Papers of the Week

Oral squamous cell carcinoma (OSCC) is one of the most painful cancers, which interferes with orofacial function including talking and eating. We report that legumain (Lgmn) cleaves protease-activated receptor-2 (PAR) in the acidic OSCC microenvironment to cause pain. Lgmn is a cysteine protease of late endosomes and lysosomes that can be secreted; it exhibits maximal activity in acidic environments. The role of Lgmn in PAR-dependent cancer pain is unknown. We studied Lgmn activation in human oral cancers and oral cancer mouse models. Lgmn was activated in OSCC patient tumors, compared to matched normal oral tissue. After intraplantar, facial or lingual injection, Lgmn evoked nociception in wild-type (WT) female mice but not in female mice lacking PAR in Na1.8-positive neurons (), nor in female mice treated with a Lgmn inhibitor, LI-1. Inoculation of an OSCC cell line caused mechanical and thermal hyperalgesia that was reversed by LI-1. and deletion attenuated mechanical allodynia in female mice with carcinogen-induced OSCC. Lgmn caused PAR-dependent hyperexcitability of trigeminal neurons from WT female mice. deletion, LI-1 and inhibitors of adenylyl cyclase or protein kinase A prevented the effects of Lgmn. Under acidified conditions, Lgmn cleaved within the extracellular N-terminus of PAR at Asn↓Arg, proximal to the canonical trypsin activation site. Lgmn activated PAR by biased mechanisms in HEK293 cells to induce Ca mobilization, cAMP formation and protein kinase A/D activation, but not β-arrestin recruitment or PAR endocytosis. Thus, in the acidified OSCC microenvironment Lgmn activates PAR by biased mechanisms that evoke cancer pain.Oral squamous cell carcinoma (OSCC) is one of the most painful cancers. We report that legumain (Lgmn), which exhibits maximal activity in acidic environments, cleaves protease-activated receptor-2 (PAR) on neurons to produce OSCC pain. Active Lgmn was elevated in OSCC patient tumors, compared to matched normal oral tissue. Lgmn evokes pain-like behavior through PAR Exposure of pain-sensing neurons to Lgmn decreased the current required to generate an action potential through PAR Inhibitors of adenylyl cyclase and protein kinase A prevented the effects of Lgmn. Lgmn activated PAR to induce calcium mobilization, cAMP formation and activation of protein kinase D and A, but not β-arrestin recruitment or PAR endocytosis. Thus, Lgmn is a biased agonist of PAR that evokes cancer pain.