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P2X7 receptor: An emerging therapeutic target in acute myeloid leukemia (Review)

  • Authors:
    • Yunqing Liu
    • Hongfan Xue
    • Hanheng Mai
    • Tan Sang
    • Zonghong Li
    • Na Wang
    • Lili Feng
  • View Affiliations / Copyright

    Affiliations: School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong 261053, P.R. China, Outpatient Department Management, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China, Department of Hematology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China, Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
    Copyright: © Liu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 84
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    Published online on: May 22, 2026
       https://doi.org/10.3892/ijo.2026.5897
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Abstract

The P2X7 receptor (P2X7R) is a ligand‑gated ion channel that exhibits bifunctional properties, switching between a cation‑permeable channel and a large cytolytic pore. In acute myeloid leukemia (AML), P2X7R is aberrantly overexpressed, particularly in leukemia stem cells (LSCs) and AML blasts. Within the bone marrow niche of AML, P2X7R binding by extracellular adenosine triphosphate not only contributes to a profound immunosuppressive niche that protects the AML cells from immune surveillance, but also drives LSC proliferation, survival, homing, and self‑renewal through downstream signaling cascades, including the cAMP response element‑binding protein/phosphoglycerate dehydrogenase/serine metabolic axis, PBX homeobox 3, Wnt/β‑catenin, and c‑Myc. Elevated P2X7R expression is associated with poor prognosis, chemoresistance, and disease recurrence of AML. The central role of P2X7R in AML pathophysiology makes it a potential biomarker for prognostic stratification and a promising therapeutic target. Several targeting strategies are currently under investigation, including the small molecule antagonists and specific anti‑P2X7R antibodies. Furthermore, a therapeutic approach involves combining P2X7R inhibition with conventional chemotherapy. In conclusion, targeting the P2X7R pathway represents a potential novel and multi‑faceted strategy to improve outcomes for patients with AML by remodeling its protective microenvironment and directly attacking the leukemia cells.
View Figures

Figure 1

Structure and function of P2X7R.
P2X7R presents a typical dolphin-like structural conformation
(21). Low concentrations of ATP
stimulation rapidly open P2X7R as an ion channel, while sustained
activation, particularly under high concentrations of eATP,
gradually opens macropores (24-26). In AML, the full-length of P2X7RA
mediates both ion channel activation and macropore formation, while
the P2X7RB variant only retains basic channel activity due to the
lack of the C-terminal domain. The macropores formed by P2X7RA
permit the passage of DNR, thereby promoting the chemosensitivity
of AML cells (37). P2X7R, P2X7
receptor; ATP, adenosine triphosphate; eATP, extracellular
adenosine triphosphate; AML, acute myeloid leukemia; DNR,
daunorubicin; TM2, second transmembrane helices.

Figure 2

Effects of P2X7R on HSPCs,
macrophages, DCs, and CD8+ T cells in the BM niche of
AML. (A) ATP released into the BM niche of AML activates P2X7R on
HSPCs, promoting mobilization, inhibiting colony-forming ability
and engraftment potential (49).
(B) P2X7R activation drives monocyte differentiation into M1
macrophages by enhancing glycolysis, while promoting
differentiation into immunosuppressive M2 macrophages through
enhancement of OXPHOS (53). (C)
DNR induces apoptosis of AML cells and triggers substantial ATP
release, thereby facilitating DC maturation and enhancing antigen
presentation. Elevated eATP upregulates IDO-1 expression in DCs,
which promotes the differentiation of
CD4+CD25− T cells into Tregs, and restrains
the immune response of leukemia-specific T cells (43). (D) In CD8+ T cells,
P2X7R inhibition enhances T-cell function by promoting cell cycle
activity, tumor antigen-specific T cells, and secretion of IFN-γ
and IL-4 (64-66). On the other hand, P2X7R inhibition
inhibits T-cell activity via the downregulation of NFAT-1, which in
turn reduces the secretion of IFN-γ, TGF-α and Nur77 (66). P2X7R, P2X7 receptor; HSPCs,
hematopoietic stem and progenitor cells; DCs, dendritic cells; BM,
bone marrow; AML, acute myeloid leukemia; ATP, adenosine
triphosphate; OXPHOS, oxidative phosphorylation; DNR, daunorubicin;
eATP, extracellular adenosine triphosphate; IDO-1, indoleamine
2,3-dioxygenase 1; Tregs, regulatory T cells; IFN-γ, interferon-γ;
IL-4, interleukin 4; NFAT-1, nuclear factor of activated T cells 1;
TGF-α, transforming growth factor-α.

