In a previous analysis, we showed that MAGE-As were the most frequently expressed cancer-testis antigens in human bladder tumours. Here, we further characterized by RT-PCR the expression of this family of genes by analyzing specifically MAGE-A3, -A4, -A8 and -A9 mRNAs in 46 bladder tumours and 10 normal urothelia. We found that they were expressed in 30, 33, 56 and 54% of tumours, respectively. Although MAGE-A8 was the most frequent, its expression was low and was also found in most normal urothelia. The other MAGE-A mRNAs were all tumour-specific but MAGE-A9 mRNA was expressed at a higher level and was two times more frequent in superficial than in invasive tumours. To study the expression of the protein, we produced 2 MAGE-A9-specific monoclonal antibodies (mAbs) presenting no cross-reactivity with other MAGE-A proteins. MAb 14A11, was used to analyse the expression of the antigen in testis and tumour samples by immunohistochemistry. In testis, MAGE-A9 expression was restricted to primary spermatocytes. Most bladder tumours that expressed the MAGE-A9 transcript were positive with mAb 14A11. Staining was heterogeneous but half of the tumours showed over 75% positive cells. Finally, we showed that treatment of bladder cancer cells with the methylation inhibitor, 5-aza-2 0 -deoxycytidine, alone or in combination with the histone deacetylase inhibitors MS-275 and 4-phenylbutyrate could strongly induce the expression of MAGE-A9. These results show that MAGE-A9 is frequently expressed in superficial bladder cancer and could be a relevant target for immunotherapy or chemoimmunotherapy because its expression can be induced by chemotherapeutic drugs. ' 2007 Wiley-Liss, Inc.Key words: bladder cancer; cancer-testis antigens; MAGE-A9; immunotherapy; DNA methylation Bladder cancer is the fifth most common cancer in the Western world. Most of these tumours are transitional cell carcinomas and about 75% are superficial. 1 Although most of these tumours present a good prognosis, they are associated with a high rate of recurrence since more than 60% will recur after surgery, and a significant proportion of these recurrences (5-25%) will be progression toward a more aggressive disease. Superficial bladder cancer thus represents a unique opportunity to develop and test cancer vaccines that could be used after surgery to prevent tumour recurrence, in an ideal setting of low tumour burden. Moreover, we hypothesize that this type of cancer could respond well to specific immunotherapy because it is one of the rare cancers to show clinical response after intravesical instillation of bacillus CalmetteGuerin, a nonspecific immunotherapy treatment. 1 Cancer-testis antigens (CTAs) possess several features of ideal targets for cancer immunotherapy. They are expressed in a large variety of tumours but their expression in normal tissues is restricted to gametogenic tissues, which are immunopriviledged because of their lack or low expression of HLA molecules. [2][3][4] Moreover, several studies have shown the existence of natural cellular an...