Breast cancer is the most frequently diagnosed cancer among women in the United States with >200,000 new cases reported every year. Aggressive forms of breast cancers most commonly metastasize to bones, which constitutes the key factor for high morbidity rate and associated suffering. Metastatic breast tumor growth in bones leads to chronic pain in the limbs, pelvis and spines, which is undermanaged with existing pain medications, mainly morphine derivatives. As palliative care is the major therapeutic goal for patients with breast cancer bone metastasis, a better understanding of signaling crosstalk between metastatic bone tumor microenvironment and the adjacent sensory nerve fibers is necessary for the development of highly efficacious analgesics for chronic bone cancer pain. Metastatic breast cancer cells secrete high levels of parathyroid hormone-related peptide (PTHrP), which act on osteoblasts and osteoclasts to induce bone lysis/destruction and subsequent release of nutrients and cell signaling molecules that stimulate tumor growth. Here I propose a novel hypothesis that PTHrP, by acting through its receptor PTH1 on sensory afferents, induce constitutive nociceptor sensitization via upregulation of activity/expression of the transient receptor potential vanilloid-1 (TRPV1) channel, which might underlie a mechanism for chronic pain associated with metastatic breast/bone cancers. The TRPV1 channel is normally activated only at noxious temperatures (e43oC). However, PTHrP acting through the PTH1 receptor could induce phosphorylation of TRPV1 protein and lead to constitutive channel activation at body temperatures (d37oC), a mechanism that could underlie chronic pain in the absence of any overt stimulation.
Aim 1 of my study will determine the specific cellular signaling events that underlie PTHrP-modulation of TRPV1 channel activity/expression in sensory neurons, and nociceptor sensitization. I will utilize patch-clamp electrophysiology, Ca2+ imaging, and membrane protein biochemistry to determine the molecular mechanisms underlying TRPV1 modulation by PTHrP.
Aim 2 of my study will determine the role of PTHrP-modulation of TRPV1 in sensory afferents on chronic bone pain in vivo using scid mice xenografts of human breast cancer cells, MDA-MB231-BoM-1833, that metastasize to bones when injected intracardialy. I will use a series of un-evoked/spontaneous bone-related pain behavioral assessments in these mice with metastatic breast/bone tumors. I will also utilize pharmacological inhibition of PTHrP and TRPV1 in these mice, to further confirm the contribution of PTHrP-modulation of TRPV1 in chronic bone pain associated with metastatic breast/bone tumor growth. My proposed studies will advance our understanding of how the interplay between metastatic breast/bone tumors and sensory neurons mediate chronic pain. Findings from this study will significantly contribute to the development of effective pharmacotherapies for chronic pain associated with metastatic bone cancers.

Public Health Relevance

Chronic pain associated with bone-metastasized breast cancers significantly diminishes the quality of life for women with this metastatic form of breast cancers. Breast cancers frequently metastasize to bones and cause chronic debilitating pain, which is undermanaged with the currently available analgesic regimen. Understanding the precise neurobiological mechanisms underlying this form of chronic pain is paramount for the development of novel and effective analgesic therapeutics. Specific modulation of the activity/expression of the key pain-transducing channel TRPV1 in sensory neurons that innervate bones, by PTHrP, which is secreted at elevated levels in bone-metastasized breast tumor microenvironment, is a potential neurobiological mechanism for chronic pain, and can be targeted for the development of pharmacotherapeutics for treating such pain.)

National Institute of Health (NIH)
National Cancer Institute (NCI)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZRG1-F02B-M (20))
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Korczak, Jeannette F
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University of Iowa
Schools of Medicine
Iowa City
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Mickle, Aaron D; Shepherd, Andrew J; Loo, Lipin et al. (2015) Induction of thermal and mechanical hypersensitivity by parathyroid hormone-related peptide through upregulation of TRPV1 function and trafficking. Pain 156:1620-36
Mickle, Aaron D; Shepherd, Andrew J; Mohapatra, Durga P (2015) Sensory TRP channels: the key transducers of nociception and pain. Prog Mol Biol Transl Sci 131:73-118
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