Previous studies by our group as well as others have shown that acute adenosine exposure enhances lung vascular endothelial barrier integrity and protects against increased permeability lung edema. In contrast, there is growing evidence that sustained adenosine exposure has detrimental effects on the lungs, including lung edema. It is well established that adenosine modulates lung inflammation. However, little is known concerning the effect of sustained adenosine exposure on lung endothelial cells (ECs), which are critical to the maintenance of the alveolar-capillary barrier. We show that exogenous adenosine plus adenosine deaminase inhibitor caused sustained elevation of adenosine in lung ECs. This sustained adenosine exposure decreased EC barrier function, elevated cellular reactive oxygen species levels, and activated p38, JNK, and RhoA. Inhibition of equilibrative nucleoside transporters (ENTs) prevented sustained adenosine-induced p38 and JNK activation and EC barrier dysfunction. Inhibition of p38, JNK, or RhoA also partially attenuated sustained adenosine-induced EC barrier dysfunction. These data indicate that sustained adenosine exposure causes lung EC barrier dysfunction via ENT-dependent intracellular adenosine uptake and subsequent activation of p38, JNK, and RhoA. The antioxidant N-acetylcysteine and the NADPH inhibitor partially blunted sustained adenosine-induced JNK activation but were ineffective in attenuation of p38 activation or barrier dysfunction. p38 was activated exclusively in mitochondria, whereas JNK was activated in mitochondria and cytoplasm by sustained adenosine exposure. Our data further suggest that sustained adenosine exposure may cause mitochondrial oxidative stress, leading to activation of p38, JNK, and RhoA in mitochondria and resulting in EC barrier dysfunction.Keywords: adenosine deaminase; equilibrative nucleoside transporters; oxidative stress; MAP kinases; RhoA Increased permeability pulmonary edema is a life-threatening complication characteristic of acute lung injury (ALI) and acute respiratory distress syndrome. The purine nucleoside adenosine has been shown to protect (1-4) and cause (5) pulmonary edema and inflammation in animal models of ALI. The mechanisms governing these paradoxical effects of adenosine are poorly understood.Adenosine is a potent signaling molecule. Under homeostatic conditions, extracellular adenosine concentrations are low (40-600 nM) (6). However, extracellular adenosine levels are increased in response to tissue injury. High plasma adenosine (10-190 mM) has been reported in patients with sepsis-induced ALI (7, 8) and tissue ischemia (9). Adenosine is also significantly elevated in the lungs of animals with ALI caused by acute hypoxia (10-13), high tidal volume ventilation (14), endotoxin (15), and bleomycin (16). Acutely elevated adenosine has been shown to have a protective, antiinflammatory effect in various animal models of ALI (1-4). However, nonsurviving patients with sepsis have much higher plasma adenosine than survivors (7), suggesti...