Figure 3

Upstream and downstream signaling
pathways of P2X7R in AML. (A) ATP released into the BM niche from
osteoblasts and dying AML cells can be sequentially hydrolyzed into
ADP, AMP and adenosine by CD39 and CD73 (43). (B) P2X7R promotes AML progression
by activating multiple downstream pathways, including the
CREB/Phgdh/serine metabolic axis (12), Pbx3 (13), Wnt/β-catenin (77) and c-Myc (37). P2X7R, P2X7 receptor; AML, acute
myeloid leukemia; ATP, adenosine triphosphate; BM, bone marrow;
ADP, adenosine diphosphate; AMP, adenosine monophosphate; CREB,
cAMP response element-binding protein; Phgdh, phosphoglycerate
dehydrogenase; Pbx3, PBX homeobox 3; Panx1, pannexin 1; CX43,
connexin-43; LSC, leukemia stem cell; DNR, daunorubicin; CREB, cAMP
response element-binding protein.
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Copy and paste a formatted citation
Spandidos Publications style
Liu Y, Xue H, Mai H, Sang T, Li Z, Wang N and Feng L: P2X7 receptor: An emerging therapeutic target in acute myeloid leukemia (Review). Int J Oncol 69: 84, 2026.
APA
Liu, Y., Xue, H., Mai, H., Sang, T., Li, Z., Wang, N., & Feng, L. (2026). P2X7 receptor: An emerging therapeutic target in acute myeloid leukemia (Review). International Journal of Oncology, 69, 84. https://doi.org/10.3892/ijo.2026.5897
MLA
Liu, Y., Xue, H., Mai, H., Sang, T., Li, Z., Wang, N., Feng, L."P2X7 receptor: An emerging therapeutic target in acute myeloid leukemia (Review)". International Journal of Oncology 69.1 (2026): 84.
Chicago
Liu, Y., Xue, H., Mai, H., Sang, T., Li, Z., Wang, N., Feng, L."P2X7 receptor: An emerging therapeutic target in acute myeloid leukemia (Review)". International Journal of Oncology 69, no. 1 (2026): 84. https://doi.org/10.3892/ijo.2026.5897
Copy and paste a formatted citation
x
Spandidos Publications style
Liu Y, Xue H, Mai H, Sang T, Li Z, Wang N and Feng L: P2X7 receptor: An emerging therapeutic target in acute myeloid leukemia (Review). Int J Oncol 69: 84, 2026.
APA
Liu, Y., Xue, H., Mai, H., Sang, T., Li, Z., Wang, N., & Feng, L. (2026). P2X7 receptor: An emerging therapeutic target in acute myeloid leukemia (Review). International Journal of Oncology, 69, 84. https://doi.org/10.3892/ijo.2026.5897
MLA
Liu, Y., Xue, H., Mai, H., Sang, T., Li, Z., Wang, N., Feng, L."P2X7 receptor: An emerging therapeutic target in acute myeloid leukemia (Review)". International Journal of Oncology 69.1 (2026): 84.
Chicago
Liu, Y., Xue, H., Mai, H., Sang, T., Li, Z., Wang, N., Feng, L."P2X7 receptor: An emerging therapeutic target in acute myeloid leukemia (Review)". International Journal of Oncology 69, no. 1 (2026): 84. https://doi.org/10.3892/ijo.2026.5897
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