To monitor antigen-specific CD4؉ T cells during a recall immune response to tetanus toxoid (TT), a sequential analysis including ex vivo phenotyping and cytokine flow cytometry, followed by cloning and T-cell-receptor (TCR) spectratyping of cytokine-positive CD4 ؉ T cells, was performed. Grossly, twice as many TT-specific CD4 ؉ T-cell clones, ex vivo derived from the CCR7 ؉ subsets appears to target the bulk of antigen-specific T cells and to reach an analytical power sufficient to adequately delineate in field trials the profile of the antigen-specific response to vaccine.Phenotypic characterization of antigen-specific CD4 ϩ T cells with distinct functional properties represents currently a major challenge in human applied experimental immunology. Ex vivo analysis of these cell populations is critical, since in vitro culture may alter composition and functional properties of the populations of interest. If major histocompatibility complex (MHC) class I tetramer/peptide complexes did greatly facilitate the analysis of antigen specific CD8 ϩ T cells, the use of MHC class II tetramer/peptide has been hampered by the complexity of MHC class II tetramer production, by the usually low CD4 ϩ T-cell precursor frequency, by an often-degenerated peptide epitope specificity, and by non-MHC class II moleculerestricted allelic expression (12,15,24,35,36). As an alternative approach to circumvent these difficulties, we here applied cytokine flow cytometry (9, 11), now extensively used to define ex vivo frequencies and phenotypic and functional characteristics of viral antigen-specific CD4 ϩ T cells (8,22,43), coupled to T-cell-receptor (TCR) spectratype analysis. Indeed, characterization of the unique complementary determining region 3 (CDR3) sequence expression of CD4 ϩ (or CD8 ϩ ) T-cell clones appears to be a sensitive method for monitoring qualitative and quantitative T-cell responses during natural infection or vaccination (21,23,45,48).In the present study, tetanus toxoid (TT) was used as a model vaccine antigen that likely shares common functional characteristics with other nonviral antigens, such as a low frequency of specific CD4 ϩ T cells in the periphery at steady state and a specific CD4 ϩ T-cell response to multiple epitope peptides presented by MHC class II molecules (16,36,40). Using ex vivo cell phenotyping and cloning in combination with TCR spectratype analysis of cytokine-positive CD4 ϩ T cells, we sought to establish experimental conditions to track ex vivo antigenspecific CD4 ϩ T cells in conditions that are likely to reflect clinical situations such as vaccination, nonviral pathogen infections, or allergic diseases.