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Antigen-presenting cell

Antigen-presenting cells (APCs) are a heterogeneous group of immune cells that process exogenous or endogenous antigens into peptides and present them on the surface via (MHC) molecules to activate T lymphocytes, thereby bridging innate and adaptive immunity. These cells are essential for initiating cellular immune responses by providing the necessary signals for T-cell recognition, proliferation, and differentiation. APCs are broadly classified into professional and non-professional types based on their efficiency in and expression of costimulatory molecules. Professional APCs, including dendritic cells, macrophages, and B cells, are highly effective at capturing antigens through or , processing them into peptides, and loading them onto molecules for presentation to CD4+ helper T cells, while also capable of on to + cytotoxic T cells. They express high levels of and costimulatory molecules like and , which deliver the second signal required for full T-cell activation, along with secretion as a third signal to direct the . In contrast, non-professional APCs, such as fibroblasts and hepatocytes, primarily present endogenous antigens via to + T cells but lack and costimulatory signals, limiting their role to alerting the without robust activation. Dendritic cells stand out as the most potent professional APCs, specializing in activating naïve T cells in lymphoid organs and migrating to sites of to prime responses against or tumors. Macrophages contribute to both and effector functions like in tissues, supporting chronic inflammation and pathogen clearance. B cells, uniquely, use their B-cell receptors to internalize specific antigens for presentation, facilitating T-cell-dependent antibody production and . Emerging evidence also suggests that certain granulocytes, like neutrophils and , may function as APCs under specific conditions, expanding the repertoire of cells involved in immune surveillance. Overall, APCs play a critical role in maintaining , combating , and underpinning therapeutic strategies like vaccines and cancer immunotherapies.

Overview

Definition and Role

Antigen-presenting cells (APCs) are specialized immune cells that capture, process, and display antigens bound to (MHC) molecules on their surface, thereby initiating adaptive immune responses by activating T lymphocytes. These cells bridge the innate and adaptive arms of the by sampling environmental antigens through or and presenting them to T cells in lymphoid tissues, enabling specific recognition of pathogens or altered self-antigens. The core function of APCs involves two primary pathways: MHC class I molecules present short peptides (typically 8–10 amino acids) derived from intracellular proteins to CD8+ cytotoxic T cells, triggering the elimination of infected or malignant cells; in contrast, MHC class II molecules display longer peptides (13–25 amino acids) from extracellular sources to CD4+ helper T cells, which then orchestrate broader immune activation, including B cell differentiation and cytokine production. This antigen-specific presentation is essential for T cell proliferation, differentiation into effector cells, and the establishment of immunological memory. APCs are broadly categorized into professional and non-professional types, with professional APCs distinguished by their constitutive expression of high levels of molecules and co-stimulatory signals necessary for robust T cell priming, whereas non-professional APCs primarily utilize for presentation and require activation signals to express inefficiently. The APC function exhibits evolutionary conservation across jawed vertebrates, reflecting the ancient origin of MHC-based as a cornerstone of adaptive immunity. Quantitatively, a single APC can display thousands of unique peptides bound to approximately 10,000–200,000 MHC complexes on its surface, allowing surveillance of a diverse repertoire.

