Adenosine A2A signaling in mood disorders: How far have we come?

Over the years, evidence has continued to support the role of the adenosinergic system in shaping emotional behavior and its impact on the development of mood disorders. In the 1980s, pioneering studies revealed that tricyclic antidepressants could modulate the levels of adenosine and adenosine metabolism. Moreover, evidence from animal models support a regulation of adenosine receptors in brain regions involved in emotional responses, and the role of pharmacological manipulation of adenosine receptors on behavioral despair, anxiety, locomotion, rewards processing and cognition. Clinical research has focused on the effects of caffeine, a non-selective adenosine receptor antagonist, and in genetic polymorphisms in adenosine receptors on emotional regulation in psychiatric patients. Recently, the approval of Istradefylline as an adjunctive treatment for Parkinson's disease holds great promise to expand our understanding of adenosine A2A receptors (A2AR) blockade in humans. Furthermore, recent advancements in transgenic lines and optogenetic techniques have highlighted the role of adenosine receptors in specific cell types and brain circuits that control emotional behavior. In this review, our focus will be on A2AR, given their strong association to stress-related conditions, mood disorders, and the potential of A2AR antagonists in clinical research. We will discuss the progress achieved in understanding its role in emotional regulation, emphasizing functions across distinct cell types and potential applications as a pharmacological target for mood disorders in the upcoming years.