Abstract:
The present invention provides a therapeutic method for treating biological diseases that includes the administration of an effective amount of a suitable antibiotic agent, antifungal agent or antiviral agent in conjunction with an A 2A  adenosine receptor agonist. If no anti-pathogenic agent is known the A 2A  agonist can be used alone to reduce inflammation, as may occur during infection with antibiotic resistant bacteria, or certain viruses such as those that cause SARS or Ebola. Optionally, the method includes administration of a type IV PDE inhibitor.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation-in-part of U.S. patent application Ser. No. 10/379,154, filed Mar. 3, 2003; which is a continuation of U.S. patent application Ser. No. 09/827,083, filed Apr. 5, 2001, issued as U.S. Pat. No. 6,531,457, on Mar. 11, 2003; which is a continuation of U.S. application Ser. No. 09/333,387, filed Jun. 15, 1999, now U.S. Pat. No. 6,232,297, issued May 15, 2001, which claims priority of U.S. provisional patent application Ser. Nos. 60/118,029, filed Feb. 1, 1999, 60/124,316, filed Mar. 12, 1999, 60/133,374, filed May 10, 1999 and 60/135,573, filed May 24, 1999 all of which are incorporated by reference herein. 
     This application is also a continuation-in-part of U.S. application Ser. No. 10/263,379, filed Oct. 1, 2002, now U.S. Pat. No. 7,214,665, issued May 8, 2007, which claims priority from U.S. provisional patent application Ser. No. 60/326,517, filed Oct. 1, 2001, and U.S. provisional patent application Ser. No. 60/383,200, filed May 24, 2002, all of which are incorporated by reference herein. 
    
    
     GOVERNMENT FUNDING 
     The invention described herein was made with government support under Grant Number (R01-HL37942), awarded by the National Institutes of Health. The United States Government has certain rights in the invention. 
    
    
     BACKGROUND OF THE INVENTION 
     The inflammatory response serves the purpose of eliminating harmful agents from the body. There is a wide range of pathogenic insults that can initiate an inflammatory response including infection, allergens, autoimmune stimuli, immune response to transplanted tissue, noxious chemicals, and toxins, ischemia/reperfusion, hypoxia, mechanical and thermal trauma. Inflammation normally is a very localized action which serves in expulsion, attenuation by dilution, and isolation of the damaging agent and injured tissue. The body&#39;s response becomes an agent of disease when it results in inappropriate injury to host tissues in the process of eliminating the targeted agent, or responding to a traumatic insult. 
     As examples, inflammation is a component of pathogenesis in several vascular diseases or injuries. Examples include: ischemia/reperfusion injury (N. G. Frangogiannis et al., in  Myocardial Ischemia: Mechanisms, Reperfusion, Protection , M. Karmazyn, ed., Birkhuser Verlag (1996) at 236-284; H. S. Sharma et al.,  Med. of Inflamm.,  6, 175 (1987)), atherosclerosis (R. Ross,  Nature,  362, 801 (1993)), inflammatory aortic aneurysms (N. Girardi et al.,  Ann. Thor. Surg.,  64, 251 (1997); D. I. Walker et al.,  Brit. J. Surg.,  59, 609 (1972); R. L. Pennell et al.,  J. Vasc. Surg.,  2, 859 (1985)), and restenosis following balloon angioplasty (see, R. Ross cited above). The cells involved with inflammation include leukocytes (i.e., the immune system cells—neutrophils, eosinophils, lymphocytes, monocytes, basophils, macrophages, dendritic cells, and mast cells), the vascular endothelium, vascular smooth muscle cells, fibroblasts, and myocytes. 
     The release of inflammatory cytokines such as tumor necrosis factor-alpha (TNFα) by leukocytes is a means by which the immune system combats pathogenic invasions, including infections. TNFα stimulates the expression and activation of adherence factors on leukocytes and endothelial cells, primes neutrophils for an enhanced inflammatory response to secondary stimuli and enhances adherent neutrophil oxidative activity. See, Sharma et al., cited above. In addition, macrophages/dendritic cells act as accessory cells processing antigen for presentation to lymphocytes. The lymphocytes, in turn, become stimulated to act as pro-inflammatory cytotoxic cells. 
     Generally, cytokines stimulate neutrophils to enhance oxidative (e.g., superoxide and secondary products) and nonoxidative (e.g., myeloperoxidase and other enzymes) inflammatory activity. Inappropriate and over-release of cytokines can produce counterproductive exaggerated pathogenic effects through the release of tissue-damaging oxidative and nonoxidative products (K. G. Tracey et al.,  J. Exp. Med.,  167, 1211 (1988); and D. N. Männel et al.,  Rev. Infect. Dis.,  9 (suppl. 5), S602-S606 (1987)). For example, TNFα can induce neutrophils to adhere to the blood vessel wall and then to migrate through the vessel to the site of injury and release their oxidative and non-oxidative inflammatory products. 
     Although monocytes collect slowly at inflammatory foci, given favorable conditions, the monocytes develop into long-term resident accessory cells and macrophages. Upon stimulation with an inflammation trigger, monocytes/macrophages also produce and secrete an array of cytokines (including TNFα), complement, lipids, reactive oxygen species, proteases and growth factors that remodel tissue and regulate surrounding tissue functions. 
     For example, inflammatory cytokines have been shown to be pathogenic in: arthritis (C. A. Dinarello,  Semin. Immunol.,  4, 133 (1992)); ischemia (A. Seekamp et al.,  Agents - Actions - Supp.,  41, 137 (1993)); septic shock (D. N. Männel et al.,  Rev. Infect. Dis.,  9 (suppl. 5), S602-S606 (1987)); asthma (N. M. Cembrzynska et al.,  Am. Rev. Respir. Dis.,  147, 291 (1993)); organ transplant rejection (D. K. Imagawa et al.,  Transplantation,  51, 57 (1991); multiple sclerosis (H. P. Hartung,  Ann. Neurol.,  33, 591 (1993)); AIDS (T. Matsuyama et al.,  AIDS,  5, 1405 (1991)); and in alkali-burned eyes (F. Miyamoto et al.,  Opthalmic Res.,  30, 168 (1997)). In addition, superoxide formation in leukocytes has been implicated in promoting replication of the human immunodeficiency virus (HIV) (S. Legrand-Poels et al.,  AIDS Res. Hum. Retroviruses,  6, 1389 (1990)). 
     One disease that can be treated via transplantation is diabetes mellitus. The incidence of diabetes mellitus is predicted to increase significantly in the next decade, and it already affects an estimated 130 million people worldwide. Diabetes affects 16 million Americans and consumes one out of every eight health care dollars. Despite the efficacy of insulin therapy, the devastating secondary complications, including nephropathy, neuropathy, retinopathy, and cardiovascular disease, can shorten life expectancy by as much as one third. 
     One method for treatment of diabetes is β-cell replacement therapy. This treatment is the best way to achieve ideal blood glucose control and stop the progression of the secondary complications of Diabetes. Islet transplantation is an attractive alternative to either insulin injection or whole organ pancreas transplantation. This method avoids the technical complications of solid-organ pancreas transplantation, related to thrombosis of the blood supply to the whole-organ allograft and the danger of activation of the digestive enzymes associated with the exocrine function. In addition, islet transplantation provides the opportunity to manipulate the islets prior to transplantation in order to decrease immunogenicity of the allograft. 
     Unfortunately, many recipients need 2 to 3 transplantations to achieve insulin independence even after transplantation of more than 250,000 Ieq. According to statistics, while the number of patients in the USA who are diagnosed with type I diabetes annually is about 30,000, the number of pancreas donated for transplantation is approximately 6000. These donated pancreases are not solely used for islet transplantation. 
     The majority of islet grafts are lost early after transplantation (within the first 3 days post-transplantation, more than half of islet grafts will die). Growing evidence implicates a nonspecific inflammatory reaction in the host microenvironment at the site of islet implantation and transplantation as one of the main reasons for islet graft early death. 
     Islets are believed to be highly sensitive to the toxic effects of inflammatory mediators. P-selectin exposed on activated platelets can also stimulate monocytes and macrophages to secrete chemokines that are deleterious to islets. The high concentrations of TNF-a, IL-1b, and NO generated at the site of the allograft may also have direct toxic effects on islets. Moreover, isolated human islets are also believed to express many genes involved in the generation of inflammatory responses after isolation. The expression of IL-1β, IL-8, MIP-2, MCP-1, and MIF have been found to rise after the isolation procedure, and after transplantation this upregulation may induce an intense inflammation and enhance subsequent specific immune response. As a result of this initial strong inflammatory response, subsequent antigen presentation would probably be promoted, leading to accelerated and reinforced cell mediated immunity in a later phase. 
     The detrimental effects of this instant inflammatory reaction may provide a reasonable explanation for the relatively low success rates in clinical islet transplantation and may explain the need for islets from several donors to obtain normoglycemia in the transplant recipient. Strategies to efficiently inhibit these cascade reactions at the time of transplantation and during the first postoperative days may be of great importance in improving the outcome of clinical islet transplantation. 
     It is well known that adenosine and some analogs of adenosine that nonselectively activate adenosine receptor subtypes decrease neutrophil production of inflammatory oxidative products (B. N. Cronstein et al.,  Ann. N.Y. Acad. Sci.,  451, 291 (1985); P. A. Roberts et al.,  Biochem. J.,  227, 669 (1985); D. J. Schrier et al.,  J. Immunol.,  137, 3284 (1986); B. N. Cronstein et al.,  Clinical Immunol. and Immunopath.,  42, 76 (1987); M. A. Iannone et al., in  Topics and Perspective in Adenosine Research , E. Gerlach et al., eds., Springer-Verlag, Berlin, p. 286 (1987); S. T. McGarrity et al.,  J. Leukocyte Biol.,  44, 411421 (1988); J. De La Harpe et al.,  J. Immunol.,  143, 596 (1989); S. T. McGarrity et al.,  J. Immunol.,  142, 1986 (1989); and C. P. Nielson et al.,  Br. J. Pharmacol.,  97, 882 (1989)). For example, adenosine has been shown to inhibit superoxide release from neutrophils stimulated by chemoattractants such as the synthetic mimic of bacterial peptides, f-met-leu-phe (fMLP), and the complement component C 5 a (B. N. Cronstein et al.,  J. Immunol.,  135, 1366 (1985)). Adenosine can decrease the greatly enhanced oxidative burst of PMN (neutrophil) first primed with TNF-α and then stimulated by a second stimulus such as f-met-leu-phe (G. W. Sullivan et al.,  Clin. Res.,  41, 172A (1993)). Additionally, it has been reported that adenosine can decrease the rate of HIV replication in a T-cell line (S. Sipka et al.,  Acta. Biochim. Biopys. Hung.,  23, 75 (1988)). However, there is no evidence that in vivo adenosine has anti-inflammatory activity (G. S. Firestein et al.,  Clin. Res.,  41, 170A (1993); and B. N. Cronstein et al.,  Clin. Res.,  41, 244A (1993)). 
     It has been suggested that there is more than one subtype of adenosine receptor on neutrophils that can have opposite effects on superoxide release (B. N. Cronstein et al.,  J. Clin. Invest.,  85, 1150 (1990)). The existence of A 2A  receptor on neutrophils was originally demonstrated by Van Calker et al. (D. Van Calker et al.,  Eur. J. Pharmacology,  206, 285 (1991)). 
     There has been progressive development of compounds that are more and more potent and/or selective as agonists of A 2A  adenosine receptors (AR) based on radioligand binding assays and physiological responses. Initially, compounds with little or no selectivity for A 2A  receptors were developed, such as adenosine itself or 5′-carboxamides of adenosine, such as 5′-N-ethylcarboxamidoadenosine (NECA) (B. N. Cronstein et al.,  J. Immunol.,  135, 1366 (1985)). Later, it was shown that addition of 2-alkylamino substituents increased potency and selectivity, e.g., CV1808 and CGS21680 (M. F. Jarvis et al.,  J. Pharmacol. Exp. Ther.,  251, 888 (1989)). 2-Alkoxy-substituted adenosine derivatives such as WRC-0090 are even more potent and selective as agonists at the coronary artery A 2A  receptor (M. Ueeda et al.,  J. Med. Chem.,  34, 1334 (1991)). The 2-alklylhydrazino adenosine derivatives, e.g., SHA 211 (also called WRC-0474) have also been evaluated as agonists at the coronary artery A 2A  receptor (K. Niiya et al.,  J. Med. Chem.,  35, 4557 (1992)). 
     There is one report of the combination of relatively nonspecific adenosine analogs, R-phenylisopropyladenosine (R-PIA) and 2-chloroadenosine (Cl-Ado) with a phosphodiesterase (PDE) inhibitor resulting in a lowering of neutrophil oxidative activity (M. A. Iannone et al.,  Topics and Perspectives in Adenosine Research , E. Garlach et al., eds., Springer-Verlag, Berlin, pp. 286-298 (1987)). However, R-PIA and Cl-Ado analogs are actually more potent activators of A 1  adenosine receptors than of A 2A  adenosine receptors and, thus, are likely to cause side effects due to activation of A 1  receptors on cardiac muscle and other tissues causing effects such as “heart block.” 
     There remains a need for compounds that are useful for treating an inflammatory response caused by an immune response to transplanted tissue and that can enhance the survival rate of transplanted organs after transplantation. 
     SUMMARY OF THE INVENTION 
     The present invention provides a therapeutic method for treating an inflammatory response caused by an immune response to transplanted tissue, comprising the administration to a patient in need thereof of an effective amount of an A 2A  adenosine receptor agonist. In one embodiment, the immune response is a transplant rejection, or graft versus host disease. 
     The present invention also provides method for transplanting tissues (cells) or organs in a mammal in need thereof wherein the method includes treatment of an inflammatory response, caused by an immune response to transplanted tissue (e.g., bone marrow, cornea, kidney, lung, liver, heart, skin, pancreatic islets) including transplant rejection, and graft versus host disease, with A 2A  adenosine receptor agonists. 
     The agonists of A 2A  adenosine receptors of the invention can inhibit neutrophil, macrophage and T cell activation and thereby reduce inflammation caused immune responses. The effects of adenosine A 2A  agonists can be enhanced by type IV phosphodiesterase inhibitors such as rolipram. 
     The invention also provides compounds of the invention for use in medical therapy (e.g., for use as an adjunct in the treatment of an inflammatory response, caused by an immune response to transplanted tissue, e.g., bone marrow, cornea, kidney, lung, liver, heart, skin, pancreatic islets) including transplant rejection, and graft versus host disease, with A 2A  adenosine receptor agonists, as well as the use of a compound of the invention for the manufacture of a medicament for reducing inflammation caused by the bacteria or virus or the treatment thereof in a mammal, such as a human. 
     In another aspect, the present invention also provides a method to treat an inflammatory response caused by an immune response to transplanted tissue including administering to a mammal in need of said therapy, an effective anti-inflammatory amount of an agonists of A 2A  adenosine receptor, optionally with a PDE-UV inhibitor, such as, rolipram. 
     The invention provides a compound of formula I for use in medical therapy, preferably for use in treating inflammation or protecting mammalian tissue from inflammation such as an inflammatory response, e.g., resulting from allergy, trauma or ischemia/reperfusion injury, as well as the use of a compound of formula I for the manufacture of a medicament for the treatment of an inflammatory response due to a pathological condition or symptom in a mammal, such as a human, which is associated with inflammation. 
     Although certain A 2A  adenosine receptor agonists have been reported to be vasodilators, and thus to be useful to directly treat hypertension, thrombus, atherosclerosis and the like, the tissue-protective anti-inflammatory activity of the compounds of formula of the invention are not suggested by the prior art. 
     The invention also includes the use of a combination of these compounds with type IV phosphodiesterase inhibitors to preferably cause synergistic decreases in the inflammatory response mediated by leukocytes. 
     The invention also provides a pharmaceutical composition comprising an effective amount of the compound of formula I, or a pharmaceutically acceptable salt thereof, in combination with a pharmaceutically acceptable diluent or carrier, and optionally, in combination with a Type IV phosphodiesterase (PDE) inhibitor. Preferably, the composition is presented as a unit dosage form. 
     Additionally, the invention provides a therapeutic method for preventing or treating a pathological condition or symptom in a mammal, such as a human, wherein the activity of A 2A  adenosine receptors is implicated and agonism of said receptors is desired, comprising administering to a mammal in need of such therapy, an effective amount of a compound of formula I, or a pharmaceutically acceptable salt thereof. It is believed that activation of A 2A  adenosine receptors inhibits inflammation by affecting neutrophils, mast cells, monocytes/macrophages, platelets T-cells and/or eosinophils. Inhibition of these inflammatory cells results in tissue protection following tissue insults. 
     Among the inflammatory responses that can be treated (including treated prophylactically) with a compound of formula I, optionally with a Type IV PDE inhibitor, are inflammation due to:
         (a) autoimmune stimulation (autoimmune diseases), such as lupus erythematosus, multiple sclerosis, infertility from endometriosis, type I diabetes mellitus including the destruction of pancreatic islets leading to diabetes and the inflammatory consequences of diabetes, including leg ulcers, Crohn&#39;s disease, ulcerative colitis, inflammatory bowel disease, osteoporosis and rheumatoid arthritis;   (b) allergic diseases such as asthma, hay fever, rhinitis, poison ivy, vernal conjunctivitis and other eosinophil-mediated conditions;   (c) skin diseases such as psoriasis, contact dermatitis, eczema, infectious skin ulcers, open wounds, cellulitis;   (d) infectious diseases including sepsis, septic shock, encephalitis, infectious arthritis, endotoxic shock, gram negative shock, Jarisch-Herxheimer reaction, anthrax, plague, tularemia, ebola, shingles, toxic shock, cerebral malaria, bacterial meningitis, acute respiratory distress syndrome (ARDS), lyme disease, HIV infection, (TNFα-enhanced HIV replication, TNFα inhibition of reverse transcriptase inhibitor activity);   (e) wasting diseases: cachexia secondary to cancer and HIV;   (f) organ, tissue or cell transplantation (e.g., bone marrow, cornea, kidney, lung, liver, heart, skin, pancreatic islets) including transplant rejection, and graft versus host disease;   (g) adverse effects from drug therapy, including adverse effects from amphotericin B treatment, adverse effects from immunosuppressive therapy, e.g., interleukin-2 treatment, adverse effects from OKT3 treatment, contrast dyes, antibiotics, adverse effects from GM-CSF treatment, adverse effects of cyclosporine treatment, and adverse effects of aminoglycoside treatment, stomatitis and mucositis due to immunosuppression;   (h) cardiovascular conditions including circulatory diseases induced or exasperated by an inflammatory response, such as ischemia, atherosclerosis, peripheral vascular disease, restenosis following angioplasty, inflammatory aortic aneurysm, vasculitis, stroke, spinal cord injury, congestive heart failure, hemorrhagic shock, ischemia/reperfusion injury, vasospasm following subarachnoid hemorrhage, vasospasm following cerebrovascular accident, pleuritis, pericarditis, and the cardiovascular complications of diabetes;   (i) dialysis, including pericarditis, due to peritoneal dialysis;   (j) gout; and   (k) chemical or thermal trauma due to burns, acid, alkali and the like.       