Historical Development

The discovery of antigen-presenting cells (APCs) began in the early 1970s, marking a foundational shift in understanding adaptive immunity. In 1973, Ralph Steinman and Zanvil Cohn identified a novel in mouse spleen cultures, characterized by dendrite-like protrusions and potent phagocytic properties, which they named dendritic cells; these cells were soon recognized for their exceptional ability to stimulate T cell proliferation, establishing them as highly efficient APCs central to immune initiation. This breakthrough bridged cellular morphology with functional , highlighting APCs' role in antigen display beyond traditional macrophages and B cells. The 1970s and 1980s saw critical advancements linking APCs to T cell specificity through (MHC) molecules. In , Rolf Zinkernagel and Peter Doherty demonstrated in experiments with , showing that cytotoxic T cells recognize viral antigens only when presented by APCs or infected cells sharing identical alleles, a discovery that illuminated APCs' indispensable role in T cell-mediated immunity and earned the in Physiology or Medicine. Building on this, Ernesto Unanue's work in the 1980s clarified for presentation; using and models, Unanue showed that exogenous antigens are internalized, degraded into peptides, and loaded onto MHC II molecules within APCs for recognition by + T cells, defining professional APC functions in helper T cell activation. From the 1990s to the 2000s, research expanded APC capabilities, particularly in dendritic cells (DCs). Studies in the 1990s established DCs' proficiency in , where exogenous s are processed and displayed on to prime + T cells, a mechanism vital for responses against viruses and tumors, as demonstrated in models of antigen uptake by splenic DCs. Simultaneously, and Charles Janeway identified Toll-like receptors (TLRs) on APCs in 1997, revealing how these pattern recognition receptors detect microbial components, induce DC maturation, upregulate co-stimulatory molecules, and enhance to bridge innate and adaptive immunity, including roles in . In the 2020s, single-cell sequencing has unveiled profound heterogeneity within APC populations, refining their classification and functional diversity. Landmark studies from 2020 onward, including analyses of human DC subsets, have delineated distinct transcriptional profiles across DC and tissue contexts, such as blood APCs in inflammatory diseases and tumor-infiltrating DCs, revealing specialized subsets with unique antigen-processing capacities and implications for tailored immune responses.30231-3)

Types of Antigen-Presenting Cells

Professional APCs

Professional antigen-presenting cells (APCs) are specialized immune cells that efficiently internalize, process, and display antigens on (MHC) molecules to CD4+ T cells, while expressing co-stimulatory molecules such as (B7-1) and (B7-2) to deliver the second signal required for T cell activation. Unlike non-professional APCs, professional APCs constitutively express high levels of MHC II and accessory molecules, enabling them to prime naive T cells and initiate adaptive immune responses. These cells play a central role in bridging innate and adaptive immunity by linking pathogen recognition to T cell-mediated effector functions. Dendritic cells (DCs), the most efficient professional APCs, originate from bone marrow-derived hematopoietic precursors, including common dendritic cell progenitors (CDPs) that differentiate into pre-DCs before seeding peripheral tissues. Immature DCs patrol tissues such as skin and mucosa, capturing antigens via macropinocytosis, , and receptors; upon activation by pathogen-associated molecular patterns, they mature, increase MHC II and co-stimulatory molecule expression, and migrate via lymphatics to draining lymph nodes to prime naive T cells. DCs are heterogeneous, comprising conventional DCs (cDCs), which excel at cross-presenting antigens on to + T cells and produce IL-12 to promote Th1 responses, and plasmacytoid DCs (pDCs), which specialize in type I production against viral infections but also contribute to . This migratory and maturation capacity makes DCs uniquely suited for initiating primary immune responses. Macrophages, another key professional APC type, arise from either embryonic yolk sac or fetal liver progenitors for tissue-resident populations or from circulating monocytes for inflammatory monocyte-derived macrophages recruited to infection sites. These cells are highly phagocytic, engulfing pathogens, apoptotic cells, and debris in tissues like lungs, liver, and , then processing antigens for local presentation to effector T cells, particularly after by interferon-gamma (IFN-γ), which upregulates MHC and co-stimulatory molecules. While less efficient at priming naive T cells than DCs, activated macrophages bridge innate clearance with adaptive responses by secreting cytokines like TNF-α and presenting antigens in situ to support ongoing or . B cells function as professional APCs by linking humoral and cellular immunity, originating from lymphoid progenitors and using surface B cell receptors (BCRs) to capture specific soluble or membrane-bound antigens at low concentrations with high affinity. Upon BCR engagement, antigens are internalized via , processed in MHC II compartments, and presented to CD4+ T helper cells to drive T-dependent responses, formation, and class-switch recombination. Unlike DCs or macrophages, B cells provide antigen-specific presentation tailored to their BCR specificity, and activation via CD40 ligand further enhances co-stimulatory expression (e.g., ), enabling them to sustain T cell help for affinity-matured production. B cells are particularly effective in secondary lymphoid organs, where they colocalize with T cells during immune responses. Professional APCs share features that underscore their , including constitutive or inducible high MHC expression for loading, migratory potential (especially in DCs and activated macrophages/ cells) to traffic antigens to T cell zones, and production of polarizing cytokines such as IL-12 by DCs or IL-6 by cells to direct T helper . These attributes ensure robust via CD28-B7 interactions, preventing T cell anergy and promoting effector functions, as detailed in antigen and T cell interaction mechanisms.

