Background
The A1 adenosine receptor is a member of the rhodopsin-related subfamily of GPCRs. Point mutations in the conserved NPxxY(x)5,6F motif at the junction of helix 7 and the C-terminus disrupt surface targeting of the receptor and result in its intracellular retention. This trafficking arrest can be overcome by addition of receptor ligands (pharmacochaperoning) that stabilize the receptor fold and thus promote surface expression. The mutants serve as a tool to explore a ramification of the retaliatory metabolite complex: hypoxia leads to intracellular accumulation of adenosine (by breakdown of ATP and by inhibition of adenosine kinase). Intracellular and extracellular adenosine levels are in equilibrium because of the action of the equilibrative nucleoside transporters. Extracellular adenosine dampens cellular metabolism by acting on inhibitory A1 adenosine receptors and thus counteracts the impact of hypoxia. If adenosine also pharmacochaperoned A1 adenosine receptors during hypoxia, it would enhance its effectiveness as a protective agent.