     Unexpectedly, it was found that administration of one or more compounds of formula (I) was effective after the onset of the inflammatory response, e.g., after the subject was afflicted with the pathology or trauma that initiates the inflammatory response. 
     Tissue or cells comprising ligand bound receptor sites can be used to measure the selectively of test compounds for specific receptor subtypes, the amount of bioactive compound in blood or other physiological fluids, or can be used as a tool to identify potential therapeutic agents for the treatment of diseases or conditions associated with receptor site activation, by contacting said agents with said ligand-receptor complexes, and measuring the extent of displacement of the ligand and/or binding of the agent, or the cellular response to said agent (e.g., cAMP accumulation). 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         FIG. 1  shows blood glucose levels in mg/dL over time in a model for tissue rejection in mice, where the mice have received a transplant of 100 insulin-producing pancreatic islets, in the absence of any compound of the invention. 
         FIG. 2  shows blood glucose levels in mg/dL over time in a model for tissue rejection in mice, where the mice have received a transplant of 100 insulin-producing pancreatic islets, in the presence of inventive compound ATL146e at a dose of 10 ng/kg/min for 7 days. 
         FIG. 3  shows blood glucose levels in mg/dL over time in a model for tissue rejection in mice, where the mice have received a transplant of 150 insulin-producing pancreatic islets, in the absence of any compound of the invention. 
         FIG. 4  shows blood glucose levels in mg/dL over time in a model for tissue rejection in mice, where the mice have received a transplant of 150 insulin-producing pancreatic islets, in the presence of inventive compound ATL146e at a dose of 60 ng/kg/min administered starting 1 day before the transplant then for 7 days. 
         FIG. 5  shows blood glucose levels in mg/dL over time in a model for tissue rejection in mice, where the mice have received a transplant of 100 insulin-producing pancreatic islets, in the presence of inventive compound ATL146e at a dose of 60 ng/kg/min administered starting 1 day before the transplant then for 7 days. 
         FIG. 6  shows blood glucose levels in mg/dL over time in a model for tissue rejection in mice, where the mice have received a transplant of 50 insulin-producing pancreatic islets, in the absence of any compound of the invention. 
         FIG. 7  shows blood glucose levels in mg/dL over time in a model for tissue rejection in mice, where the mice have received a transplant of 50 insulin-producing pancreatic islets, in the presence of inventive compound ATL146e at a dose of 60 ng/kg/min administered starting 1 day before the transplant then for 7 days. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The following definitions are used, unless otherwise described. Halo is fluoro, chloro, bromo, or iodo. Alkyl, alkoxy, aralkyl, alkylaryl, etc. denote both straight and branched alkyl groups; but reference to an individual radical such as “propyl” embraces only the straight chain radical, a branched chain isomer such as “isopropyl” being specifically referred to. Aryl includes a phenyl radical or an ortho-fused bicyclic carbocyclic radical having about nine to ten ring atoms in which at least one ring is aromatic. Heteroaryl encompasses a radical attached via a ring carbon of a monocyclic aromatic ring containing five or six ring atoms consisting of carbon and one to four heteroatoms each selected from the group consisting of non-peroxide oxygen, sulfur, and N(X) wherein X is absent or is H, O, (C 1 -C 4 )alkyl, phenyl or benzyl, as well as a radical of an ortho-fused bicyclic heterocycle of about eight to ten ring atoms derived therefrom, particularly a benz-derivative or one derived by fusing a propylene, trimethylene, or tetramethylene diradical thereto. 
     It will be appreciated by those skilled in the art that the compounds of formulas (I), (II), (III), and (IV) have more than one chiral center and may be isolated in optically active and racemic forms. Preferably, the riboside moiety of the compounds is derived from D-ribose, i.e., the 3′,4′-hydroxyl groups are alpha to the sugar ring and the 2′ and 5′ groups is beta (3R, 4S, 2R, 5S). When the two groups on the cyclohexyl group are in the 1- and 4-position, they are preferably trans. Some compounds may exhibit polymorphism. It is to be understood that the present invention encompasses any racemic, optically-active, polymorphic, or stereoisomeric form, or mixtures thereof, of a compound of the invention, which possess the useful properties described herein, it being well known in the art how to prepare optically active forms (for example, by resolution of the racemic form by recrystallization techniques, or enzymatic techniques, by synthesis from optically-active starting materials, by chiral synthesis, or by chromatographic separation using a chiral stationary phase) and how to determine adenosine agonist activity using the tests described herein, or using other similar tests which are well known in the art. 
     Specific and preferred values listed below for radicals, substituents, and ranges, are for illustration only; they do not exclude other defined values or other values within defined ranges for the radicals and substituents. 
     Specifically, (C 1 -C 8 )alkyl can be methyl, ethyl, propyl, isopropyl, butyl, iso-butyl, sec-butyl, pentyl, 3-pentyl, hexyl, heptyl or octyl. As used herein, the term “cycloalkyl” encompasses bicycloalkyl (norbornyl, 2.2.2-bicyclooctyl, etc.) and tricycloalkyl (adamantyl, etc.), optionally comprising 1-2 N, O or S. Cycloalkyl also encompasses (cycloalkyl)alkyl. Thus, (C 3 -C 6 )cycloalkyl can be cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl and the like. (C 1 -C 8 )alkoxy can be methoxy, ethoxy, propoxy, isopropoxy, butoxy, iso-butoxy, sec-butoxy, pentoxy, 3-pentoxy, or hexyloxy; (C 2 -C 6 )alkenyl can be vinyl, allyl, 1-propenyl, 2-propenyl, 1-butenyl, 2-butenyl, 3-butenyl, 1-pentenyl, 2-pentenyl, 3-pentenyl, 4-pentenyl, 1-hexenyl, 2-hexenyl, 3-hexenyl, 4-hexenyl, or 5-hexenyl; (C 2 -C 6 )alkynyl can be ethynyl, 1-propynyl, 2-propynyl, 1-butynyl, 2-butynyl, 3-butynyl, 1-pentynyl, 2-pentynyl, 3-pentynyl, 4-pentynyl, 1-hexynyl, 2-hexynyl, 3-hexynyl, 4-hexynyl, or 5-hexynyl; (C 1 -C 6 )alkanoyl can be acetyl, propanoyl or butanoyl; halo(C 1 -C 6 )alkyl can be iodomethyl, bromomethyl, chloromethyl, fluoromethyl, trifluoromethyl, 2-chloroethyl, 2-fluoroethyl, 2,2,2-trifluoroethyl, or pentafluoroethyl; hydroxy(C 1 -C 6 )alkyl can be hydroxymethyl, 1-hydroxyethyl, 2-hydroxyethyl, 1-hydroxypropyl, 2-hydroxypropyl, 3-hydroxypropyl, 1-hydroxybutyl, 4-hydroxybutyl, 1-hydroxypentyl, 5-hydroxypentyl, 1-hydroxyhexyl, or 6-hydroxyhexyl; (C 1 -C 6 )alkoxycarbonyl (CO 2 R 2 ) can be methoxycarbonyl, ethoxycarbonyl, propoxycarbonyl, isopropoxycarbonyl, butoxycarbonyl, pentoxycarbonyl, or hexyloxycarbonyl; (C 1 -C 6 )alkylthio can be methylthio, ethylthio, propylthio, isopropylthio, butylthio, isobutylthio, pentylthio, or hexylthio, (C 2 -C 6 )alkanoyloxy can be acetoxy, propanoyloxy, butanoyloxy, isobutanoyloxy, pentanoyloxy, or hexanoyloxy; aryl can be phenyl, indenyl, or naphthyl; and heteroaryl can be furyl, imidazolyl, triazolyl, triazinyl, oxazoyl, isoxazoyl, thiazolyl, isothiazoyl, pyraxolyl, pyrrolyl, pyrazinyl, tetrazolyl, puridyl (or its N-oxide), thienyl, pyrimidinyl (or its N-oxide), indolyl, isoquinolyl (or its N-oxide) or quinolyl (or its N-oxide). 
     Aryl denotes a phenyl radical or an ortho-fused bicyclic carbocyclic radical having about nine to ten ring atoms in which at least one ring is aromatic. Heteroaryl denotes a radical of a monocyclic aromatic ring containing five or six ring atoms consisting of carbon and 1, 2, 3, or 4 heteroatoms each selected from the group consisting of non-peroxide oxygen, sulfur, and N(Y) wherein Y is absent or is H, O, (C 1 -C 8 )alkyl, phenyl or benzyl, as well as a radical of an ortho-fused bicyclic heterocycle of about eight to ten ring atoms derived therefrom, particularly a benz-derivative or one derived by fusing a propylene, trimethylene, or tetramethylene diradical thereto. 
     The term “heterocycle” generally represents a non aromatic heterocyclic group, having from 3 to about 10 ring atoms, which can be saturated or partially unsaturated, containing at least one heteroatom (e.g., 1, 2, or 3) selected from the group consisting of oxygen, nitrogen, and sulfur. Specific, “heterocycle” groups include monocyclic, bicyclic, or tricyclic groups containing one or more heteroatoms selected from the group consisting of oxygen, nitrogen, and sulfur. A “heterocycle” group also can include one or more oxo groups (═O) attached to a ring atom. Non-limiting examples of heterocycle groups include 1,3-dioxolane, 1,4-dioxane, 1,4-dithiane, 2H-pyran, 2-pyrazoline, 4H-pyran, chromanyl, imidazolidinyl, imidazolinyl, indolinyl, isochromanyl, isoindolinyl, morpholine, piperazinyl, piperidine, piperidyl, pyrazolidine, pyrazolidinyl, pyrazolinyl, pyrrolidine, pyrroline, quinuelidine, thiomorpholine, and the like. 
     The term “alkylene” refers to a divalent straight or branched hydrocarbon chain (e.g. ethylene —CH 2 CH 2 —). 
     The term “aryl(C 1 -C 8 )alkylene” for example includes benzyl, phenethyl, 3-phenylpropyl, naphthylmethyl and the like. 
     As used herein the term “in conjunction with” refers to co-administration of an anti-rejection agent with the A 2A  adenosine receptor agonist. The co-administration of an agent and an A 2A  adenosine receptor agonists includes administration of the agent and agonist either simultaneously, as a mixture, or sequentially. The sequential administration of the A 2A  adenosine receptor agonists can be prior to administration of the agent, within minutes or up to about 48 hours either before the administration of the agent. The A 2A  adenosine receptor agonists can also be administered after the agent. Preferably the administration of the A 2A  adenosine receptor agonists will be within about 24 hours and more preferably within about 12 hours. 
     In one embodiment, the patient is administered the A 2A  adenosine receptor agonists prior to transplantation. In another embodiment, the patient is implanted with a pump containing the A 2A  adenosine receptor agonists prior to transplantation. 
     The carbon atom content of various hydrocarbon-containing moieties is indicated by a prefix designating the minimum and maximum number of carbon atoms in the moiety, i.e., the prefix C i -C j  indicates a moiety of the integer “i” to the integer “j” carbon atoms, inclusive. Thus, for example, (C 1 -C 8 )alkyl refers to alkyl of one to eight carbon atoms, inclusive. 
     The compounds of the present invention are generally named according to the IUPAC or CAS nomenclature system. Abbreviations which are well known to one of ordinary skill in the art may be used (e.g., “Ph” for phenyl, “Me” for methyl, “Et” for ethyl, “h” for hour or hours and “rt” for room temperature). 
     In one embodiment, agonists of A 2A  adenosine receptors that are useful in the practice of the present invention include compounds having the formula (I): 
     
