T he synovial sarcoma X breakpoint (SSX)3 genes are located on the X chromosome and encode a family of highly homologous nuclear proteins. Two family members, SSX-1 and SSX-2 were initially identified as fusion partners of the SYT gene in t(X;18)-positive synovial sarcomas (1, 2). Later, serological analysis of tumor cDNA expression libraries (SEREX), revealed recognition of the SSX-2 encoded Ag by Abs from cancer patients (3). Three additional homologous genes, SSX-3, -4, and -5, were identified (4, 5) either through screening of a testicular cDNA library with allogeneic patient serum (SSX-3 (5)) or by analysis of homologous sequences amplified by SSX-specific primers (SSX-3 (4), SSX-4, and -5 (5)). Recently, SSX genes and pseudogenes have been further characterized, resulting in the definition of nine (SSX-1 to -9) genes (6). Expression of the majority of the SSX genes, including SSX-1 to -5 and SSX-7, is restricted to gametogenic cells, not found in most adult normal tissues, but is detected in tumors of different histological types (7-9). Therefore, Ags of the SSX family are targets of interest for immunotherapy of cancer.Among SSX genes, SSX-1, -2, -4, and -5 are the most commonly expressed. Surveys of SSX gene expression in different human tumor types have shown expression of several family members in a significant proportion of tumors, although at variable levels depending on the particular histological type. In 325 specimens of human neoplasms from various histological origins, expression of SSX-4 was found in 15% of all tumors, including 10 of 48 (20.8%) malignant melanomas tested (7). More recently expression of SSX-4 has been reported by us (9) in 23% of sarcomas and by others in several different tumor types, such as 73% of hepatocellular carcinomas (8), 35% of primary lung cancers (10), 67% of neuroblastomas (11), and 20% of gastric carcinomas (12).We have previously reported that one Ag of the family, SSX-2, is naturally immunogenic in cancer patients bearing Ag-expressing tumors, and identified both CD8 ϩ and CD4 ϩ SSX-2-derived T cell epitopes (13-15). However, no information was thus far available on T cell responses to other SSX Ags. Here, we report the analysis of CD4 ϩ T cell responses against SSX-4, in melanoma patients. Upon in vitro stimulation with a pool of long peptides spanning the protein sequence, we could detect and isolate SSX-4-specific CD4 ϩ T cells from four melanoma patients bearing Agexpressing tumors. We isolated SSX-4-specific clonal CD4 ϩ T cell populations recognizing several distinct antigenic sequences restricted by different HLA class II alleles including some among the HLA-DR alleles more frequently expressed in several major ethnic groups. Interestingly, the majority of the identified sequences were located within the Krüppel-associated box (KRAB) repression domain in the N-terminal region of the protein.