In comparison to other classes of cell surface receptors, the medicinal chemistry at P2X (ligandgated ion channels) and P2Y (G protein-coupled) nucleotide receptors has been relatively slow to develop. Recent effort to design selective agonists and antagonists based on a combination of library screening, empirical modification of known ligands, and rational design have led to the introduction of potent antagonists of the P2X 1 (derivatives of pyridoxal phosphates and suramin), P2X 3 (A-317491), P2X 7 (derivatives of the isoquinoline KN-62), P2Y 1 (nucleotide analogues MRS 2179 and MRS 2279), P2Y 2 (thiouracil derivatives such as AR-C126313), and P2Y 12 (nucleotide/nucleoside analogues AR-C69931X and AZD6140) receptors. A variety of native agonist ligands (ATP, ADP, UTP, UDP, and UDP-glucose) are currently the subject of structural modification efforts to improve selectivity. MRS2365 is a selective agonist for P2Y 1 receptors. The dinucleotide INS 37217 potently activates the P2Y 2 receptor. UTP-γ-S and UDP-β-S are selective agonists for P2Y 2 /P2Y 4 and P2Y 6 receptors, respectively. The current knowledge of the structures of P2X and P2Y receptors, is derived mainly from mutagenesis studies. Site-directed mutagenesis has shown that ligand recognition in the human P2Y 1 receptor involves individual residues of both the TMs (3, 5, 6, and 7), as well as EL 2 and 3. The binding of the negativelycharged phosphate moiety is dependent on positively charged lysine and arginine residues near the exofacial side of TMs 3 and 7.