Muscarinic receptors, particularly the type 3 subtype (M3R), have an important role in exocrine secretion. M3R normally function in HSG cells originated from human submandibular gland ducts, but not in A253 and SGT cells, derived from human submandibular carcinoma and salivary gland adenocarcinoma. However, the underlying mechanism of this suppression has remained elusive. In this study, we examined whether M3R function is suppressed by epigenetic modulation of the receptor. To this end, we investigated the mRNA transcript and protein levels of the M3R using reverse transcriptase-PCR, western blot, and confocal microscopy analyses. Global DNA methylation assays, methylation-specific PCR, and bisulfite sequencing were also performed to understand the epigenetic status of the M3R CpG island. We found that A253 cells expressed all subtypes of muscarinic receptors, except M3R, on the mRNA level. However, treatment of cells with 5-aza-2 0 -deoxycytidine (5-Aza-CdR), a DNA-demethylating agent, increased the expression levels of both M3R mRNA transcript and protein in proportion to the incubation period. 5-Aza-CdR completely restored the carbacholinduced calcium response, which was not observed in untreated A253 cells. In untreated A253 cells, all CG pairs from the 1st to 14th were methylated and 5-Aza-CdR treatment demethylated one of the methylated CG pairs. We also examined the methylation pattern of M3R CpG island in human cancer tissue. Interestingly, the result was very similar to those of A253 cells. All CG pairs in M3R CpG island were also methylated. Another salivary gland tumor cell line, SGT, also showed the similar methylation pattern, heavy methylation in M3R CpG island. It is concluded that CpG island in M3R is hypermethylated in cancer cell lines and human cancer. Our results further suggest that 5-Aza-CdR could potentially be used to restore the function of M3R, suppressed in some cancer cell types. Epigenetic regulation by CpG methylation has an important role in tumorigenesis, and is also crucial to mounting a successful response to cancer therapy. CpG islands in DNA are methylated de novo in a tissue-specific manner, and the patterns of methylation are fixed in subsequent cell divisions by methyltransferase activity. 1 Recent studies have indicated that hypermethylation of CpG islands within the promoter and 5 0 regions of genes is an important epigenetic mechanism for suppressing gene expression. 2-4 DNA hypermethylation may directly affect the basal transcriptional machinery by altering the secondary structure of DNA and inducing chromosome remodeling through methyl group-binding proteins and histone deacetylase, thereby leading to transcriptional repression. 5 5-Aza-2 0 -deoxycytidine (5-Aza-CdR, decitabine) is a prodrug that has been shown to be phosphorylated, and thus activated, by deoxytidine kinase. 5-Aza-CdR is a nucleotide analog that is incorporated into DNA, where it irreversibly inactivates DNA methyltransferase (DNMT); 5-Aza-CdR is also an S-phase-specific agent. 6 The cytosine DNMT gen...