Non-Professional APCs

Non-professional antigen-presenting cells (APCs) encompass a diverse group of non-immune cells, including epithelial cells, fibroblasts, endothelial cells, and others such as neutrophils and , that express MHC molecules to display antigens on their surface but generally provide limited or absent co-stimulatory signals like and CD86. This restricted capacity distinguishes them from professional APCs and often results in suboptimal T cell activation, potentially favoring over immunity. These cells primarily utilize the MHC class I pathway for presenting endogenous antigens to CD8+ T cells, facilitating immune surveillance against virally infected or transformed cells within tissues. In response to inflammatory stimuli, such as IFN-γ, non-professional APCs can upregulate MHC class II expression, enabling exogenous antigen processing and presentation to CD4+ T cells; for instance, keratinocytes and alveolar epithelial cells inducibly express MHC II under these conditions to support local responses. Representative examples highlight their tissue-specific roles: neutrophils function as transient APCs during early inflammatory phases, upregulating to present antigens like CMV pp65 to memory + T cells. Astrocytes in the express MHC II in pathological contexts, such as , where they present α-synuclein-derived peptides to + T cells, contributing to . Fibroblasts and endothelial cells, including liver sinusoidal endothelial cells, cross-present antigens via MHC I or II to modulate T cell effector functions in stromal environments. Despite these capabilities, non-professional APCs cannot efficiently prime naive T cells owing to their low expression of co-stimulatory and molecules, frequently inducing T cell anergy, , or regulatory responses instead. This limitation underscores their auxiliary role, reliant on professional APCs for initial T cell activation. In settings like and , these cells amplify localized immunity by sustaining to memory or effector T cells, thereby enhancing tissue repair and containment without broad systemic activation.

Antigen Processing Mechanisms

MHC Class I Pathway

The MHC class I pathway processes endogenous antigens derived from cytosolic proteins, generating peptides that are presented on the cell surface to activate cytotoxic + T cells for immune surveillance against intracellular threats. Cytosolic proteins, including viral proteins produced during infection, mutated tumor antigens, and normal self-proteins, are ubiquitinated and degraded by the 26S into short peptides typically 8-10 in length. These peptides represent a snapshot of intracellular , enabling the to detect abnormalities such as or neoplastic transformations while maintaining to self-antigens under steady-state conditions. Following proteasomal cleavage, suitable peptides are transported from the into the () lumen by the transporter associated with (), a heterodimeric that selectively favors peptides of appropriate length and sequence for . In the , nascent molecules—consisting of a heavy chain, β2-microglobulin (β2m), and initially bound to the chaperone —undergo a conformational change to form the -loading complex (). This complex includes , ERp57, and tapasin, which facilitates editing and to ensure high-affinity ; tapasin acts as a catalyst, bridging and to promote the release of low-affinity peptides and stabilize high-affinity complexes. The resulting stable - (pMHC I) complex dissociates from the and traffics through the Golgi apparatus to the surface for . The stability of pMHC I complexes is critical for effective and can be quantified by the binding change, given by the equation: \Delta G = RT \ln(K_d) where \Delta G is the , R is the , T is the in , and K_d is the ; lower K_d values yield a more negative \Delta G, indicating higher-affinity, more stable complexes that resist dissociation and enhance T cell recognition. This pathway is tightly regulated, with interferon-gamma (IFN-γ) enhancing its efficiency by upregulating subunits (forming immunoproteasomes), expression, and transcription to amplify during immune activation. Conversely, viruses like human cytomegalovirus (HCMV) evade detection by deploying proteins such as US2 and US11, which redirect heavy chains to the for proteasomal degradation, thereby inhibiting loading and surface expression.