       
                 
         
             
             
         
      
     
     wherein 
     Z is CR 3 R 4 R 5  or NR 4 R 5 ; each R 1  is independently hydrogen, halo, —OR a , —SR a , (C 1 -C 8 )alkyl, cyano, nitro, trifluoromethyl, trifluoromethoxy, (C 3 -C 8 )cycloalkyl, heterocycle, heterocycle(C 1 -C 8 )alkylene-, aryl, aryl(C 1 -C 8 )alkylene-, heteroaryl, heteroaryl(C 1 -C 8 )alkylene-, —CO 2 R a , R a C(═O)O—, R a C(═O)—, —OCO 2 R a , R b R c NC(═O)O—, R a OC(═O)N(R b )—, R b R c N—, R b R c NC(═O)—, R a C(═O)N(R b )—, R b R c NC(═O)N(R b )—, R b R c NC(═S)N(R b )—, —OPO 3 R a , R a OC(═S)—, R a C(═S)—, —SSR a , R a S(═O)—, R a S(═O) 2 —, or —N═NR b ; 
     each R 2  is independently hydrogen, halo, (C 1 -C 8 )alkyl, (C 3 -C 8 )cycloalkyl, heterocycle, heterocycle(C 1 -C 8 )alkylene-, aryl, aryl(C 1 -C 8 )alkylene-, heteroaryl, or heteroaryl(C 1 -C 8 )alkylene-; or 
     R 1  and R 2  and the atom to which they are attached is C═O, C═S or C═NR d , 
     R 4  and R 5  together with the atoms to which they are attached form a saturated or partially unsaturated, mono-, bicyclic- or aromatic ring having 3, 4, 5, 6, 7, 8, 9 or 10 ring atoms optionally comprising 1, 2, 3, or 4 heteroatoms selected from non-peroxide oxy (—O—), thio (—S—), sulfinyl (—SO—), sulfonyl (—S(O) 2 —) or amine (—NR b —) in the ring; 
     wherein any ring comprising R 4  and R 5  is substituted with from 1 to 14 R 6  groups; wherein each R 6  is independently halo, —OR a , —SR a , (C 1 -C 8 )alkyl, cyano, nitro, trifluoromethyl, trifluoromethoxy, (C 1 -C 8 )cycloalkyl, (C 6 -C 12 )bicycloalkyl, heterocycle or heterocycle (C 1 -C 8 )alkylene-, aryl, aryl (C 1 -C 8 )alkylene-, heteroaryl, heteroaryl(C 1 -C 8 )alkylene-, —CO 2 R a , R a C(═O)O—, R a C(═O)—, —OCO 2 R a , R b R c NC(═O)O—, R a OC(═O)N(R b )—, R b R c N—, R b R c NC(═O)—, R a C(═O)N(R b )—, R b R c NC(═O)N(R b )—, R b R c NC(═S)N(R b )—, —OPO 3 R a , R a OC(═S)—, R a C(═S)—, —SSR a , R a S(═O)—, —NNR b , or two R 6  groups and the atom to which they are attached is C═O, C═S or; two R groups together with the atom or atoms to which they are attached can form a carbocyclic or heterocyclic ring; 
     R 3  is hydrogen, halo, —OR a , —SR a , (C 1 -C 8 )alkyl, cyano, nitro, trifluoromethyl, trifluoromethoxy, (C 3 -C 8 )cycloalkyl, heterocycle, heterocycle(C 1 -C 8 )alkylene-, aryl, aryl(C 1 -C 8 )alkylene-, heteroaryl, heteroaryl(C 1 -C 8 )alkylene-, —CO 2 R a , R a C(═O)O—, R a C(═O)—, —OCO 2 R a , R b R c NC(═O)O—, R a OC(═O)N(R b )—, R b R c N—, R b R c NC(═O)—, R a C(═O)N(R b )—, R b R c NC(═O)N(R b )—, R b R c NC(═S)N(R b )—, —OPO 3 R a , R a OC(═S)—, R a C(═S)—, —SSR a , R a S(═O)—, R a S(═O) 2 —, —NNR b ; or if the ring formed from CR 4 R 5  is aryl or heteroaryl or partially unsaturated then R 3  can be absent; 
     each R 7  is independently hydrogen, (C 1 -C 8 )alkyl, (C 3 -C 8 )cycloalkyl, aryl or aryl(C 1 -C 8 )alkylene, heteroaryl, heteroaryl(C 1 -C 8 )alkylene-; 
     X is —CH 2 OR a , —CO 2 R a , —OC(O)R a , —CH 2 OC(O)R a , —C(O)NR b R b , —CH 2 SR a , —C(S)OR a , —OC(S)R a , —CH 2 OC(S)R a  or —C(S)NR b R c  or —CH 2 N(R b )(R c ); 
     wherein any of the alkyl, cycloalkyl, heterocycle, aryl, or heteroaryl, groups of R 1 , R 2 , R 3 , R 6  and R 7  is optionally substituted on carbon with one or more (e.g. 1, 2, 3, or 4) substituents selected from the group consisting of halo, —OR a , —SR a , (C 1 -C 8 )alkyl, cyano, nitro, trifluoromethyl, trifluoromethoxy, (C 3 -C 8 )cycloalkyl, (C 6 -C 12 )bicycloalkyl, heterocycle or heterocycle(C 1 -C 8 )alkylene-, aryl, aryloxy, aryl(C 1 -C 8 )alkylene-, heteroaryl, heteroaryl(C 1 -C 8 )alkylene-, —CO 2 R a , R a C(═O)O—, R a C(═O)—, —OCO 2 R a , R b R c NC(═O)O—, R a OC(═O)N(R b )—, R b R c N—, R b R c NC(═O)—, R a C(═O)N(R b )—, R b R c NC(═O)N(R b )—, R b R c NC(═S)N(R b )—, —OPO 3 R a , R a OC(═S)—, R a C(═S)—, —SSR a , R a S(═O) p —, R b R c NS(O) p —, and —N═NR b ; 
     wherein any (C 1 -C 8 )alkyl, (C 3 -C 8 )cycloalkyl, (C 6 -C 12 )bicycloalkyl, (C 1 -C 8 )alkoxy, (C 1 -C 8 )alkanoyl, (C 1 -C 8 )alkylene, or heterocycle, is optionally partially unsaturated; 
     each R a , R b  and R c  is independently hydrogen, (C 1 -C 8 )alkyl, or (C 1 -C 8 )alkyl substituted with 1-3 (C 1 -C 8 )alkoxy, (C 3 -C 8 )cycloalkyl, (C 1 -C 8 )alkylthio, amino acid, aryl, aryl(C 1 -C 8 )alkylene, heteroaryl, or heteroaryl(C 1 -C 8 )alkylene; or R b  and R c , together with the nitrogen to which they are attached, form a pyrrolidino, piperidino, morpholino, or thiomorpholino ring; and R d  is hydrogen or (C 1 -C 6 )alkyl; m is 0 to about 8 and p is 0 to 2; or a pharmaceutically acceptable salt thereof. 
     In another embodiment, the invention includes the use of compounds of formula (I) provided that when CR 4 R 5  is a carbocyclic ring then at least one of R 1 , R 2 , or R 3  is a group other than hydrogen or at least one R 6  group is a group other than —CH 2 OH, —CO 2 R a , R a C(═O)—, R a C(═O)OCH 2 — or R b R c NC(═O)—; and provided that m is at least I when Z is NR 4 R 5 . 
     Specific and preferred values listed below for radicals, substituents, and ranges, are for illustration only; they do not exclude other defined values or other values within defined ranges for the radicals and substituents. 
     A specific immune response is an inflammatory response from a transplant rejection. 
     A specific transplant rejection is from an organ, tissue or cell transplantation. 
     Specific cells are bone marrow, skin, or pancreatic islets. 
     More specific cells are pancreatic islets. 
     Specific organs include a cornea, kidney, lung, liver, or heart. 
     A specific value for R 1  is hydrogen, —OH, —CH 2 OH, —OMe, —OAc, —NH 2 , —NHMe, —NMe 2  or —NHAc. 
     Another specific value for R 1  is hydrogen, —OH, —OMe, —OAc, —NH 2 , —NHMe, —NMe 2  or —NHAc. 
     Another specific value for R 1  is hydrogen, —OH, —OMe, or —NH 2 . 
     Another specific value for R 1  is hydrogen, —OH, or —NH 2 . 
     A more specific value for R 1  is hydrogen or —OH. 
     A specific value for R 1 , R 2  and the carbon atom to which they are attached is carbonyl (C═O). 
     A specific value for R 2  is hydrogen or (C 1 -C 8 )alkyl, cyclopropyl, cyclohexyl or benzyl. 
     Another specific value for R 2  is hydrogen, methyl, ethyl or propyl. 
     Another specific value for R 2  is hydrogen or methyl. 
     A more specific value for R 2  is hydrogen. 
     A specific value for R 3  is hydrogen, OH, OMe, OAc, NH 2 , NHMe, NMe 2  or NHAc. 
     Another specific value for R 3  is hydrogen, OH, OMe, or NH 2 . 
     Another specific value for R 3  is hydrogen, OH, or NH 2 . 
     A more specific value for R 3  is hydrogen or OH. 
     A specific value for the ring comprising R 4 , R 5  and the atom to which they are connected is cyclopentane, cyclohexane, piperidine, dihydro-pyridine, tetrahydro-pyridine, pyridine, piperazine, decaline, tetrahydro-pyrazine, dihydro-pyrazine, pyrazine, dihydro-pyrimidine, tetrahydro-pyrimidine, hexahydro-pyrimidine, pyrazine, imidazole, dihydro-imidazole, imidazolidine, pyrazole, dihydro-pyrazole, and pyrazolidine. 
     A more specific value for the ring comprising R 4  and R 5  and the atom to which they are connected is, cyclohexane, piperidine or piperazine. 
     A specific value for R 6  is (C 1 -C 8 )alkyl, or substituted (C 1 -C 8 )alkyl, —OR a , —CO 2 R a , R a C(═O)—, R a C(═O)O—, R b R c N—, R b R c NC(═O)—, or aryl. 
     Another specific value for R 6  is (C 1 -C 8 )alkyl, —OR a , —CO 2 R a , R a C(═O)—, R a C(═O)O—, R b R c N—, R b R c NC(═O)—, or aryl. 
     Another specific value for R 6  is methyl, ethyl, butyl, OH, OR a , —CO 2 R a , R a C(═O)—, OC(═O)CH 2 CH 3 , —CONR b R c , —NR b R c  or phenyl. 
     Another specific value for R 6  is OH, OMe, methyl, ethyl, t-butyl, —CO 2 R a , —C(═O)NR b R c , —OAc, —NH 2 , —NHMe, —NMe 2 , —NHEt or —N(Et) 2 . 
     Another specific value for R 6  is —(CH 2 ) 1-2 OR a , —(CH 2 ) 1-2 C(═O)OR a , —(CH 2 ) 1-2 OC(═O)R a , —(CH 2 ) 1-2 C(═O)R a , —(CH 2 ) 1-2 OCO 2 R a , —(CH 2 ) 1-2 NHR a , —(CH 2 ) 1-2 NR b R c , —(CH 2 ) 1-2 OC(═O)NHR a , or —(CH 2 ) 1-2 OC(═O)NR b R c . 
     Another specific value for R 6  is —CH 2 OH, —CH 2 OAc, —CH 2 OCH 3 , —CH 2 C(═O)OCH 3 , —CH 2 C(═O)CH 3 , —CH 2 C(═O)CH 3 , —CH 2 OCO 2 CH 3 , —CH 2 NH(CH 3 ), or —(CH 2 ) 1-2 N(CH 3 ) 2 . 
     Another specific value for R 6  is methyl, ethyl, t-butyl, phenyl, —CO 2 R a , —CONR b R c , or R a C(═O)—. 
     Another specific value for R 6  is —CH 2 OH, —CH 2 OAc, —C(═O)OCH 3 , —C(—O)CH 3 , OCO 2 CH 3 —OCO 2 CH 3 , —CH 2 NH(CH 3 ), or —(CH 2 ) 1-2 N(CH 3 ) 2 . 
     A more specific value for R 6  is methyl, ethyl, —CO 2 R a —CONR b R c , or R a C(═O)—. 
     A specific number of R 6  groups substituted on the R 4 R 5  ring is from 1 to about 4. 
     Specific values for R a  and R b  are independently hydrogen, (C 1 -C 4 )alkyl, aryl or aryl(C 1 -C 8 )alkylene. 
     More specific values for R a  and R b  are independently hydrogen, methyl, ethyl, phenyl or benzyl. 
     A more specific value for R a  is (C 1 -C 8 )alkyl. 
     Another specific value for R a  is methyl, ethyl, propyl or butyl. 
     A more specific value for R a  is methyl, ethyl, i-propyl, i-butyl or tert-butyl. 
     Another specific value for R b  and R c  is a ring. 
     A specific value for R 7  is hydrogen, alkyl, aryl or aryl(C 1 -C 8 )alkylene. 
     Another specific value for R 7  is hydrogen, methyl or ethyl, phenyl or benzyl. 
     A more specific value for R 7  is H, or methyl. 
     A specific value for —N(R 7 ) 2  is amino, methylamino, dimethylamino, ethylamino, pentylamino, diphenylethylamino, pyridylmethylamino, diethylamino or benzylamino. 
     A specific value for —N(R 7 ) 2  is amino, methylamino, dimethylamino, ethylamino, diethylamino diphenylethylamino, pentylamino or benzylamino. 
     A specific value for N(R 7 ) 2  is amino, or methylamino. 
     A specific value for X is —CH 2 OR a , —CO 2 R a , —OC(O)R a , —CH 2 OC(O)R a , —C(O)NR b R c . 
     Another specific value for X is —CH 2 OR a  or —C(O)NR b R c . 
     A more specific value for X is —CH 2 OH or —C(O)NHCH 2 CH 3 . 
     A specific value for m is 0, 1, or 2. 
     A more specific value for m is 0, or 1. 
     Specific examples of rings comprising R 4 , R 5  and the atom to which they are connected include: 
                                
where q is from 0 to 14 and R d  is hydrogen, provided that when q is zero then R d  is not hydrogen.
 
