine triphosphate (ATP) and adenosine on the heart and blood vessels 1 . A landmark paper by Pamela Holton in 1959 showed that, during antidromic stimulation of sensory nerves, ATP was released to the rabbit ear artery in sufficient amounts to produce changes in vascular tone 2 . Then, in 1970, Burnstock et al. found evidence for the role of ATP as a neurotransmitter in nonadrenergic, noncholinergic (NANC) nerves supplying the gut 3 , and, in 1972, the word 'purinergic' was coined and the purinergic-neurotransmission hypothesis was put forward 4 (Fig 1). This concept met with considerable resistance for many years because ATP had been established as an intracellular energy source involved in various metabolic cycles, and it was thought that such a ubiquitous molecule was unlikely to be involved in selective extracellular signalling. However, the concept is now widely accepted. Later, it was established that ATP is a cotransmitter with classical transmitters in both the peripheral and the central nervous systems, and that purines are powerful extracellular messengers to non-neuronal cells, including exocrine and endocrine, secretory, endothelial, b...