MHC Class II Pathway

The MHC class II pathway is the primary mechanism by which professional antigen-presenting cells (APCs) process and present exogenous antigens to CD4+ helper T cells, enabling the activation of adaptive immune responses against extracellular pathogens. Exogenous antigens, such as those derived from bacteria or allergens, are internalized by APCs through receptor-mediated endocytosis, macropinocytosis, or phagocytosis, entering the endocytic pathway as vesicles that mature into early endosomes, late endosomes, and lysosomes. Within these acidic compartments, particularly the MHC class II-containing compartments (MIIC), the antigens are degraded by lysosomal proteases into peptides typically ranging from 13 to 25 amino acids in length, which are suitable for binding to MHC class II molecules. This vesicular processing pathway ensures that extracellular threats are selectively displayed to CD4+ T cells, distinguishing it from the cytosolic pathway used for endogenous antigens. MHC class II molecules are synthesized in the (ER) as αβ heterodimers, which associate with the invariant (Ii, also known as CD74) to form a nonameric complex that stabilizes the structure and prevents premature peptide binding. The Ii directs the complex away from the ER and Golgi apparatus via clathrin-coated pits to the endocytic pathway, ultimately targeting it to the MIIC compartments where occurs. In these late endosomal/lysosomal structures, the Ii undergoes sequential : first by cathepsins S, L, or F to generate smaller fragments, and finally to the class II-associated invariant peptide (CLIP), which occupies the peptide-binding groove of . This degradation is facilitated by the acidic environment and enzymes like asparaginyl , ensuring controlled access for antigenic peptides. Peptide loading onto MHC class II is mediated by HLA-DM (H-2M in mice), a non-classical MHC class II-like molecule that acts as a peptide editor in the MIIC compartment. HLA-DM catalyzes the removal of CLIP from the groove and facilitates the exchange for higher-affinity antigenic s generated from the degraded exogenous antigens, optimizing the stability and immunogenicity of the -MHC class II complex. In some cases, HLA-DO modulates HLA-DM activity to fine-tune selection, particularly in B cells. Once loaded, the -MHC class II complexes are transported via tubular endosomes or multivesicular bodies to the plasma membrane for presentation. The invariant chain plays a crucial protective role by blocking the MHC class II groove during transit, preventing the binding of endogenous s that would otherwise contaminate the exogenous antigen display. This pathway is predominantly active in professional APCs such as dendritic cells, macrophages, and B cells, where expression is upregulated by the CIITA in response to interferon-γ or other signals. Defects in this regulatory machinery, such as mutations in CIITA or RFX , lead to bare lymphocyte syndrome type II ( deficiency), an autosomal recessive disorder characterized by absent surface expression, , and recurrent infections due to impaired + T cell . In an exceptional case of , dendritic cells can utilize elements of the pathway to process exogenous antigens in endosomal compartments and present them to + T cells, broadening the through mechanisms involving phagosomal escape or alternative transfer, though this is less common than the standard + T cell activation.

Interaction with T Cells

Antigen Recognition

recognition by T cells occurs through the binding of the (TCR) to -major histocompatibility complex (pMHC) complexes displayed on the surface of antigen-presenting cells (APCs). The TCR specifically recognizes the fragment bound within the MHC groove, while the MHC molecule itself interacts with the TCR's (CDR) loops, particularly CDR1 and CDR2, which contact the MHC helices. This interaction is enhanced by coreceptors: on helper T cells binds to molecules, stabilizing the complex and recruiting signaling molecules, whereas on cytotoxic T cells associates with , similarly facilitating adhesion and signal initiation. The specificity of this recognition drives , where T cells with TCRs exhibiting high affinity for a particular pMHC are preferentially activated and expanded. is amplified through multivalent interactions, as multiple TCR-pMHC pairs form within the , allowing even low-affinity interactions to trigger responses. This process ensures that only antigen-specific T cell clones proliferate, maintaining immune precision while accommodating for broad coverage. Kinetically, TCR-pMHC is governed by rapid on-rates and off-rates, with dwell times typically in the milliseconds to seconds range, enabling serial engagement where a single pMHC can sequentially bind and trigger multiple TCRs on the same or different T cells. This model amplifies signaling from sparse antigens on , as one APC can activate numerous T cells before downregulation of surface TCRs occurs. Such dynamics occur primarily in secondary lymphoid organs like lymph nodes, where naive T cells scan APCs in structured T cell zones for efficient encounter. T cell activation requires engagement of approximately 3-10% of surface TCRs, corresponding to roughly 8,000 triggered TCRs on a typical expressing about 100,000 receptors, to surpass the activation threshold and initiate downstream events. This level of occupancy ensures robust discrimination between self and foreign antigens while preventing overactivation.

