RT Journal Article SR Electronic T1 A Second Drug Binding Site in P2X3 JF bioRxiv FD Cold Spring Harbor Laboratory SP 2024.06.10.598171 DO 10.1101/2024.06.10.598171 A1 Thach, Trung A1 Dhanabalan, KanagaVijayan A1 Nandekar, Prajwal Prabhakarrao A1 Stauffer, Seth A1 Heisler, Iring A1 Alvarado, Sarah A1 Snyder, Jonathan A1 Subramanian, Ramaswamy YR 2024 UL http://biorxiv.org/content/early/2024/06/14/2024.06.10.598171.abstract AB Purinergic P2X3 receptors form trimeric cation-gated channels, which are activated by extracellular ATP. P2X3 plays a crucial role in chronic cough and affects over 10% of the population. Despite considerable efforts to develop drugs targeting P2X3, the highly conserved structure within the P2X receptor family presents obstacles for achieving selectivity. Camlipixant, a potent and selective P2X3 antagonist, is currently in phase III clinical trials. However, the mechanisms underlying receptor desensitization, ion permeation, principles governing antagonism, and the structure of P2X3 when bound to camlipixant remain elusive. In this study, we established a stable cell line expressing homotrimeric P2X3 and utilized a peptide scaffold to purify the complex and determine its structure using cryo-electron microscopy (cryo-EM). P2X3 binds to camlipixant at a previously unidentified drug-binding site and functions as an allosteric inhibitor. Structure-activity studies combined with modeling and simulations have shed light on the mechanisms underlying the selective targeting and inhibition of P2X3 by camlipixant, distinguishing it from other members of the P2X receptor family.Competing Interest StatementThe Research was funded by Elanco Animal Health and some of the authors work for Elanco Animal Health.