     More specific examples of rings comprising R 4 , R 5  and the atom to which they are connected include: 
     
       
                 
         
             
             
         
      
     
     Specific values for the ring comprising R 4 , R 5  and the atom to which they are connected are 2-methyl cyclohexane, 2,2-dimethylcyclohexane, 2-phenylcyclohexane, 2-ethylcyclohexane, 2,2-diethylcyclohexane, 2-tert-butyl cyclohexane, 3-methyl cyclohexane, 3,3-dimethylcyclohexane, 4-methyl cyclohexane, 4-ethylcyclohexane, 4-phenyl cyclohexane, 4-tert-butyl cyclohexane, 4-carboxymethyl cyclohexane, 4-carboxyethyl cyclohexane, 3,3,5,5-tetramethyl cyclohexane, 2,4-dimethyl cyclopentane. 4-cyclohexanecarboxyic acid, 4-cyclohexanecarboxyic acid esters, or 4-methyloxyalkanoyl-cyclohexane. 
     More specific values for the ring comprising R 4 , R 5  and the atom to which they are connected are 4-piperidine, 4-piperidene-1-carboxylic acid, 4-piperidine-1-carboxylic acid methyl ester, 4-piperidine-1-carboxylic acid ethyl ester, 4-piperidine-1-carboxylic acid propyl ester, 4-piperidine-1-carboxylic acid tert-butyl ester, 1-piperidine, 1-piperidine-4-carboxylic acid methyl ester, 1-piperidine-4-carboxylic acid ethyl ester, 1-piperidine-4-carboxylic acid propyl ester, 1-piperidine-4-caboxylic acid tert-butyl ester, 1-piperidine-4-carboxylic acid methyl ester, 3-piperidine, 3-piperidene-1-carboxylic acid, 3-piperidine-1-carboxylic acid methyl ester, 3-piperidine-1-carboxylic acid tert-butyl ester, 1,4-piperazine, 4-piperazine-1-carboxylic acid, 4-piperazine-1-carboxylic acid methyl ester, 4-piperazine-1-carboxylic acid ethyl ester, 4-piperazine-1-carboxylic acid propyl ester, 4-piperazine-1-carboxylic acid tert-butylester, 1,3-piperazine, 3-piperazine-1-carboxylic acid, 3-piperazine-1-carboxylic acid methyl ester, 3-piperazine-1-carboxylic acid ethyl ester, 3-piperazine-1-carboxylic acid propyl ester, 3-piperidine-1-carboxylic acid tert-butylester, 1-piperidine-3-carboxylic acid methyl ester, 1-piperidine-3-carboxylic acid ethyl ester, 1-piperidine-3-carboxylic acid propyl ester or 1-piperidine-3-caboxylic acid tert-butyl ester. 
     Another group of specific values for the ring comprising R 4  and R 5  are 2-methyl cyclohexane, 2,2-dimethylcyclohexane, 2-phenyl cyclohexane, 2-ethylcyclohexane, 2,2-diethylcyclohexane, 2-tert-butyl cyclohexane, 3-methyl cyclohexane, 3,3-dimethylcyclohexane, 4-methyl cyclohexane, 4-ethylcyclohexane, 4-phenyl cyclohexane, 4-tert-butyl cyclohexane, 4-carboxymethyl cyclohexane, 4-carboxyethyl cyclohexane, 3,3,5,5-tetramethyl cyclohexane, 2,4-dimethyl cyclopentane, 4-piperidine-1-carboxylic acid methyl ester, 4-piperidine-1-carboxylic acid tert-butyl ester 4-piperidine, 4-piperazine-1-carboxylic acid methyl ester, 4-piperidine-1-carboxylic acid tert-butylester, 1-piperidine-4-carboxylic acid methyl ester, 1-piperidine-4-caboxylic acid tert-butyl ester, tert-butylester, 1-piperidine-4-carboxylic acid methyl ester, or 1-piperidine-4-caboxylic acid tert-butyl ester, 3-piperidine-1-carboxylic acid methyl ester, 3-piperidine-1-carboxylic acid tert-butyl ester, 3-piperidine, 3-piperazine-1-carboxylic acid methyl ester, 3-piperidine-1-carboxylic acid tert-butylester, 1-piperidine-3-carboxylic acid methyl ester, 1-piperidine-3-caboxylic acid tert-butyl ester. 
     Specific compounds of formula (I) are those wherein each R 7  is H, X is ethylaminocarbonyl and 
     R 1  is hydroxy, R 2  is hydrogen, and Z is 4-carboxycyclohexyl, wherein R a  is hydrogen, 4; Z is 4-methoxycarbonylcyclohexylmethyl, R a  is methyl, 5; R 1  and R 2  together are oxo, Z is a 4-carbonylcyclohexyl group, wherein R a  is methyl, methoxy, ethyl, ethoxy, propyl, isopropoxy, -isobutyl, tert-butyl, amine, methylamine or dimethylamine, 6. 
     
       
                 
         
             
             
         
      
     
     Another group of specific compounds of formula (I) are those wherein each R 7  is H, X is ethylaminocarbonyl, R 1  is hydroxy, R 2  is hydrogen, and Z is a substituted 4-(methyleneoxycarbonyl)cyclohexyl group, wherein R a  is methyl, ethyl, propyl, tert-butyl, methoxy, ethoxy, methylamine or dimethylamine, 7; or R 1  and R 2  together are oxo, and Z is a substituted-(methyleneoxycarbonyl)cyclohexyl group, wherein R a  is methyl, ethyl, propyl, tert-butyl, methoxy, ethoxy, methylamine or dimethylamine, 8. 
     
       
                 
         
             
             
         
      
     
     Another group of specific compounds of formula (I) are those wherein each R 7  is H, X is ethylaminocarbonyl, and R 1  and R 2  are each hydrogen, and Z is a 1-piperidyl-4-carboxylic acid or ester group, wherein R a  is hydrogen, methyl, ethyl, propyl, isopropyl, or t-butyl, 9; R 1  and R 2  together are oxo, and Z is a 1-piperidyl-4-carboxylic acid or ester group, wherein R a  is hydrogen, methyl, ethyl, propyl, isopropyl, or t-butyl, 10; R 1  and R 2  are each hydrogen and Z is a 4-(methyleneoxycarbonyl)piperidin-4-yl group wherein R a  is methyl, ethyl, propyl or t-butyl, amine, methylamine, dimethylamine, 11; or R 1  and R 2  together are oxo, and Z is a 4-(methyleneoxycarbonyl)piperidin-4-yl wherein R a  is methyl, ethyl, propyl or t-butyl, amine, methylamine, dimethylamine, 12; R 1  and R 2  are each hydrogen and Z is a 4-(methyleneoxycarbonyl)piperidin-4-yl-oxy wherein R a  is hydrogen, methyl, ethyl, propyl isopropyl, isobutyl, or t-butyl, 13 or R 1  and R 2  together are oxo, Z is a 4-(methyleneoxycarbonyl)piperidin-4-yl-oxy wherein R a  is hydrogen, methyl, ethyl, propyl, isopropyl, isobutyl, or t-butyl, 14. 
     
       
                 
         
             
             
         
      
     
     Another group of specific compounds of formula (I) are those wherein each R 7  is H, X is ethylaminocarbonyl, R 1  and R 2  are each hydrogen, and Z is a 4-piperidyl-1-carboxylic acid or ester group, wherein R a  is methyl, ethyl, propyl, isopropyl, isobutyl, or t-butyl, 15, R 1  is hydroxy, R 2  is hydrogen, and Z is a 4-piperidyl-1-carboxylic acid or ester group, wherein R a  is methyl, ethyl, propyl, isopropyl, isobutyl, or t-butyl, 16; or R 1  and R 2  together are oxo, and Z is a 4-piperidyl-1-carboxylic acid or ester group, wherein R a  is methyl, ethyl, propyl, isopropyl, isobutyl, or t-butyl, 17. 
     
       
                 
         
             
             
         
      
     
     Another group of specific compounds of formula (I) are those wherein each R 7  is H, X is ethylaminocarbonyl, R 1  and R 2  are each hydrogen, Z is a 4-piperazine-1-carboxylic acid or ester group wherein R a  is methyl, ethyl, isopropyl, isobutyl, or t-butyl, 18; or R 1  and R 2  together are oxo, Z is a 4-piperazine-1-carboxylic acid or ester group wherein R a  is methyl, ethyl, isopropyl, isobutyl, or t-butyl, 19. 
     
       
                 
         
             
             
         
      
     
     Specific A 2A  adenosine receptor agonists suitable for use with the present invention include those described in U.S. Pat. No. 6,232,297 and in U.S. Patent Application No. 2003/0186926 A1. 
     Examples of compounds useful in practicing the invention are illustrated in tables 1, 2, 3, 4, 5, 6 and 7 below: 
     
       
         
               
             
               
               
               
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
           
               
                 Compound 
                 R 
                 R 1   
                 R 2   
                 R 6   
               
               
                   
               
               
                 ATL2037 
                 NECA 
                 H 
                 H 
                 CH 2 OH 
               
               
                 MP9056 
                 NECA 
                 OH 
                 H 
                 CH 2 OH 
               
               
                 ATL146a 
                 NECA 
                 H 
                 H 
                 CO 2 H 
               
               
                 MP9057 
                 NECA 
                 OH 
                 H 
                 CO 2 H 
               
               
                 ATL146e 
                 NECA 
                 H 
                 H 
                 CO 2 Me 
               
               
                 MP9058 
                 NECA 
                 OH 
                 H 
                 CO 2 Me 
               
               
                 JR2145 
                 CH 2 OH 
                 H 
                 H 
                 CO 2 Me 
               
               
                 MP9059 
                 CH 2 OH 
                 OH 
                 H 
                 CO 2 Me 
               
               
                 ATL193 
                 NECA 
                 H 
                 H 
                 CH 2 OAc 
               
               
                 MP9060 
                 NECA 
                 OH 
                 H 
                 CH 2 Oac 
               
               
                 JR2147 
                 CH 2 OH 
                 H 
                 H 
                 CH 2 Oac 
               
               
                 MP9061 
                 CH 2 OH 
                 OH 
                 H 
                 CH 2 Oac 
               
               
                 JR3023 
                 NECA 
                 H 
                 H 
                 CH 2 N(CH 3 ) 2   
               
               
                 MP9062 
                 NECA 
                 OH 
                 H 
                 CH 2 N(CH 3 ) 2   
               
               
                 JR3021 
                 NECA 
                 H 
                 H 
                 COOCH 2 CH 2 NHBoc 
               
               
                 MP9063 
                 NECA 
                 OH 
                 H 
                 COOCH 2 CH 2 NHBoc 
               
               
                 JR3033 
                 NECA 
                 H 
                 H 
                 COOCH 2 CH 2 NH 2   
               
               
                 MP9064 
                 NECA 
                 OH 
                 H 
                 COOCH 2 CH 2 NH 2   
               
               
                 JR3037 
                 NECA 
                 H 
                 H 
                 CONHCH 2 CH 3   
               
               
                 MP9065 
                 NECA 
                 OH 
                 H 
                 CONHCH 2 CH 3   
               
               
                 JR3055 
                 NECA 
                 H 
                 H 
                 CONH 2   
               
               
                 MP9072 
                 NECA 
                 OH 
                 H 
                 CONH 2   
               
               
                 JR3065 
                 NECA 
                 H 
                 H 
                 CONHMe 
               
               
                 MP9066 
                 NECA 
                 OH 
                 H 
                 CONHMe 
               
               
                 JR3067B 
                 NECA 
                 H 
                 H 
                 Me, cis CO 2 Me 
               
               
                 MP9067 
                 NECA 
                 OH 
                 H 
                 Me, cis CO 2 Me 
               
               
                 JR3067A 
                 NECA 
                 H 
                 H 
                 Me, trans CO 2 Me 
               
               
                 MP9068 
                 NECA 
                 OH 
                 H 
                 Me, trans CO 2 Me 
               
               
                 JR3087 
                 NECA 
                 H 
                 H 
                 CH 2 CH 3   
               
               
                 MP9069 
                 NECA 
                 OH 
                 H 
                 CH 2 CH 3   
               
               
                 JR3159A 
                 NECA 
                 OH 
                 H 
                 H 
               
               
                 JR3159B 
                 NECA 
                 OH 
                 H 
                 H 
               
               
                 JR3119 
                 NECA 
                 H 
                 H 
                 COCH 3   
               
               
                 MP9070 
                 NECA 
                 OH 
                 H 
                 COCH 3   
               
               
                 JR3121 
                 NECA 
                 H 
                 H 
                 CHCH 3 (OH) 
               
