Résumé : Cytotoxicity is the capacity for immune cells to kill infected or malignant cells in order to eliminate pathogens and tumours through different mechanisms including the exocytosis of perforin-containing cytosolic granules. This crucial property is usually restricted to specialized innate and adaptive lymphocytes such as natural killer (NK) cells and CD8 T cells. T lymphocytes differentiate in the thymus and are delivered to the peripheral blood as naive T cells committed to either the CD8 or the CD4 lineage. CD8 T cells are programmed to acquire cytotoxic effector functions under the control of the transcription factor (TF) Runx3. The fate of CD4 T cells is to acquire multiple helper functions through the action of the TF ThPOK that promotes CD4 helper functions and restricts the CD8 cytotoxic program. However, this restriction is not absolute as cytotoxic CD4 (CD4CTX) T cells differentiate in vivo, indicating that the multipotency of human naive CD4 T cells includes the ability to acquire perforin expression and potent cytotoxicity in vitro and ex vivo. This cytotoxic potential correlates with outcome in human pathology and mediates protection against viral challenge and tumour eradication in murine models. CD4CTX T cells are terminally differentiated effector memory T cells that accumulate during cytomegalovirus chronic infection and ageing. They are phenotypically and functionally related to T helper type 1 (Th1)-effector memory cells. However, whether they belong to the Th1 pathway or constitute a separate specialized helper T cell subset is unknown. In this work, we show that CD4CTX T cell differentiation is an integral part of the Th1 pathway. Indeed, CD4 T cells acquire cytotoxic potential early in the memory differentiation process as central memory Th1 but not Th2 and Th17 cells are epigenetically primed to develop a cytotoxic program. The expression of perforin and other cytotoxic genes present a stepwise increase profile that is specific of the Th1 differentiation pathway. This profile has been recapitulated in an in vitro model of effector CD4 T cell differentiation in which naive CD4 T cells acquire cytotoxicity one to two weeks after polyclonal stimulation when cultured in presence of Th1 cytokines. The molecular regulation of CD4CTX T cells is poorly understood and most available data have been generated in mice. These data include the observation of intraepithelial CD4CTX T cells in the mouse gut after loss of ThPOK expression and subsequent up-regulation of a Runx3-dependent cytotoxic program. Other candidate regulators of CD4 T cell cytotoxic function include the TF regulating Th1 and CD8CTX T cells differentiation such as Runx3, T-bet and Eomesodermin (Eomes). We show that the transcriptional program of human CD4CTX T cells is enriched in CD8-lineage genes. However, by contrast to CD4CTX T cells from the mouse intestine, human circulating CD4CTX T cells maintain the expression of ThPOK and even up-regulate this TF upon differentiation from naive CD4 T cells. Surprisingly, this sustained expression of ThPOK was compatible with the establishment of a T-bet- and Runx3-dependent cytotoxic transcriptional program. The specific knockdown of T-bet or Runx3 but not Eomes resulted in impaired cytotoxic differentiation whereas ThPOK knockdown enhanced perforin expression and cytotoxicity. We propose that CD4CTX T cells constitute the terminal stage of Th1 memory differentiation and that ThPOK, Runx3 and T-bet co-regulate this process by instructing a cytotoxic transcriptional network largely shared with CD8CTX T cells. The modulation of this network is a potential target for novel immunotherapeutic strategies in viral infections and cancer.