An Itch Receptor Drives Melanoma.

Mas-Related GPCR X4 (MRGPRX4) is a sensory neuron-restricted receptor for cholestatic itch. Here, we identify MRGPRX4 as an unexpected melanoma driver. MRGPRX4 is upregulated in melanoma and is confined to invasive, neural-crest-like and pre-EMT states associated with dedifferentiation and therapy resistance. Ectopic MRGPRX4 expression in mouse melanocytes drives 100% penetrant, highly metastatic melanoma, demonstrating oncogenic behavior. MRGPRX4 promotes melanoma cell proliferation and invasion through basal, ligand-independent, PI3K-AKT-MAPK activation. Multi-omics links MRGPRX4 expression to a mesenchymal/neural-crest-like program that defines a distinct invasive MRGPRX4+ niche. Comparing transcptomics of MRGPRX4-driven tumors shows a broad overlap with BRAF/NRAS-driven tumors; however, the MRGPRX4 model also enriches an ECM-rich, invasive neural crest-like melanoma state. MRGPRX4 further remodels the tumor microenvironment toward an immunosuppressive, checkpoint-high state enriched in suppressive myeloid cells. Pharmacologic MRGPRX4 inhibition suppresses basal signaling and limits melanoma growth and invasion. In sum, melanoma exploits MRGPRX4 to acquire an invasive and immunosuppressive phenotype, nominating this somatosensory GPCR as a promising therapeutic target.