               
                 MP9071 
                 NECA 
                 OH 
                 H 
                 CHCH 3 (OH) 
               
               
                 JR3139 
                 NECA 
                 OH 
                 C 6 H 11   
                 H 
               
               
                   
               
               
                 NECA = CH 3 CH 2 N(H)C(O)— 
               
             
          
         
       
     
     
       
         
               
             
               
               
               
               
               
             
           
               
                 TABLE 2 
               
             
             
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
           
               
                   
                 Compound 
                 R 1   
                 R 2   
                 R 6   
               
               
                   
                   
               
               
                   
                 JR3261 
                 H 
                 H 
                 H 
               
               
                   
                 JR3259 
                 H 
                 H 
                 CO 2 tBu 
               
               
                   
                 JR3269 
                 H 
                 H 
                 CO 2 Et 
               
               
                   
                 JR4011 
                 H 
                 H 
                 CO 2 iBu 
               
               
                   
                 JR4009 
                 H 
                 H 
                 CO 2 iPr 
               
               
                   
                 JR4007 
                 H 
                 H 
                 CO 2 Me 
               
               
                   
                 JR4051 
                 H 
                 H 
                 COC(CH 3 ) 3   
               
               
                   
                 JR4047 
                 H 
                 H 
                 COCH 2 (CH 3 ) 3   
               
               
                   
                 MP9047 
                 H 
                 H 
                 COCH 3   
               
               
                   
                 MP9048 
                 H 
                 H 
                 C(O)N(CH 3 ) 2   
               
               
                   
                 MP9049 
                 H 
                 H 
                 C(O)N(CH 3 )Et 
               
               
                   
                 MP9050 
                 H 
                 H 
                 C(O)N(CH 3 )iPr 
               
               
                   
                 MP9051 
                 H 
                 H 
                 C(O)N(CH 3 )iBu 
               
               
                   
                 MP9052 
                 H 
                 H 
                 C(O)NH(CH 3 ) 
               
               
                   
                 MP9053 
                 H 
                 H 
                 C(O)NH(Et) 
               
               
                   
                 MP9054 
                 H 
                 H 
                 C(O)NH(iPr) 
               
               
                   
                 MP9055 
                 H 
                 H 
                 C(O)NH(iBu) 
               
               
                   
                 TX3261 
                 OH 
                 H 
                 H 
               
               
                   
                 TX3259 
                 OH 
                 H 
                 CO 2 tBu 
               
               
                   
                 TX3269 
                 OH 
                 H 
                 CO 2 Et 
               
               
                   
                 TX4011 
                 OH 
                 H 
                 CO 2 iBu 
               
               
                   
                 TX4009 
                 OH 
                 H 
                 CO 2 iPr 
               
               
                   
                 TX4007 
                 OH 
                 H 
                 COMe 
               
               
                   
                 TX4051 
                 OH 
                 H 
                 COC(CH 3 ) 3   
               
               
                   
                 TX4047 
                 OH 
                 H 
                 COCH 2 (CH 3 ) 3   
               
               
                   
                 TX9047 
                 OH 
                 H 
                 COCH 3   
               
               
                   
                 TX9048 
                 OH 
                 H 
                 C(O)N(CH 3 ) 2   
               
               
                   
                 TX9049 
                 OH 
                 H 
                 C(O)N(CH 3 )Et 
               
               
                   
                 TX9050 
                 OH 
                 H 
                 C(O)N(CH 3 )iPr 
               
               
                   
                 TX9051 
                 OH 
                 H 
                 C(O)N(CH 3 )iBu 
               
               
                   
                 TX9052 
                 OH 
                 H 
                 C(O)NH(CH 3 ) 
               
               
                   
                 TX9053 
                 OH 
                 H 
                 C(O)NH(Et) 
               
               
                   
                 TX9054 
                 OH 
                 H 
                 C(O)NH(iPr) 
               
               
                   
                 TX9055 
                 OH 
                 H 
                 C(O)NH(iBu) 
               
               
                   
                   
               
             
          
         
       
     
     
       
         
               
             
               
               
               
               
               
             
           
               
                 TABLE 3 
               
             
             
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
           
               
                   
                 Compound 
                 n 
                 R 3   
                 R 6   
               
               
                   
                   
               
               
                   
                 JR3135 
                 1 
                 OH 
                 H 
               
               
                   
                 JR3089 
                 2 
                 OH 
                 H 
               
               
                   
                 JR3205 
                 2 
                 NH 2   
                 H 
               
               
                   
                 JR3177A 
                 2 
                 OH 
                 2-CH 3   
               
               
                   
                 JR3177B 
                 2 
                 OH 
                 2-CH 3   
               
               
                   
                 JR3181A 
                 2 
                 OH 
                 2-CH 3   
               
               
                   
                 JR3181B 
                 2 
                 OH 
                 2-CH 3   
               
               
                   
                 JR3227 
                 2 
                 OH 
                 2-C(CH 3 ) 3   
               
               
                   
                 JR9876 
                 2 
                 OH 
                 2-C 6 H 5   
               
               
                   
                 JR3179 
                 2 
                 OH 
                 3-CH 3   
               
               
                   
                 JR3221 
                 2 
                 OH(R) 
                 3-CH 3 (R) 
               
               
                   
                 ATL203 
                 2 
                 OH(S) 
                 3-CH 3 (R) 
               
               
                   
                 MP9041 
                 2 
                 OH(R) 
                 3-CH 3 (S) 
               
               
                   
                 MP9042 
                 2 
                 OH(S) 
                 3-CH 3 (S) 
               
               
                   
                 JR3201B 
                 2 
                 OH 
                 2-(CH 3 ) 2   
               
               
                   
                 MP9043 
                 2 
                 OH(R) 
                 3-CH 2 CH 3 (R) 
               
               
                   
                 MP9044 
                 2 
                 OH(S) 
                 3-CH 2 CH 3 (R) 
               
               
                   
                 MP9045 
                 2 
                 OH(R) 
                 3-CH 2 CH 3 (S) 
               
               
                   
                 MP9046 
                 2 
                 OH(S) 
                 3-CH 2 CH 3 (S) 
               
               
                   
                 JR3163 
                 2 
                 OH 
                 3-(CH 3 ) 2 , 5-(CH 3 ) 2   
               
               
                   
                 JR9875 
                 2 
                 OH 
                 4-CH 3   
               
               
                   
                 JR3149 
                 2 
                 OH 
                 4-C 2 H 5   
               
               
                   
                 JR3203 
                 2 
                 OH 
                 4-C(CH 3 ) 3   
               
               
                   
                 JR3161 
                 2 
                 OH 
                 4-C 6 H 5   
               
               
                   
                   
               
             
          
         
       
     
     
       
         
               
             
               
               
               
               
               
             
           
               
                 TABLE 4 
               
             
             
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
           
               
                   
                 Compound 
                 R 1   
                 R 2   
                 R 6   
               
               
                   
                   
               
               
                   
                 JR3213 
                 H 
                 H 
                 CO 2 Et 
               
               
                   
                 JR3281 
                 H 
                 H 
                 CO 2 tBu 
               
               
                   
                 JR3289 
                 H 
                 H 
                 H 
               
               
                   
                 JR4025 
                 H 
                 H 
                 cyclohexyl 
               
               
                   
                 JR4053 
                 H 
                 H 
                 COMe 
               
               
                   
                 JR4049 
                 H 
                 H 
                 CO 2 iBu 
               
               
                   
                 JR3283 
                 H 
                 H 
                 2-Pyrimidinyl 
               
               
                   
                 MP9029 
                 H 
                 H 
                 COMe 
               
               
                   
                 MP9030 
                 H 
                 H 
                 COC(CH 3 ) 3   
               
               
                   
                 MP9031 
                 H 
                 H 
                 COCH 2 (CH 3 ) 3   
               
               
                   
                 MP9032 
                 H 
                 H 
                 COCH 3   
               
               
                   
                 MP9033 
                 H 
                 H 
                 C(O)N(CH 3 ) 2   
               
               
                   
                 MP9034 
                 H 
                 H 
                 C(O)N(CH 3 )Et 
               
               
                   
                 MP9035 
                 H 
                 H 
                 C(O)N(CH 3 )iPr 
               
               
                   
                 MP9036 
                 H 
                 H 
                 C(O)N(CH 3 )iBu 
               
               
                   
                 MP9037 
                 H 
                 H 
                 C(O)NH(CH 3 ) 
               
               
                   
                 MP9038 
                 H 
                 H 
                 C(O)NH(Et) 
               
               
                   
                 MP9039 
                 H 
                 H 
                 C(O)NH(iPr) 
               
               
                   
                 MP9040 
                 H 
                 H 
                 C(O)NH(iBu) 
               
               
                   
                   
               
             
          
         
       
     
     
       
         
               
             
               
               
               
               
               
             
           
               
                 TABLE 5 
               
             
             
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
           
               
                 Compound 
                 R 
                 R 1   
                 R 2   
                 R 6   
               
               
                   
               
               
                 MP9021 
                 NECA 
                 H 
                 H 
                 CH 2 OH 
               
               
                 MP9022 
                 NECA 
                 H 
                 H 
                 CO 2 H 
               
               
                 JR3251 
                 NECA 
                 H 
                 H 
                 CO 2 Me 
               
               
                 JR3279 
                 NECA 
                 H 
                 H 
                 CO 2 Et 
               
               
                 MP9027 
                 CH 2 OH 
                 H 
                 H 
                 CO 2 Me 
               
               
                 MP9028 
                 NECA 
                 H 
                 H 
                 CO 2 MeCH 2 OAc 
               
               
                 MP9015 
                 CH 2 OH 
                 H 
                 H 
                 CH 2 OAc 
               
               
                 MP9016 
                 NECA 
                 H 
                 H 
                 CH 2 N(CH 3 ) 2   
               
               
                 MP9017 
                 NECA 
                 H 
                 H 
                 COOCH 2 CH 2 NHBoc 
               
               
                 MP9018 
                 NECA 
                 H 
                 H 
                 COOCH 2 CH 2 NH 2   
               
               
                 MP9019 
                 NECA 
                 H 
                 H 
                 CONHCH 2 CH 3   
               
               
                 MP9020 
                 NECA 
                 H 
                 H 
                 CONH 2   
               
               
                 MP9023 
                 NECA 
                 H 
                 H 
                 CONHMe 
               
               
                 MP9024 
                 NECA 
                 H 
                 H 
                 CH 2 CH 3   
               
               
                 MP9025 
                 NECA 
                 H 
                 H 
                 COCH 3   
               
               
                 MP9026 
                 NECA 
                 H 
                 H 
                 CHCH 3 (OH). 
               
               
                   
               
               
                 NECA = CH 3 CH 2 N(H)C(O)— 
               
             
          
         
       
     
     
       
         
               
             
               
               
               
               
               
             
           
               
                 TABLE 6 
               
             
             
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
           
               
                 Compound 
                 R 
                 R 1   
                 R 2   
                 R 6   
               
               
                   
               
               
                 MP9001 
                 NECA 
                 H 
                 H 
                 CH 2 OH 
               
               
                 MP9002 
                 NECA 
                 H 
                 H 
                 CO 2 H 
               
               
                 JR3253 
                 NECA 
                 H 
                 H 
                 CO 2 Me 
               
               
                 MP9003 
                 CH 2 OH 
                 H 
                 H 
                 CO 2 Me 
               
               
                 MP9004 
                 NECA 
                 H 
                 H 
                 CH 2 OAc 
               
               
                 MP9005 
                 CH 2 OH 
                 H 
                 H 
                 CH 2 OAc 
               
               
                 MP9006 
                 NECA 
                 H 
                 H 
                 CH 2 N(CH 3 ) 2   
               
               
                 MP9007 
                 NECA 
                 H 
                 H 
                 COOCH 2 CH 2 NHBoc 
               
               
                 MP9008 
                 NECA 
                 H 
                 H 
                 COOCH 2 CH 2 NH 2   
               
               
                 MP9009 
                 NECA 
                 H 
                 H 
                 CONHCH 2 CH 3   
               
               
                 MP9010 
                 NECA 
                 H 
                 H 
                 CONH 2   
               
               
                 MP9011 
                 NECA 
                 H 
                 H 
                 CONHMe 
               
               
                 MP9012 
                 NECA 
                 H 
                 H 
                 CH 2 CH 3   
               
               
                 MP9013 
                 NECA 
                 H 
                 H 
                 COCH 3   
               
               
                 MP9014 
                 NECA 
                 H 
                 H 
                 CHCH 3 (OH) 
               
               
                   
               
               
                 NECA = CH 3 CH 2 N(H)C(O)— 
               
             
          
         
       
     
     
       
         
               
             
               
               
               
               
               
             
           
               
                 TABLE 7 
               
             
             
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
           
               
                 Compound 
                 R 
                 Y 
                 Y′ 
                 R 6   
               
               
                   
               
               
