Structural insights into the orthosteric inhibition of P2X receptors by non-ATP-analog antagonists

Reviewer #1 (Public Review):

This work provides new mechanistic insights into the competitive inhibition in the mammalian P2X7 receptors using structural and functional approaches. The authors solved the structure of panda (pd) P2X7 in the presence of the classical competitive antagonists PPNDS and PPADS. They find that both drugs bind to the orthosteric site employed by the physiological agonist ATP. However, owing to the presence of a single phosphate group, they prevent movements in the flipper domain required for channel opening. The authors performed structure-based mutational analysis together with electrophysiological characterization to understand the subtype-specific binding of these drugs. It is known from previous studies that P2X1 and P2X3 are more sensitive to these drugs as compared to P2X7, hence, the residues adjacent to the ATP binding site in pdP2X7 were mutated to those present in P2X1. They observed that mutations of Q143, I214, and Q248 into lysine (hP2X1) increased the P2X7 sensitivity to PPNDS, whereas in P2X1, mutations of these lysines to alanine reduced sensitivity to PPNDS, suggesting that these key residues contribute to the subunit-specific sensitivity to these drugs. Similar experiments were done in hP2X3 to demonstrate its higher sensitivity to PPNDS. This preprint provides a useful framework for developing subtype-specific drugs for the family of P2X receptor channels, an area that is currently relatively unexplored.

The conclusions of the paper are mostly well supported, but need some clarification for the following:

1. Why was the crystallization construct of panda P2X7 used for structural studies instead of rat P2X7 with the cytoplasmic ballast which is a more complete receptor that is closely related to the human receptor? Can the authors provide a justification for this choice?

2. Was there a good reason why hP2X1 and hP2X3 currents were recorded in perforated patches, whereas pdP2X7 currents were recorded using the whole-cell configuration? It seems that the extent of rundown is less of a problem with perforated patch recordings. Can the authors comment and perhaps provide a justification? It would also be good to present data for repeated applications of ATP alone using protocols similar to those for testing antagonists so the reader can better appreciate the extent of run down with different recording configurations for the different receptors.

3. The data in Fig. S1, panel A shows multiple examples where the currents activated by ATP after removal of the antagonist are considerably smaller than the initial ATP application. Is this due to rundown or incomplete antagonist unbinding? It is interesting that this wasn't observed with hP2X1 and hP2X3 even though they have a higher affinity for the antagonist. Showing examples of rundown without antagonist application would help to distinguish these distinct phenomena and it would be good for the authors to comment on this in the text. It is also curious why a previous study on pdP2X7 did not seem to have problems with rundown (see Karasawa and Kawate. eLife, 2016).

4. The written presentation could be improved as there are many instances where the writing lacks clarity and the reader has to guess what the authors wish to communicate.

Reviewer #2 (Public Review):

Summary:
P2X receptors play pivotal roles in physiological processes such as neurotransmission and inflammation, making them promising drug targets. This study, through cryo-EM and functional experiments, reveals the structural basis of the competitive inhibition of the PPNDS and PPADS on mammalian P2X7 receptors. Key findings include the identification of the orthosteric site for these antagonists, the revelation of how PPADS/PPNDS binding impedes channel-activating conformational changes, and the pinpointing of specific residues in P2X1 and P2X3 subtypes that determine their heightened sensitivity to these antagonists. These insights present a comprehensive understanding that could guide the development of improved drugs targeting P2X receptors. This work will be a valuable addition to the field.

Strengths and weaknesses:
The combination of structural experiments and mutagenesis analyses offers a deeper understanding of the mechanism. While the inclusion of MD simulation is appreciated, providing more insights from the simulation might further strengthen this already compelling story.