Cisplatin is the most commonly used anticancer drug for the treatment of testicular germ cell tumors (TGCTs). The hypersensitivity of TGCTs to cisplatin is a subject of widespread interest. Here, we show that high-mobility group box protein 4 (HMGB4), a protein preferentially expressed in testes, uniquely blocks excision repair of cisplatin-DNA adducts, 1,2-intrastrand cross-links, to potentiate the sensitivity of TGCTs to cisplatin therapy. We used CRISPR/ Cas9-mediated gene editing to knockout the HMGB4 gene in a testicular human embryonic carcinoma and examined cellular responses. We find that loss of HMGB4 elicits resistance to cisplatin as evidenced by cell proliferation and apoptosis assays. We demonstrate that HMGB4 specifically inhibits repair of the major cisplatin-DNA adducts in TGCT cells by using the human TGCT excision repair system. Our findings also reveal characteristic HMGB4-dependent differences in cell cycle progression following cisplatin treatment. Collectively, these data provide convincing evidence that HMGB4 plays a major role in sensitizing TGCTs to cisplatin, consistent with shielding of platinum-DNA adducts from excision repair.platinum anticancer drug | testicular cancer | high-mobility group protein T esticular germ cell tumors (TGCTs) are among the few tumor types that can be clinically cured with chemotherapy owing to the potency of cisplatin (1). The introduction of cisplatin in combination chemotherapy helped advance cure rates from 5% to the current level of 90% (2). In the clinic, cisplatin is used with bleomycin and either vinblastine or etoposide to treat metastatic testicular neoplasms (3-6). The well-studied antitumor activity of cisplatin involves binding to DNA, inhibition of transcription, and induction of apoptosis (7,8). Cellular events leading to apoptosis are multifactorial and begin with uptake followed by chemical transformation of cisplatin. Following aquation, or replacement of the chloride ligands in [Pt(NH 3 ) 2 Cl 2 ] by water, the activated drug binds to DNA, generating mainly 1,2-intrastrand d(GpG) cross-links that block RNA polymerase II, ultimately signaling cell death (9-11). Recently, a cisplatinsequencing (cisplatin-seq) approach was used to confirm DNA as the target for cisplatin at the genome scale by base resolution analysis (12). High-mobility group proteins such as high-mobility group box protein 1 (HMGB1) recognize these specific cisplatin-DNA adducts and promote the toxicity of cisplatin to tumors by interfering with excision and other repair pathways (13,14).HMGB1 binds selectively to cisplatin 1,2-intrastrand d(GpG) and d(ApG) cross-links, which account for ∼90% of all platinum (Pt)-DNA adducts (15,16). Studies of the interaction of HMGB1 and other cisplatin-DNA recognition proteins such as Irx1 in yeast (17, 18) with cisplatin-modified DNA revealed bending of the DNA with attendant shielding from excision repair in vitro and subsequent sensitization of cancer cells to cisplatin treatment (13,19). Related studies showed cooperative HMGB1 and XP...