Co-Stimulatory and Inhibitory Signals

Antigen-presenting cells (APCs) deliver a second signal to T cells through co-stimulatory and inhibitory molecules, which modulate the outcome of (TCR) engagement with peptide-MHC complexes, as outlined in the two-signal model of T cell activation. In this model, signal 1 is provided by TCR recognition of , while signal 2 arises from co-stimulatory interactions that promote full activation, proliferation, and differentiation; without signal 2, T cells may enter a state of anergy, characterized by unresponsiveness to subsequent stimulation. The primary co-stimulatory pathway involves on T cells binding to (B7-1) and (B7-2) on APCs, which enhances T cell survival, proliferation, and cytokine production, particularly interleukin-2 (IL-2), essential for clonal expansion. This interaction occurs at the and amplifies downstream signaling pathways, including PI3K-Akt and activation, leading to increased expression of anti-apoptotic proteins like . Other co-stimulatory molecules include on T cells interacting with ICOSL on APCs, which is critical for the differentiation of T follicular helper (Tfh) cells by promoting Bcl-6 expression and migration to B cell follicles. Additionally, (CD137) engagement supports the generation and persistence of memory CD8+ T cells by enhancing survival signals and metabolic reprogramming during effector responses.00121-X) In contrast, inhibitory signals prevent excessive T cell activation and maintain immune homeostasis. CTLA-4 on activated T cells competes with CD28 for binding to CD80 and CD86 but with higher affinity, thereby dampening co-stimulation and reducing IL-2 production, proliferation, and effector function. Similarly, PD-1 on T cells binds PD-L1 (B7-H1) on APCs, delivering inhibitory signals that promote T cell exhaustion in chronic antigen exposure settings, such as persistent infections or tumors, by recruiting phosphatases like SHP-2 to suppress TCR signaling.90071-X) The balance between co-stimulatory and inhibitory signals determines T cell fate, with the absence of leading to anergy, as demonstrated in models where TCR engagement without signaling results in hyporesponsiveness and impaired IL-2 responsiveness. Professional APCs, such as dendritic cells, tightly regulate this balance by upregulating co-stimulatory molecules like and upon maturation triggered by (TLR) ligands, such as or viral RNA, which shifts them from a tolerogenic to an immunogenic state. This upregulation enhances their capacity to activate naive T cells while minimizing inhibitory signals during early immune responses.

Roles in Immune Responses

Adaptive Immunity Activation

Antigen-presenting cells (APCs), particularly dendritic cells (DCs), initiate adaptive immunity by migrating from peripheral tissues to draining s upon encountering antigens, where they present processed peptides via (MHC) molecules to naive T cells. This migration is regulated by like CCL21 and CCR7 expression, enabling efficient delivery of antigens to secondary lymphoid organs. In the , antigen-bearing DCs form stable clusters with antigen-specific naive T cells through prolonged interactions lasting hours, during which T cells scan multiple DCs at a rate of at least 500 per hour, leading to T cell activation, proliferation, and differentiation into effector subsets such as Th1, Th2, or Treg cells. A single antigen-bearing DC can engage over ten peptide-specific T cells simultaneously and prime hundreds of naive T cells through these dynamic contacts, amplifying the . APCs further direct T cell differentiation via secreted cytokines that provide signal 3 in T cell activation. For instance, APC-derived IL-12, produced by macrophages and DCs, promotes Th1 differentiation by upregulating IL-12Rβ2 and synergizing with IL-18 to drive interferon-γ (IFN-γ) production in precursor T cells. In contrast, DCs contribute to Treg differentiation by producing and activating transforming growth factor-β (TGF-β), particularly through integrin αvβ8-mediated cleavage of latent TGF-β, which induces expression in naive CD4+ T cells, especially in mucosal environments. Once primed, activated CD4+ T cells orchestrate downstream adaptive responses by providing help to other immune cells. CD4+ T cells assist B cells in production and class switching through CD40 ligand interactions and cytokines like IL-4, while enhancing + T cell via IFN-γ secretion that upregulates costimulatory molecules on DCs. Additionally, CD4+ T cells activate macrophages for improved and microbial killing by inducing phagosome-lysosome fusion and production of reactive oxygen and species via IFN-γ and CD40 signaling. APCs also support formation through sustained , which programs the proliferative and functional capacity of long-lived central and peripheral cells. Prolonged presentation by DCs, facilitated by immune complexes binding Fcγ receptors, delays CD8+ T cell contraction post-infection and enhances secondary responses by promoting IL-2 and IFN-γ production in cells. This sustained interaction ensures durable immunity without excessive .

