Intracellular cAMP Sensor EPAC: Physiology, Pathophysiology, and Therapeutics Development

Physiol Rev. 2018 Apr 1;98(2):919-1053. doi: 10.1152/physrev.00025.2017.


This review focuses on one family of the known cAMP receptors, the exchange proteins directly activated by cAMP (EPACs), also known as the cAMP-regulated guanine nucleotide exchange factors (cAMP-GEFs). Although EPAC proteins are fairly new additions to the growing list of cAMP effectors, and relatively "young" in the cAMP discovery timeline, the significance of an EPAC presence in different cell systems is extraordinary. The study of EPACs has considerably expanded the diversity and adaptive nature of cAMP signaling associated with numerous physiological and pathophysiological responses. This review comprehensively covers EPAC protein functions at the molecular, cellular, physiological, and pathophysiological levels; and in turn, the applications of employing EPAC-based biosensors as detection tools for dissecting cAMP signaling and the implications for targeting EPAC proteins for therapeutic development are also discussed.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Acetylcysteine / analogs & derivatives*
  • Acetylcysteine / metabolism
  • Animals
  • Cytoplasm / metabolism*
  • Erythromycin / analogs & derivatives*
  • Erythromycin / metabolism
  • Guanine Nucleotide Exchange Factors / metabolism*
  • Humans
  • Protein Transport / physiology
  • Receptors, Cyclic AMP / metabolism*
  • Signal Transduction / physiology


  • Guanine Nucleotide Exchange Factors
  • Receptors, Cyclic AMP
  • Erythromycin
  • erythromycin propionate-N-acetylcysteinate
  • Acetylcysteine