                 RJ1111 
                 NECA 
                 CH 
                 CH 
                 CO 2 Me 
               
               
                 RJ1112 
                 NECA 
                 CH 
                 N 
                 CO 2 Me 
               
               
                 RJ1113 
                 NECA 
                 N 
                 CH 
                 CO 2 Me 
               
               
                 RJ1114 
                 NECA 
                 N 
                 N 
                 CO 2 Me 
               
               
                 RJ1115 
                 NECA 
                 CH 
                 CH 
                 CH 2 OH 
               
               
                 RJ1116 
                 NECA 
                 CH 
                 N 
                 CH 2 OH 
               
               
                 RJ1117 
                 NECA 
                 N 
                 CH 
                 CH 2 OH 
               
               
                 RJ1118 
                 NECA 
                 N 
                 N 
                 CH 2 OH 
               
               
                 RJ1119 
                 NECA 
                 CH 
                 CH 
                 CO 2 H 
               
               
                 RJ1120 
                 NECA 
                 CH 
                 N 
                 CO 2 H 
               
               
                 RJ1121 
                 NECA 
                 N 
                 CH 
                 CO 2 H 
               
               
                 RJ1122 
                 NECA 
                 N 
                 N 
                 CO 2 H 
               
               
                 RJ1123 
                 NECA 
                 CH 
                 CH 
                 CH 2 OAc 
               
               
                 RJ1124 
                 NECA 
                 CH 
                 N 
                 CH 2 OAc 
               
               
                 RJ1125 
                 NECA 
                 N 
                 CH 
                 CH 2 OAc 
               
               
                 RJ1126 
                 NECA 
                 N 
                 N 
                 CH 2 OAc 
               
               
                 RJ1127 
                 NECA 
                 CH 
                 CH 
                 CONH 2   
               
               
                 RJ1128 
                 NECA 
                 CH 
                 N 
                 CONH 2   
               
               
                 RJ1129 
                 NECA 
                 N 
                 CH 
                 CONH 2   
               
               
                 RJ1130 
                 NECA 
                 N 
                 N 
                 CONH 2   
               
               
                 RJ1131 
                 NECA 
                 CH 
                 CH 
                 CONHMe 
               
               
                 RJ1132 
                 NECA 
                 CH 
                 N 
                 CONHMe 
               
               
                 RJ1133 
                 NECA 
                 N 
                 CH 
                 CONHMe 
               
               
                 RJ1134 
                 NECA 
                 N 
                 N 
                 CONHMe 
               
               
                 RJ1135 
                 NECA 
                 CH 
                 CH 
                 CO 2 tBu 
               
               
                 RJ1136 
                 NECA 
                 CH 
                 N 
                 CO 2 tBu 
               
               
                 RJ1137 
                 NECA 
                 N 
                 CH 
                 CO 2 tBu 
               
               
                 RJ1138 
                 NECA 
                 N 
                 N 
                 CO 2 tBu 
               
               
                 RJ1139 
                 NECA 
                 CH 
                 CH 
                 CO 2 Et 
               
               
                 RJ1140 
                 NECA 
                 CH 
                 N 
                 CO 2 Et 
               
               
                 RJ1141 
                 NECA 
                 N 
                 CH 
                 CO 2 Et 
               
               
                 RJ1142 
                 NECA 
                 N 
                 N 
                 CO 2 Et 
               
               
                 RJ1143 
                 NECA 
                 CH 
                 CH 
                 CO 2 iBu 
               
               
                 RJ1144 
                 NECA 
                 CH 
                 N 
                 CO 2 iBu 
               
               
                 RJ1145 
                 NECA 
                 N 
                 CH 
                 CO 2 iBu 
               
               
                 RJ1146 
                 NECA 
                 N 
                 N 
                 CO 2 iBu 
               
               
                 RJ1147 
                 NECA 
                 CH 
                 CH 
                 CO 2 iPr 
               
               
                 RJ1148 
                 NECA 
                 CH 
                 N 
                 CO 2 iPr 
               
               
                 RJ1149 
                 NECA 
                 N 
                 CH 
                 CO 2 iPr 
               
               
                 RJ1150 
                 NECA 
                 N 
                 N 
                 CO 2 iPr 
               
               
                 RJ1151 
                 NECA 
                 CH 
                 CH 
                 COMe 
               
               
                 RJ1152 
                 NECA 
                 CH 
                 N 
                 COMe 
               
               
                 RJ1153 
                 NECA 
                 N 
                 CH 
                 COMe 
               
               
                 RJ1154 
                 NECA 
                 N 
                 N 
                 COMe 
               
               
                 RJ1155 
                 NECA 
                 CH 
                 CH 
                 COC(CH 3 ) 3   
               
               
                 RJ1156 
                 NECA 
                 CH 
                 N 
                 COC(CH 3 ) 3   
               
               
                 RJ1157 
                 NECA 
                 N 
                 CH 
                 COC(CH 3 ) 3   
               
               
                 RJ1158 
                 NECA 
                 N 
                 N 
                 COCCH 3 ) 3   
               
               
                 RJ1159 
                 NECA 
                 CH 
                 CH 
                 COCH 2 CH 3 ) 3   
               
               
                 RJ1160 
                 NECA 
                 CH 
                 N 
                 COCH 2 CH 3 ) 3   
               
               
                 RJ1161 
                 NECA 
                 N 
                 CH 
                 COCH 2 (CH 3 ) 3   
               
               
                 RJ1162 
                 NECA 
                 N 
                 N 
                 COCH 2 (CH 3 ) 3   
               
               
                 RJ1163 
                 NECA 
                 CH 
                 CH 
                 C(O)N(CH 3 ) 2   
               
               
                 RJ1164 
                 NECA 
                 CH 
                 N 
                 C(O)N(CH 3 ) 2   
               
               
                 RJ1165 
                 NECA 
                 N 
                 CH 
                 C(O)N(CH 3 ) 2   
               
               
                 RJ1166 
                 NECA 
                 N 
                 N 
                 C(O)N(CH 3 ) 2   
               
               
                 RJ1167 
                 NECA 
                 CH 
                 CH 
                 C(O)N(CH 3 )Et 
               
               
                 RJ1168 
                 NECA 
                 CH 
                 N 
                 C(O)N(CH 3 )Et 
               
               
                 RJ1169 
                 NECA 
                 N 
                 CH 
                 C(O)N(CH3)Et 
               
               
                 RJ1170 
                 NECA 
                 N 
                 N 
                 C(O)N(CH 3 )Et 
               
               
                 RJ1171 
                 NECA 
                 CH 
                 CH 
                 C(O)N(CH 3 )iPr 
               
               
                 RJ1172 
                 NECA 
                 CH 
                 N 
                 C(O)N(CH 3 )iPr 
               
               
                 RJ1173 
                 NECA 
                 N 
                 CH 
                 C(O)N(CH 3 )iPr 
               
               
                 RJ1174 
                 NECA 
                 N 
                 N 
                 C(O)N(CH 3 )iPr 
               
               
                 RJ1175 
                 NECA 
                 CH 
                 CH 
                 C(O)N(CH 3 )iBu 
               
               
                 RJ1176 
                 NECA 
                 CH 
                 N 
                 C(O)N(CH 3 )iBu 
               
               
                 RJ1177 
                 NECA 
                 N 
                 CH 
                 C(O)N(CH 3 )iBu 
               
               
                 RJ1178 
                 NECA 
                 N 
                 N 
                 C(O)N(CH 3 )iBu 
               
               
                 RJ1179 
                 NECA 
                 CH 
                 CH 
                 C(O)NH(Et) 
               
               
                 RJ1180 
                 NECA 
                 CH 
                 N 
                 C(O)NH(Et) 
               
               
                 RJ1181 
                 NECA 
                 N 
                 CH 
                 C(O)NH(Et) 
               
               
                 RJ1182 
                 NECA 
                 N 
                 N 
                 C(O)NH(Et) 
               
               
                 RJ1183 
                 NECA 
                 CH 
                 CH 
                 C(O)NH(iPr) 
               
               
                 RJ1184 
                 NECA 
                 CH 
                 N 
                 C(O)NH(iPr) 
               
               
                 RJ1185 
                 NECA 
                 N 
                 CH 
                 C(O)NH(iPr) 
               
               
                 RJ1186 
                 NECA 
                 N 
                 N 
                 C(O)NH(iPr) 
               
               
                 RJ1187 
                 NECA 
                 CH 
                 CH 
                 C(O)NH(iBu) 
               
               
                 RJ1188 
                 NECA 
                 CH 
                 N 
                 C(O)NH(iBu) 
               
               
                 RJ1189 
                 NECA 
                 N 
                 CH 
                 C(O)NH(iBu) 
               
               
                 RJ1190 
                 NECA 
                 N 
                 N 
                 C(O)NH(iBu) 
               
               
                 RJ1191 
                 NECA 
                 CH 
                 CH 
                 CH 2 OCOCH 3   
               
               
                 RJ1192 
                 NECA 
                 N 
                 CH 
                 CH 2 OCOCH 3   
               
               
                 RJ1193 
                 NECA 
                 CH 
                 CH 
                 CH 2 OCOEt 
               
               
                 RJ1194 
                 NECA 
                 N 
                 CH 
                 CH 2 OCOEt 
               
               
                 RJ1195 
                 NECA 
                 CH 
                 CH 
                 CH 2 OCOiPr 
               
               
                 RJ1196 
                 NECA 
                 N 
                 CH 
                 CH 2 OCOiPr 
               
               
                 RJ1197 
                 NECA 
                 CH 
                 CH 
                 CH 2 OCOiBu 
               
               
                 RJ1198 
                 NECA 
                 N 
                 CH 
                 CH 2 OCOiBu 
               
               
                   
               
               
                 NECA =0 CH 3 CH 2 N(H)C(O)— 
               
             
          
         
       
     
     In another embodiment, agonists of A 2A  adenosine receptors that are useful in the practice of the present invention include compounds having the formula (II): 
     
       
                 
         
             
             
         
      
     
     wherein Z is CR 3 R 4 R 5 ; each R 1 , R 2  and R 3  is hydrogen; R 4  and R 5  together with the carbon atom to which they are attached form a cycloalkyl ring having 3, 4, 5, 6, 7, 8, 9 or 10 ring atoms; and 
     wherein the ring comprising R 4  and R 5  is substituted with —(CH 2 ) 0-6 —Y; where Y is —CH 2 OR a , —CO 2 R a , —OC(O)R a , —CH 2 OC(O)R a , —C(O)NR b R c , —CH 2 SR a , —C(S)OR a , —OC(S)R a , —CH 2 OC(S)R a  or C(S)NR b R c  or —CH 2 N(R b )(R c ); 
     each R 7  is independently hydrogen, (C 1 -C 8 )alkyl, (C 3 -C 8 )cycloalkyl, aryl or aryl(C 1 -C 8 )alkylene; 
     X is —CH 2 OR a , —CO 2 R a , —OC(O)R a , —CH 2 OC(O)R a , —C(O)NR b R c , —CH 2 SR a , —C(S)OR a , —OC(S)R a , —CH 2 OC(S)R a  or C(S)NR b R c  or —CH 2 N(R b )(R c ); 
     each R a , R b  and R c  is independently hydrogen, (C 1 -C 8 )alkyl, or (C 1 -C 8 )alkyl substituted with 1-3 (C 1 -C 8 )alkoxy, (C 3 -C 8 )cycloalkyl, (C 1 -C 8 )alkylthio, amino acid, aryl, aryl(C 1 -C 8 )alkylene, heteroaryl, or heteroaryl(C 1 -C 8 )alkylene; or R b  and R c , together with the nitrogen to which they are attached, form a pyrrolidino, piperidino, morpholino, or thiomorpholino ring; and m is 0 to about 6; or a pharmaceutically acceptable salt thereof. 
     A specific value for —N(R 7 ) 2  is amino, monomethylamino or cyclopropylamino. 
     A specific value for Z is carboxy- or —(C 1 -C 4 )alkoxycarbonyl-cyclohexyl(C 1 -C 4 )alkyl. 
     A specific value for R a  is H or (C 1 -C 4 )alkyl, i.e., methyl or ethyl. 
     A specific value for R b  is H, methyl or phenyl. 
     A specific value for R c  is H, methyl or phenyl. 
     A specific value for —(CR 1 R 2 ) m — is —CH 2 — or —CH 2 —CH 2 —. 
     A specific value for X is CO 2 R a , (C 2 -C 5 )alkanoylmethyl or amido. 
     A specific value for Y is CO 2 R a , (C 2 -C 5 )alkanoylmethyl or amido. 
     A specific value for m is 1. 
     Specific compounds useful for practicing the invention are compounds JR3259, JR3269, JR4011, JR4009, and JR4007. 
     Specific A 2A  adenosine receptor agonists suitable for use with the present invention having formula (II) include those described in U.S. Pat. No. 6,232,297. Specific compounds of formula (II) are those wherein each R 7  is H, X is ethylaminocarbonyl and Z is 4-carboxycyclohexylmethyl (DWH-146a), Z is 4-methoxycarbonylcyclohexylmethyl (DWH-146e), Z is 4-isopropylcarbonyl-cyclohexylmethyl (AB-1), Z is 4-acetoxymethyl-cyclohexylmethyl (JMR-193) or Z is 4-pyrrolidine-1-carbonylcyclohexylmethyl (AB-3). These compounds are depicted below. 
     
       
                 
         
             
             
         
      
     
     The specific A 2A  adenosine receptor agonists suitable for use with the present invention having formula (II) include those described in U.S. Pat. No. 6,232,297. These compounds, having formula (II), can be prepared according to the methods described therein. 
     Another specific group of agonists of A 2A  adenosine receptors that are useful in the practice of the present invention include compounds having the general formula (III): 
     
       
                 
         
             
             
         
      
     
     wherein Z 2  is a group selected from the group consisting of —OR 12 , —NR 13 R 14 , a —C≡C-Z 3 , and —NH—N═R 17 ; 
     each Y 2  is individually H, C 1 -C 6  alkyl, C 3 -C 7  cycloalkyl, phenyl or phenyl C 1 -C 3  alkyl; 
     R 12  is
         a) C 1-4 -alkyl;   b) C 1-4 -alkyl substituted with one or more C 1-4 -alkoxy groups, halogens (fluorine, chlorine or bromine), hydroxy groups, amino groups, mono(C 1-4 -alkyl)amino groups, di(C 1-4 -alkyl)amino groups or C 6-10 -aryl groups wherein the aryl groups may be substituted with one or more halogens (fluorine, chlorine or bromine), C 1-4 -alkyl groups, hydroxy groups, amino groups, mono(C 1-4 -alkyl)amino groups or di(C 1-4 -alkyl)amino groups); or   c) C 6-10 -aryl; or (d) C 6-10 -aryl substituted with one or more halogens (fluorine, chlorine or bromine), hydroxy groups, amino groups, mono(C 1-4 -alkyl)amino groups, di(C 1-4 -alkyl)amino groups or C 1-4 -alkyl groups;       

     one of R 13  and R 14  has the same meaning as R 12  and the other is hydrogen; and 
     R 17  is a group having the formula (i) 
     
       
                 
         
             
             
         
      
     
     wherein each of R 15  and R 16  independently may be hydrogen, (C 3 -C 7 )cycloalkyl or any of the meanings of R 12 , provided that R 15  and R 16  are not both hydrogen; 
     X 2  is CH 2 OH, CH 3 , CO 2 R 20  or C(═O)NR 21 R 22  wherein R 20  has the same meaning as R 13  and wherein R 21  and R 22  have the same meanings as R 15  and R 16  or R 21  and R 22  are both H; 
     Z 3  has one of the following meanings:
         a) C 6 -C 10  aryl, optionally substituted with one to three halogen atoms, C 1 -C 6  alkyl, C 1 -C 6  haloalkyl, C 1 -C 6  alkoxy, C 1 -C 6  haloalkoxy, C 2 -C 6  alkoxycarbonyl, C 2 -C 6  alkoxyalkyl, C 1 -C 6  alkylthio, thio, CHO, cyanomethyl, nitro, cyano, hydroxy, carboxy, C 2 -C 6  acyl, amino C 1 -C 3  monoalkylamino, C 2 -C 6  dialkylamino, methylenedioxy or aminocarbonyl;   b) a group of formula —(CH 2 ) q -Het wherein q is 0 or an integer from 1 to 3 and Het is 5 or 6 membered heterocyclic aromatic or non-aromatic ring, optionally benzocondensed, containing 1 to 3 heteroatoms selected from non-peroxide oxygen, nitrogen or sulphur, linked through a carbon atom or through a nitrogen atom;   c) C 3 -C 7  cycloalkyl optionally containing unsaturation or C 2 -C 4  alkenyl;   d)       

     
       
                 
         
             
             
         
      
         
         
           
             wherein
           R 23  is hydrogen, methyl or phenyl;   R 24  is hydrogen, C 1 -C 6  linear or branched alkyl, C 5 -C 6  cycloalkyl or C 3 -C 7  cycloalkenyl, phenyl-C 1 -C 2 -alkyl or R 23  and   R 24 , taken together, form a 5 or 6-membered carbocyclic ring or   R 25  is hydrogen and R 23  and R 24 , taken together, form an oxo group or a corresponding acetalic derivative;   R 25  is OH, NH 2  dialkylamino, halogen, cyano; and n is 0 or 1 to 4; or   
         
             e) C 1 -C 16  alkyl, optionally comprising 1-2 double bonds, O, S or NY 2 ; or a pharmaceutically acceptable salt thereof. 
           
