The capsaicin (vanilloid) receptor, VR1, is a sensory neuron-specific ion channel that serves as a polymodal detector of pain-producing chemical and physical stimuli. The response of VR1 to capsaicin or noxious heat is dynamically potentiated by extracellular protons within a pH range encountered during tissue acidosis, such as that associated with arthritis, infarction, tumor growth, and other forms of injury. A molecular determinant for this important physiological activity was localized to an extracellular Glu residue (E600) in the region linking the fifth transmembrane domain with the putative pore-forming region of the channel. We suggest that this residue serves as a key regulatory site of the receptor by setting sensitivity to other noxious stimuli in response to changes in extracellular proton concentration. We also demonstrate that protons, vanilloids, and heat promote channel opening through distinct pathways, because mutations at a second site (E648) selectively abrogate proton-evoked channel activation without diminishing responses to other noxious stimuli. Our findings provide molecular evidence for stimulus-specific steps in VR1 activation and offer strategies for the development of novel analgesic agents. P ain is initiated when noxious thermal, mechanical, or chemical stimuli excite the peripheral terminals of specialized primary afferent neurons called nociceptors (1). Tissue damage, such as that associated with infection, inflammation, or ischemia, produces an array of chemical mediators that activate or sensitize nociceptor terminals to elicit pain and promote tenderness at the site of injury. An important component of this proalgesic response is local acidosis, namely, a reduction in extracellular pH to levels below the physiological norm of Ϸ7.6 (2). Protons are capable of modulating the activity of a number of receptors and ion channels expressed by primary afferent nociceptors, including acid-sensitive channels of the degenerin family (3), ATPgated channels (4, 5), and vanilloid receptors (6, 7). Analyses of native and cloned vanilloid receptors suggest that they play a role in mediating sustained proton responses in vivo (8)(9)(10)(11)(12). This is further supported by the profoundly reduced responses to acid in cultured dorsal root ganglion neurons and isolated skin nerve preparations of mice with a targeted disruption of the gene encoding for the cloned capsaicin (vanilloid) receptor VR1 (13).Vanilloid receptors are nociceptor-specific cation channels that serve as the molecular target for capsaicin, the main pungent ingredient in ''hot'' chili peppers. VR1 is homologous to members of the transient receptor potential family of ion channels first identified in the Drosophila phototransduction pathway (6,14). We have shown that, when expressed in heterologous systems, VR1 is also activated by noxious heat (6, 7) with a threshold (Ͼ43°C) resembling that of native heat-activated currents in cultured sensory neurons (15). Acidification of the extracellular milieu has two primary effects on V...