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During exercise, cardiac oxygen-consumption increases and the resulting low oxygen level in myocardium triggers coronary vasodilation. This response to hypoxia is controlled notably by the vasodilator adenosine and its A 2A receptor (A 2A R). According to the "spare receptor" pharmacological model, a strong A 2A R-mediated response can occur in the context of a large number of receptors remaining unoccupied, activation of only a weak fraction of A 2A R (evaluated using K D ) resulting in maximal cAMP production (evaluated using EC 50 ), and hence in maximal coronary vasodilation. In coronary artery disease (CAD), myocardial ischemia limits adaptation to exercise, which is commonly detected using the exercise stress test (EST). We hypothesized that spare A 2A R are present in CAD patients to correct ischemia. Seventeen patients with angiographically-documented CAD and 17 control subjects were studied. We addressed adenosine-plasma concentration and A 2A R-expression at the mononuclear cell-surface, which reflects cardiovascular expression. The presence of spare A 2A R was tested using an innovative pharmacological approach based on a homemade monoclonal antibody with agonist properties. EST was positive in 82% of patients, and in none of the controls. Adenosine plasma-concentration increased by 60% at peak exercise in patients only (p&lt;0.01). Most patients (65%), and none of the controls, had spare A 2A R (identified when EC 50 /K D ≤0.1) and a low A 2A R-expression (mean: -37% vs controls; p&lt;0.01). All patients with spare A 2A R had a positive EST whereas the subjects without spare A 2A R had a negative EST (p&lt;0.05). Spare A 2A R are therefore associated with positive EST in CAD patients and their detection may be used as a diagnostic marker.

Spare Adenosine A2a Receptors Are Associated with Positive Exercise Stress Test in Coronary Artery Disease