P2X(7) is a receptor for extracellular nucleotides expressed by different normal cell types. P2X(7) triggering may result in stimulation of cell proliferation or induction of apoptosis depending on the level of activation. P2X(7) expression and function in B-cell chronic lymphocytic leukemia has been shown to correlate with disease severity. Here, we have asked the question of whether P2X(7) is expressed and functional in neuroblastoma, a pediatric tumor of neuroectodermal origin. P2X(7) was detected both in primary neuroblastoma tumors and in neuroblastoma cell lines. In the latter cells, P2X(7) stimulation by ATP was found to trigger (a) increased intracellular calcium fluxes, (b) plasma membrane depolarization, and (c) formation of a nonselective plasma membrane permeable pore. In contrast to the usual response typically observed in the majority of cell types, P2X(7) in vitro stimulation did not induce caspase-3 activation or apoptosis of neuroblastoma cells but rather supported their proliferation. Growth stimulation was partially due to substance P release from nucleotide-activated neuroblastoma cells. Therefore, neuroblastoma cells seem to have molded P2X(7) function to their advantage in two ways (i.e., by silencing P2X(7) proapoptotic activity and by coupling P2X(7) stimulation to release of locally acting trophic factors).