         
       
    
     Specific C 6-10 -aryl groups include phenyl and naphthyl. 
     Preferably, in the compound of formula (I), Z 2  is a group of the formula (iii)
 
—O—(CH 2 ) n —Ar  (iii)
 
     wherein n is an integer from 1-4, preferably 2, and Ar is a phenyl group, tolyl group, naphthyl group, xylyl group or mesityl group. Most preferably Ar is a para-tolyl group and n=2. 
     Preferably, in the compound of formula (II), Z 2  is a group of the formula (iv)
 
—NH—N═CHCy  (iv)
 
     wherein Cy is a C 3-7 -cycloalkyl group, preferably cyclohexyl or a C 1-4  alkyl group, preferably isopropyl. 
     Preferably, in the compound of formula (III), Z 2  is a group of the formula (vii)
 
—C≡C-Z 3   (v)
 
     wherein Z 3  is C 3 -C 16  alkyl, hydroxy C 2 -C 6  alkyl or (phenyl) (hydroxymethyl). 
     Specific examples of such compounds of formula (I) include WRC-0470, WRC-0474 [SHA 211], WRC-0090 and WRC-0018, shown below: 
                                
wherein the H on CH 2 OH can optionally be replaced by ethylaminocarbonyl. Of these specific examples, WRC-0474[SHA 211] and WRC-0470 are particularly preferred.
 
     Such compounds may be synthesized as described in: Olsson et al. (U.S. Pat. Nos. 5,140,015 and 5,278,150); Cristalli (U.S. Pat. No. 5,593,975); Miyasaka et al. (U.S. Pat. No. 4,956,345); Hutchinson, A. J. et al.,  J. Pharmacol. Exp. Ther.,  251, 47 (1989); Olsson, R. A. et al.,  J. Med. Chem.,  29, 1683 (1986); Bridges, A. J. et al.,  J. Med. Chem.,  31, 1282 (1988); Hutchinson, A. J. et al.,  J. Med. Chem.,  33, 1919 (1990); Ukeeda, M. et al.,  J. Med. Chem.,  34, 1334 (1991); Francis, J. E. et al.,  J. Med. Chem.,  34, 2570 (1991); Yoneyama, F. et al.,  Eur. J. Pharmacol.,  213, 199-204 (1992); Peet, N. P. et al.,  J. Med. Chem.,  35, 3263 (1992); and Cristalli, G. et al.,  J. Med. Chem.,  35, 2363 (1992); all of which are incorporated herein by reference. 
     Another embodiment includes compounds having formula (III) where Z 2  is a group having formula (vi): 
                                
wherein R 34  and R 35  are independently H, C 1 -C 6  alkyl, C 3 -C 7  cycloalkyl, phenyl, phenyl C 1 -C 3  alkyl or R 34  and R 35  taken together with the nitrogen atom are a 5- or 6-membered heterocyclic ring containing 1-2 heteroatoms selected from non-peroxide oxygen, nitrogen (N(R 13 )) or sulphur atoms. Preferably one of R 34  and R 35  is hydrogen and the other is ethyl, methyl or propyl. More preferably one of R 34  and R 35  is hydrogen and the other is ethyl or methyl.
 
     The 2-(pyrazol-1-yl)adenosine compounds of the invention, wherein Z 2  is a group having formula (vi), can be prepared by reacting a 2-chloro- or 2-iodo adenosine derivative with an 1H-pyrazole-4-carboxamides compound having formula (vii): 
                                
where R 34  and R 35  are as described above, wherein selective protection/deprotection of the amido group is used as needed. A specific pyrazole derivative useful in practicing this invention is a compound having the formula:
 
     
       
                 
         
             
             
         
      
     
     The 1H-pyrazole-4-carboxamides can be prepared starting with 1H-pyrazole-4-carboxylic acid, available from Aldrich Chemical Co. In the first step, the acid is converted to an ester, e.g., a methyl or ethyl ester. The ester converted to the amide via aminolysis, e.g., with methylamine to form the methyl amide. The pyrazole-4-carboxamide will react with the 2-halopurines in the presence of a strong base to provide the 2-(pyrazol-1-yl)adenosine compounds having formula (III). 
     Another specific group of agonists of A 2A  adenosine receptors that are useful in the practice of the present invention include compounds having the general formula (IV): 
                                
wherein Z 4  is —NR 28 R 29 ;
 
     R 28  is hydrogen or (C 1 -C 4 )alkyl; and R 29  is
         a) (C 1 -C 4 )alkyl;   b) (C 1 -C 4 )alkyl substituted with one or more (C 1 -C 4 )alkoxy, halogen, hydroxy, amino, mono((C 1 -C 4 )alkyl)amino, di((C 1 -C 4 )alkyl)amino or (C 6 -C 10 )aryl wherein aryl is optionally substituted with one or more halogen, hydroxy, amino, (C 1 -C 4 )alkyl, R 30 OOC—((C 1 -C 4 )alkyl)-, R 3 ′ R 32 NC(═O)—((C 1 -C 4 )alkyl)-, mono((C 1 -C 4 )alkyl)amino or di((C 1 -C 4 )alkyl)amino;   c) (C 6 -C 10 )aryl; or   d) (C 6 -C 10 )aryl substituted with one or more halogen, hydroxy, amino, mono((C 1 -C 4 )alkyl)amino, di((C 1 -C 4 )alkyl)amino or (C 1 -C 4 )alkyl;       

     wherein each Y 4  is individually H, (C 1 -C 6 )alkyl, (C 3 -C 7 )cycloalkyl, phenyl or phenyl(C 1 -C 3 )alkyl; and X 4  is —C(═O)NR 31 R 32 , —COOR 30 , or —CH 2 OR 30 ; 
     wherein each of R 31  and R 32  are independently; hydrogen; C 3-7 -cycloalkyl; (C 1 -C 4 )alkyl; (C 1 -C 4 )alkyl substituted with one or more (C 1 -C 4 )alkoxy, halogen, hydroxy, —COOR 33 , amino, mono((C 1 -C 4 )alkyl)amino, di((C 1 -C 4 )alkyl)amino or (C 6 -C 10 )aryl wherein aryl is optionally substituted with one or more halogen, (C 1 -C 4 )alkyl, hydroxy, amino, mono((C 1 -C 4 )alkyl)amino or di((C 1 -C 4 )alkyl)amino; (C 6 -C 10 )aryl; or (C 6 -C 10 )aryl substituted with one or more halogen, hydroxy, amino, mono((C 1 -C 4 )alkyl)amino, di((C 1 -C 4 )alkyl)amino or (C 1 -C 4 )alkyl; 
     R 26  and R 27  independently represent hydrogen, lower alkanoyl, lower alkoxy-lower alkanoyl, aroyl, carbamoyl or mono- or di-lower alkylcarbamoyl; and R 30  and R 33  are independently hydrogen, (C 1 -C 4 )alkyl, (C 6 -C 10 )aryl or (C 6 -C 10 )aryl((C 1 -C 4 )alkyl); or a pharmaceutically acceptable salt thereof. 
     In one embodiment of formula (IV), at least one of R 28  and R 29  is (C 1 -C 4 )alkyl substituted with one or more (C 1 -C 4 )alkoxy, halogen, hydroxy, amino, mono((C 1 -C 4 )alkyl)amino, di((C 1 -C 4 )alkyl)amino or (C 6 -C 10 )aryl wherein aryl is optionally substituted with one or more halogen, hydroxy, amino, (C 1 -C 4 )alkyl, R 30 OOC—(C 1 -C 4 )alkyl, mono((C 1 -C 4 )alkyl)amino or di((C 1 -C 4 )alkyl)amino. 
     In another embodiment, at least one of R 31  and R 32  is C 1-4 alkyl substituted with one or more (C 1 -C 4 )alkoxy, halogen, hydroxy, amino, mono((C 1 -C 4 )alkyl)amino, di((C 1 -C 4 )alkyl)amino or C 6-10 -aryl wherein aryl is optionally substituted with one or more halogen, hydroxy, amino, (C 1 -C 4 )alkyl, R 30 OOC—(C 1 -C 4 )alkylene-, mono((C 1 -C 4 )alkyl)amino or di((C 1 -C 4 )alkyl)amino. 
     In another embodiment, at least one of R 28  and R 29  is C 6-10 -aryl substituted with one or more halogen, hydroxy, amino, mono((C 1 -C 4 )alkyl)amino, di((C 1 -C 4 )alkyl)amino or (C 1 -C 4 )alkyl. 
     In another embodiment, at least one of R 31  and R 32  is C 6-10 -aryl substituted with one or more halogen, hydroxy, amino, mono((C 1 -C 4 )alkyl)amino, di((C 1 -C 4 )alkyl)amino or (C 1 -C 4 )alkyl. 
     In a specific combination, R 31  is hydrogen and R 32  is (C 1 -C 4 )alkyl, cyclopropyl or hydroxy-(C 2 -C 4 )alkyl. A specific R 28  group is (C 1 -C 4 )alkyl substituted with (C 6 -C 10 )aryl, that is in turn substituted with R 30 O(O)C—(C 1 -C 4 )alkylene-. 
     A specific compound having formula (IV) is: 
                                
wherein R 30  is hydrogen, methyl, ethyl, n-propyl or isopropyl. More preferred is a compound wherein the R 30  group is methyl or ethyl. The most preferred R 30  group is methyl.
 
     Two compounds that are particularly useful in practicing the present invention have the formula: 
                                
wherein R 30  is hydrogen (acid, CGS21680) and where R 30  is methyl (ester, JR2171).
 
     The compounds of the invention having formula (IV) may be synthesized as described in: U.S. Pat. No. 4,968,697 or  J. Med. Chem.,  33, 1919-1924, (1990). 
     Specifically, the invention also provides the use of a compound of formula (I) or a pharmaceutically acceptable salt thereof to prepare a medicament for treating systemic intoxification in a mammal (e.g. a human),. 
     Specifically, the invention also provides the use of a compound of formula (I) or a pharmaceutically acceptable salt thereof to prepare a medicament for treating inflammation caused by bacterial, fungal or viral infections and the inflammation caused by the treatment of these infections, e.g., by the death of the bacterial or viral cells in a mammal (e.g. a human). 
     The present method also includes the administration of a Type IV phosphodiesterase (PDE) inhibitor in combination with compounds having formulae (I), (I), (III), and (IV). The combination of the compounds of the invention with type IV phosphodiesterase inhibitor provides synergistic decreases in the inflammatory response of immune cells. Examples of Type IV phosphodiesterase (PDE) inhibitors include those disclosed in U.S. Pat. No. 4,193,926, and WO 92-079778, and Molnar-Kimber, K. L. et al.,  J. Immunol.,  150, 295A (1993), all of which are incorporated herein by reference. 
     Suitable Type IV phosphodiesterase (PDE) inhibitors include racemic and optically active 4-(polyalkoxyphenyl)-2-pyrrolidones of general formula (VI): 
                                
(disclosed and described in U.S. Pat. No. 4,193,926) wherein R 18  and R 19  are independently the same or different and are hydrocarbon radicals having up to 18 carbon atoms with at least one being other than methyl, a heterocyclic ring, or alkyl of 1-5 carbon atoms which is substituted by one or more of halogen atoms, hydroxy, carboxy, alkoxy, alkoxycarbonyl or an amino group or amino.
 