Tolerance and Regulation

Antigen-presenting cells (APCs), particularly dendritic cells (DCs), play a pivotal in establishing central within the by presenting self-antigens to developing T cells, thereby facilitating negative selection to eliminate autoreactive thymocytes. Thymic DCs acquire self-antigens from medullary thymic epithelial cells (mTECs) expressing the (AIRE), which drives the transcription of tissue-specific antigens, enabling DCs to present these antigens via molecules to + thymocytes and induce their deletion if affinity is high. This process is essential for preventing , as AIRE deficiency impairs negative selection and leads to multi-organ , underscoring the coordinated interaction between thymic DCs and AIRE+ mTECs in central . In the periphery, APCs maintain tolerance through mechanisms that render self-reactive T cells unresponsive or eliminate them, preventing aberrant immune . Immature DCs, characterized by low expression of co-stimulatory molecules, present self-antigens to naive T cells in the absence of sufficient signals, resulting in T cell anergy—a state of functional unresponsiveness—or apoptosis-mediated deletion. Tolerogenic DCs further contribute by upregulating inhibitory molecules such as programmed death-ligand 1 (), which engages PD-1 on T cells to dampen and promote exhaustion of autoreactive clones, thereby sustaining . APCs also regulate immune responses by inducing regulatory T cells (Tregs), which suppress effector T cell activity and maintain . DCs, especially semi-mature or tolerogenic subsets, present antigens in the context of immunosuppressive cytokines like TGF-β and IL-10, driving the differentiation and expansion of + Tregs that inhibit pro-inflammatory responses. Additionally, (IDO), an enzyme highly expressed in DCs, catabolizes the along the , depleting local tryptophan levels and generating toxic metabolites that arrest T cell and induce , thus enforcing T cell suppression. Specific physiological contexts highlight APCs' tolerogenic functions, such as during where decidual DCs at the maternal-fetal interface promote to paternal antigens. These DCs exhibit an immature or tolerogenic , producing IL-10 and expressing low levels of co-stimulatory molecules, which favors Treg and prevents fetal rejection while allowing controlled immunity against pathogens. In the gut, APCs are educated by commensal to induce to harmless antigens; lamina propria DCs sample microbial products and present them in a manner that promotes Treg , ensuring mucosal and preventing inflammatory disorders. Dysregulation of APC-mediated tolerance can precipitate autoimmunity, as seen in (T1D), where impaired negative selection in the and defective by DCs allow autoreactive T cells to target pancreatic β-cells. In T1D models and patients, DCs exhibit altered and reduced IDO activity, leading to insufficient Treg induction and unchecked effector responses, highlighting the critical balance APCs maintain to avert such diseases.

