Exosites: their current status, and their relevance to the duration of action of long-acting beta 2-adrenoceptor agonists.

The four beta 2-adrenoceptor agonists, clenbuterol, bambuterol, formoterol and salmeterol, are all long-acting bronchodilators, that have distinct mechanisms for their extended durations of action. Various theories have been put forward in an attempt to explain these mechanisms. In this respect, there is strong evidence for the existence of specific additional binding sites (exosites) for salmeterol and related compounds, and that exosites exist on non-ligand recognition regions of the beta 2-adrenoceptor protein. Here, Robert Coleman and colleagues compare and contrast the profiles of action of these long-acting beta 2-adrenoceptor agonists, particularly as they relate to the role of exosites.