     Examples of hydrocarbon R 18  and R 19  groups are saturated and unsaturated, straight-chain and branched alkyl of 1-18, preferably 1-5, carbon atoms, cycloalkyl and cycloalkylalkyl, preferably 3-7 carbon atoms, and aryl and aralkyl, preferably of 6-10 carbon atoms, especially monocyclic. 
     Rolipram is an example of a suitable Type IV phosphodiesterase or PDE inhibitor included within the above formula. Rolipram has the following formula: 
     
       
                 
         
             
             
         
      
     
     In cases where compounds are sufficiently basic or acidic to form stable nontoxic acid or base salts, administration of the compounds as salts may be appropriate. Examples of pharmaceutically acceptable salts are organic acid addition salts formed with acids which form a physiological acceptable anion, for example, tosylate, methanesulfonate, acetate, citrate, malonate, tartarate, succinate, benzoate, ascorbate, α-ketoglutarate, and α-glycerophosphate. Suitable inorganic salts may also be formed, including hydrochloride, sulfate, nitrate, bicarbonate, and carbonate salts. 
     Pharmaceutically acceptable salts may be obtained using standard procedures well known in the art, for example by reacting a sufficiently basic compound such as an amine with a suitable acid affording a physiologically acceptable anion. Alkali metal (for example, sodium, potassium or lithium) or alkaline earth metal (for example calcium) salts of carboxylic acids can also be made. 
     Compounds of the present invention can conveniently be administered in a pharmaceutical composition containing the compound in combination with a suitable excipient. Such pharmaceutical compositions can be prepared by methods and contain excipients which are well known in the art. A generally recognized compendium of such methods and ingredients is Remington&#39;s Pharmaceutical Sciences by E. W. Martin (Mark Publ. Co., 15th Ed., 1975). The compounds and compositions of the present invention can be administered parenterally (for example, by intravenous, intraperitoneal or intramuscular injection), topically, orally, or rectally. 
     For oral therapeutic administration, the active compound may be combined with one or more excipients and used in the form of ingestible tablets, buccal tablets, troches, capsules, elixirs, suspensions, syrups, wafers, and the like. Such compositions and preparations should contain at least 0.1% of active compound. The percentage of the compositions and preparations may, of course, be varied and may conveniently be between about 2 to about 60% of the weight of a given unit dosage form. The amount of active compound in such therapeutically useful compositions is such that an effective dosage level will be obtained. 
     The tablets, troches, pills, capsules, and the like may also contain the following: binders such as gum tragacanth, acacia, corn starch or gelatin; excipients such as dicalcium phosphate; a disintegrating agent such as corn starch, potato starch, alginic acid and the like; a lubricant such as magnesium stearate; and a sweetening agent such as sucrose, fructose, lactose or aspartame or a flavoring agent such as peppermint, oil of wintergreen, or cherry flavoring may be added. When the unit dosage form is a capsule, it may contain, in addition to materials of the above type, a liquid carrier, such as a vegetable oil or a polyethylene glycol. Various other materials may be present as coatings or to otherwise modify the physical form of the solid unit dosage form. For instance, tablets, pills, or capsules may be coated with gelatin, wax, shellac or sugar and the like. A syrup or elixir may contain the active compound, sucrose or fructose as a sweetening agent, methyl and propylparabens as preservatives, a dye and flavoring such as cherry or orange flavor. Of course, any material used in preparing any unit dosage form should be pharmaceutically acceptable and substantially non-toxic in the amounts employed. In addition, the active compound may be incorporated into sustained-release preparations and devices. 
     The compounds or compositions can also be administered intravenously or intraperitoneally by infusion or injection. Solutions of the active compound or its salts can be prepared in water, optionally mixed with a nontoxic surfactant. Dispersions can also be prepared in glycerol, liquid polyethylene glycols, triacetin, and mixtures thereof and in oils. Under ordinary conditions of storage and use, these preparations contain a preservative to prevent the growth of microorganisms. 
     Pharmaceutical dosage forms suitable for injection or infusion can include sterile aqueous solutions or dispersions or sterile powders comprising the active ingredient which are adapted for the extemporaneous preparation of sterile injectable or infusible solutions or dispersions, optionally encapsulated in liposomes. In all cases, the ultimate dosage form should be sterile, fluid and stable under the conditions of manufacture and storage. The liquid carrier or vehicle can be a solvent or liquid dispersion medium comprising, for example, water, ethanol, a polyol (for example, glycerol, propylene glycol, liquid polyethylene glycols, and the like), vegetable oils, nontoxic glyceryl esters, and suitable mixtures thereof. The proper fluidity can be maintained, for example, by the formation of liposomes, by the maintenance of the required particle size in the case of dispersions or by the use of surfactants. The prevention of the action of microorganisms can be brought about by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, thimerosal, and the like. In many cases, it will be preferable to include isotonic agents, for example, sugars, buffers or sodium chloride. Prolonged absorption of the injectable compositions can be brought about by the use in the compositions of agents delaying absorption, for example, aluminum monostearate and gelatin. 
     Sterile injectable solutions can be prepared by incorporating the active compound in the required amount in the appropriate solvent with various of the other ingredients enumerated above, as required, followed by filter sterilization. In the case of sterile powders for the preparation of sterile injectable solutions, the preferred methods of preparation are vacuum drying and the freeze drying techniques, which yield a powder of the active ingredient plus any additional desired ingredient present in the previously sterile-filtered solutions. 
     For topical administration, the present compounds may be applied in pure form, i.e., when they are liquids. However, it will generally be desirable to administer them to the skin as compositions or formulations, in combination with a dermatologically acceptable carrier, which may be a solid or a liquid. 
     Useful solid carriers include finely divided solids such as talc, clay, microcrystalline cellulose, silica, alumina and the like. Useful liquid carriers include water, alcohols or glycols or water-alcohol/glycol blends, in which the present compounds can be dissolved or dispersed at effective levels, optionally with the aid of non-toxic surfactants. Adjuvants such as fragrances and additional antimicrobial agents can be added to optimize the properties for a given use. The resultant liquid compositions can be applied from absorbent pads, used to impregnate bandages and other dressings, or sprayed onto the affected area using pump-type or aerosol sprayers. Thickeners such as synthetic polymers, fatty acids, fatty acid salts and esters, fatty alcohols, modified celluloses or modified mineral materials can also be employed with liquid carriers to form spreadable pastes, gels, ointments, soaps, and the like, for application directly to the skin of the user. 
     Useful dosages of the compounds of formula I can be determined by comparing their in vitro activity, and in vivo activity in animal models. Methods for the extrapolation of effective dosages in mice, and other animals, to humans are known to the art; for example, see U.S. Pat. No. 4,938,949. 
     The compound is conveniently administered in unit dosage form; for example, containing about 0.05 mg to about 500 mg, conveniently about 0.1 mg to about 250 mg, most conveniently, about 1 mg to about 150 mg of active ingredient per unit dosage form. The desired dose may conveniently be presented in a single dose or as divided doses administered at appropriate intervals, for example, as two, three, four or more sub-doses per day. The sub-dose itself may be further divided, e.g., into a number of discrete loosely spaced administrations. 
     The compositions can conveniently be administered orally, sublingually, transdermally, or parenterally at dose levels of about 0.01 to about 150 μg/kg, preferably about 0.1 to about 50 μg/kg, and more preferably about 0.1 to about 10 μg/kg of mammal body weight. 
     The surgical techniques for transplanting organs are known to the person skilled in the art of organ transplantation. 
     For parenteral administration the compounds are presented in aqueous solution in a concentration of from about 0.1 to about 10%, more preferably about 0.1 to about 7%. The solution may contain other ingredients, such as emulsifiers, antioxidants or buffers. 
     The preparation of compounds useful in practicing the present invention are disclosed in U.S. patent application Ser. No. 10/236,379, filed Oct. 1, 2002, and can generally be prepared as illustrated in Schemes 1A and 1B below. Starting materials can be prepared by procedures described in these schemes, procedures described in the General methods below or by procedures that would be well known to one of ordinary skill in organic chemistry. The variables used in Schemes 1A and Scheme 1B are as defined herein or as in the claims. 
     The preparation of alkynyl cycloalkanols is illustrated in Scheme 1A. A solution of an appropriate cycloalkanone (where j is from 0-5) is prepared in a solvent such as THF. A solution of a suitable ethynylmagnesium halide compound in a solvent is added to the cycloalkanone. After addition, the solution is allowed to stir at about 20 C for about 20 hours. The reaction is monitored via TLC until the starting material is consumed. The reaction is quenched with water, filtered over a plug of sand and silica, washed with a solvent, such as EtOAc, and evaporated to provide the product. Typically, two products are formed, the isomers formed by the axial/equatorial addition of the alkyne (where m is as defined above, and the sum of m1 and m2 is from 0 to about 7) to the ketone. The compounds are purified via flash chromatography using EtOAc/Hexanes to provide the product. 
     
       
                 
         
             
             
         
      
     
     In accordance with one embodiment of the present invention a composition comprising an agonist of A 2A AR is administered to a patient to treat septic shock and systemic inflammatory response syndrome. As used herein the term “treating” includes prophylaxis of the specific disorder or condition, or alleviation of the symptoms associated with a specific disorder or condition and/or preventing or eliminating said symptoms. In one embodiment a method for treating septic shock or systemic inflammatory response syndrome is provided wherein an agonist of A 2A ARs is administered to a patient to reduce inflammation and improve survival in a patient suffering from septic shock or systemic inflammatory response syndrome. In one embodiment the A 2A AR agonist is selected from the group consisting of ATL146e, AB-1, AB-3 and JR-3213. 
     The preparation of 2-alkynyladenosines is illustrated in Scheme 1B. A flame-dried round bottom under nitrogen is charged with 5-(6-Amino-2-iodo-purin-9-yl)-3,4-dihydroxytetrahydrofuran-2-carboxylic acid ethylamide (NECA 2-Iodoadenosine) and a solvent such as DMF. The appropriate alkyne, wherein R is a —(CR 1 R 2 ) m  Z group, is dissolved in acetonitrile followed by TEA, 5 mole % Pd(PPh 3 ) 4 , and CuI. All solvents are thoroughly degassed. 
     The solution is allowed to stir for about 24 hours at room temperature, and monitored until complete by HPLC. If the reaction is not complete after this time, additional catalyst, CuI, and TEA are added. After the reaction is complete, the solvents are removed under high-vacuum and the residue taken up in a small amount of DMF. This product is isolated using preparative silica TLC. The product is purified by RP-HPLC. 
     
       
                 
         
             
             
         
      
     
     The following abbreviations have been used herein:
     2-Aas 2-alkynyladenosines;     125 I-ABA N 6 -(4-amino-3- 125 iodo-benzyl)adenosine   APCI Atmospheric pressure chemical ionization   ATL146e 4-{3-[6-Amino-9-(5-ethylcarbamoyl-3,4-dihydroxy-tetrahydro-furan-2-yl)-9H-purin-2-yl]-prop-2-ynyl}cyclo-hexanecarboxylic acid methyl ester;   CCPA 2-chloro-N 6 -cyclopentyladenosine;   CGS21680 2-[4-(2-carboxyethyl)phenethylamino]-5′-N-ethyl-carboxamidoadenosine;   Cl-IB-MECA N 6 -3-iodo-2-chlorobenzyladenosine-5′-N-methyl-uronamide;   CPA N 6 -cyclopentyladenosine   DMF dimethylformamide   DMSO dimethylsulfoxide   DMSO-d 6  deuterated dimethylsulfoxide   EtOAc ethyl acetate   eq equivalent   GPCR G protein coupled receptor; hA 2A AR, Recombinant human A 2A  adenosine receptor;   IADO 2-Iodoadenosine     125 I-APE, 2-[2-(4-amino-3-[ 125 I]iodophenyl)ethylamino]adenosine;   NECA 5′-N-ethylcarboxamidoadenosine;   IB-MECA N 6 -3-iodobenzyladenosine-5′-N-methyluronamide;   2-Iodoadenosine 5-(6-amino-2-iodo-purin-9-yl)-3,4-dihydroxytetra-hydro-furan-2carboxylic acid ethylamide   HPLC high-performance liquid chromatography   HRMS high-resolution mass spectrometry     125 I-ZM241385,  125 I-4-(2-[7-amino-2-[2-furyl][1,2,4]triazolo[2,3-α]-[1,3,5]triazin-5-yl-amino]ethyl)phenol;   INECA 2-iodo-N-ethylcarboxamidoadenosine   LC/MS liquid chromatography/mass spectrometry   m.p. melting point   MHz megahertz   MRS 1220, N-(9-chloro-2-furan-2-yl-[1,2,4]triazolo[1,5-c]-quinazolin-5-yl)-2-phenylacetamide;   MS mass spectrometry   NECA N-ethylcarboxamidoadenosine   NMR nuclear magnetic resonance   RP-HPLC reverse phase high-performance liquid chromatography   TBAF tetrabutylammonium fluoride   TBS tert-butyldimethylsilyl   TBDMSCl tert-butyldimethylsilylchloride   TEA triethylamine   TFA trifluoroacetic acid   THF tetrahydrofuan   TLC thin layer chromatography   p-TSOH para-toluenesulfonic acid   XAC 8-(4-((2-a-minoethyl)aminocarbonyl-methyloxy)-phenyl)-1-3-dipropylxanthine.   

     EXAMPLES 
     Effects of A 2A AR agonists in in vivo studies 
     The effects of A 2A AR agonist, ATL146e were studied in a mouse islet transplant model. No mice in the control group were cured with 100 islets transplanted per mouse transplantation within 17 days after transplantation (See  FIG. 1 ). In contrast, in ATL 146e treated group, (where ATL 146e was used at 10 ng/kg/min beginning with transplantation and lasting for 7 days, all mice were cured of diabetes within 17 days (See  FIG. 2 ). 
     When the dose of A 2A AR agonist, ATL 146e, was raised to 60 ng/kg/min and administered beginning 1 day before transplantation, diabetes was cured immediately with 150 islets transplanted per mouse (See  FIG. 4 ). In contrast, without the A 2A AR agonist compound, it took almost 2 weeks to achieve normoglycemia (See  FIG. 3 ). 
     When the A 2A AR agonist, ATL 146e (60 ng/kg/min), was administered 1 day before transplantation, diabetes was cured immediately with 100 islets per mouse (See  FIG. 5 ). Compared to the previous data, where cure can not be achieved at this dose of islet tissue without ATL 146e ( FIG. 1 ) or took two weeks to achieve at the lower dose ( FIG. 2 ). 
     For mice receiving only 50 islets, use of A 2A AR agonist, ATL 146e at a dose of 60 ng/kg/min, administered 1 day before transplantation also resulted in half of mice achieving normoglycemia by 14-17 days after transplantation (See  FIG. 7 ). In contrast, in the absence of ATL 146e, diabetes can not be cured by 50 islets transplanted per mouse ( FIG. 6 ). 
     In another experiment, a 50 islet transplant group was used, and the A 2A AR agonist, ATL 146e, was administered for 3 days prior to transplantation. This resulted in a cure within 7 days in 3 of 4 animals, i.e., the animals achieved normoglycemia. 
     All cited publications, patents, and patent documents are incorporated by reference herein, as though individually incorporated by reference. The invention has been described with reference to various specific and preferred embodiments and techniques. However, it should be understood that many variations and modifications may be made while remaining within the spirit and scope of the invention.