Human telomerase reverse transcriptase, hTERT, has been identified as the catalytic enzyme required for telomere elongation. hTERT is expressed in most tumor cells but seldom expressed in most human adult cells. It has been reported that 80% to 90% of hepatocellular carcinomas (HCCs) express hTERT, making the enzyme a potential target in immunotherapy for HCC. In the current study, we identified hTERT-derived, HLA-A*2402-restricted cytotoxic T cell (CTL) epitopes and analyzed hTERT-specific CTL responses in patients with HCC. Peptides containing the epitopes showed high affinity to bind HLA-A*2402 in a major histocompatibility complex binding assay and were able to induce hTERT-specific CTLs in both hTERT cDNA-immunized HLA-A*2402/K b transgenic mice and patients with HCC. The CTLs were able to kill hepatoma cell lines depending on hTERT expression levels in an HLA-A*2402-restricted manner and induced irrespective of hepatitis viral infection. The number of single hTERT epitope-specific T cells detected by ELISPOT assay was 10 to 100 specific cells per 3 ؋ 10 5 PBMCs, and positive T cell responses were observed in 6.9% to 12.5% of HCC patients. hTERT-specific T cell responses were observed even in the patients with early stages of HCC. The frequency of hTERT/tetramer ؉ CD8 ؉ T cells in the tumor tissue of patients with HCC was quite high, and they were functional. In conclusion, these results suggest that hTERT is an attractive target for T-cell-based immunotherapy for HCC, and the identified hTERT epitopes may be valuable both for immunotherapy and for analyzing host immune responses to HCC. (HEPATOLOGY 2006;43:1284-1294.) H epatocellular carcinoma (HCC) is the most frequent primary malignancy of the liver and has gained much clinical interest because of its increasing incidence. 1-3 Although current advances in therapeutic modalities have improved the prognosis of HCC patients, 4-6 the survival rate is still not satisfactory. One of the reasons for the poor prognosis is the high rate of recurrence after treatment. To protect against recurrence, tumor antigen-specific immunotherapy is an attractive strategy. Although many tumor-specific antigens have been identified in various cancers, the number of HCC-specific antigens known is still limited.Human telomerase reverse transcriptase, hTERT, has been identified as the catalytic enzyme required for telomere elongation. [7][8][9][10] Recently, several results regarding hTERT-specific cytotoxic T cell (CTL) responses were reported for humans and mice. [11][12][13][14][15][16][17][18][19][20] These reports revealed that hTERT-specific CTLs induced by stimulation with peptides or DNA-based immunization kill cancer cell lines that have high levels of hTERT, suggesting that hTERT-reactive T cell clones are not deleted from the human T cell repertoire and that hTERT may be a useful tumor-specific antigen as a target for T-cell-based immunotherapy for cancers. However, the existence of hTERT-specific CTLs and the relationship between immunological