Hyperphosphorylated paratarg-7 (pP-7) carrier state is the strongest and most frequent molecular risk factor for MGUS, multiple myeloma (MM) and Waldenstr€ om's macroglobulinemia (WM), inherited autosomal-dominantly and, depending on the ethnic background, found in up to one third of patients with MGUS/MM. Since P-7 is the antigenic target of paraproteins that do not distinguish between wtP-7 and pP-7, we investigated CD4 1 T-cell responses in pP-7 1 patients and controls. Peptides spanning amino acids 1-35 or 4-31 containing phosphorylated or nonphosphorylated serine17 were used for stimulation. CD4 1 cells from 9/14 patients (65%) showed a pP-7 specific HLA-DR restricted response. These results demonstrate that pP-7 specific CD4 1 cells can mediate help for pP-7 specific chronic antigenic stimulation of P-7 specific B cells, which might ultimately result in the clonal evolution of a B cell into MGUS/MM/WM producing a P-7 specific paraprotein. Prerequisites for pP-7 specific stimulation of CD4 1 cells appear to be both a pP-7 carrier state and an HLA-DR subtype able to present and recognize pP-7. Our results serve as an explanation for the exclusive autoimmunogenicity of the hyperphosphorylated variant of P-7 and for the different hazard ratios of pP-7 carriers from different ethnic origins to develop MGUS/MM/WM.A causal relationship between MGUS/MM and chronic antigenic stimulation has been suggested by the results of several studies, 1 but until recently only few antigenic targets/stimuli have been reported that hold scrutiny. In a modification of SEREX 2 using a commercially available human fetal brainderived protein macroarray and paraprotein-containing sera, we identified paratarg-7 as a frequent antigenic target of paraproteins from patients with MGUS, MM and Waldenstrom's macroglobulinemia (MW): 13% European, 4.8% Japanese and 37% African-American patients with MGUS//MM are carriers of pP-7. 3-6 All patients with paratarg-7 specific paraproteins are carriers of a hyperphosphorylated version of the protein (pP-7) and this hyperphosphorylation is inherited in an autosomal-dominant fashion. 7 Hyperphosphorylation of paratarg-7 is due to an inactivation of protein phosphatase 2A resulting in the failure to dephosphorylate the physiological phosphorylation of pP-7 at Ser17. 8 Because only few healthy controls carry pP-7, pP-7 carrier state is associated with an increased risk to develop MGUS/MM/WM. The fact that pP-7 carriership is associated with P-7 specific autoimmunity, but not with other autoimmune phenomena and that pP-7 carriership is a risk factor only for MGUS/MM/WM, the malignant cells of which are able to recognize and respond to P-7, but not a risk factor for other malignancies, 9 strongly suggests that pP-7 acts via autoantigenic stimulation and not by other (oncogenic) mechanisms of the hyperphosphorylated paratarg-7.Since most B-cell responses require cognate CD4 1 T-cell help, 10,11 we addressed the question whether pP-7 specific CD4 1 T-helper cells can be detected in MGUS/MM/WM patients carr...