APCs in Disease and Therapy

Cancer Immunotherapy

Antigen-presenting cells (APCs), particularly dendritic cells (DCs), play a pivotal role in cancer immunotherapy by bridging innate and adaptive immunity to elicit anti-tumor T cell responses. Therapeutic strategies aim to enhance APC function through direct manipulation or by alleviating tumor-induced suppression in the microenvironment, thereby promoting effective antigen presentation and T cell priming against tumor antigens. Dendritic cell vaccines represent a cornerstone of APC-targeted therapies, involving the ex vivo isolation, activation, and antigen loading of patient-derived DCs before reinfusion. A seminal example is sipuleucel-T, an autologous DC vaccine approved by the FDA in 2010 for metastatic castration-resistant prostate cancer, where DCs are pulsed with prostatic acid phosphatase (PAP) fused to granulocyte-macrophage colony-stimulating factor (GM-CSF) to stimulate CD4+ and CD8+ T cell responses against tumor cells expressing PAP. This approach demonstrated a 22.5% reduction in the risk of death in phase III trials, establishing personalized DC vaccination as a viable strategy despite very low objective response rates (typically <5% by RECIST criteria). Immune checkpoint blockade further harnesses APCs by countering inhibitory signals in the , where upregulated on APCs and tumor cells engages PD-1 on T cells to dampen activation. Monoclonal antibodies targeting PD-1 (e.g., nivolumab) or (e.g., ) restore APC-mediated T cell priming, often combined with APC activators like (TLR) agonists to boost DC maturation and . In preclinical models, this synergy enhances of tumor antigens via , amplifying cytotoxic T lymphocyte responses. Tumors foster that impairs APC efficacy, notably through myeloid-derived suppressor cells (MDSCs), which infiltrate the microenvironment and inhibit DC maturation by depleting and cysteine essential for , while promoting expansion. MDSCs also secrete transforming growth factor-beta (TGF-β) and interleukin-10 (IL-10), further blunting APC co-stimulatory molecule expression like /CD86. Targeting MDSCs with all-trans or phosphodiesterase-5 inhibitors has shown promise in preclinical studies by restoring DC function and enhancing efficacy. Recent advances leverage mRNA technology, adapted from vaccines by companies like /, to deliver tumor-specific neoantigens directly to APCs . These lipid nanoparticle-encapsulated mRNAs encode patient-derived tumor antigens, promoting DC uptake, , and MHC presentation to elicit robust T cell immunity; phase II trials in reported objective response rates of approximately 18% when combined with PD-1 inhibitors (e.g., BNT111 with ), while phase I trials in have demonstrated immune responses in up to 50% of patients, with ongoing evaluation of clinical outcomes as of November 2025. Emerging CAR-APC hybrids engineer APCs, such as macrophages or DCs, with chimeric antigen receptors to target tumor-associated s while retaining capabilities. For instance, HER2-targeted CAR-macrophages promote of tumor cells and subsequent to T cells, demonstrating tumor regression in xenograft models without the risks of CAR-T cells. Early clinical investigations as of 2025 explore these for solid tumors, aiming to overcome APC scarcity in immunosuppressive niches. Clinical outcomes vary by modality and cancer type, with checkpoint inhibitors achieving objective response rates of 20-45% in advanced , where high MHC class II expression on tumor cells serves as a predicting (e.g., median 14 months in PD-L1-positive cases). DC vaccines like extend median overall survival by 4.1 months in , though combination therapies with checkpoint blockade yield synergistic benefits, such as improved 1-year event-free survival rates up to 50% in select cohorts. including APC PD-L1 levels and further guide patient stratification for enhanced therapeutic precision.

Autoimmune and Infectious Diseases

In autoimmune diseases, antigen-presenting cells (APCs) such as dendritic cells and s can become hyperactive, leading to aberrant presentation of self-antigens and perpetuation of inflammation. In (RA), APCs, particularly macrophages and dendritic cells in the synovium, present citrullinated peptides derived from proteins modified by peptidylarginine deiminase enzymes, triggering + T cell responses against these neoantigens and contributing to destruction. s also serve as APCs in RA by internalizing and presenting citrullinated antigens via , amplifying autoreactive T cell activation and production. Therapeutic interventions targeting APC functions include rituximab, a that depletes + B cells, thereby reducing their role as APCs and decreasing antigen-specific T cell stimulation in autoimmune conditions like RA and systemic lupus erythematosus. Clinical trials have shown that rituximab leads to sustained B cell depletion, correlating with reduced disease activity and levels in RA patients. In infectious diseases, pathogens often exploit or manipulate APCs to evade immune detection and promote persistence. Human immunodeficiency virus (HIV) employs its Nef protein to downregulate expression on infected APCs and T cells, sequestering these molecules intracellularly via interactions with trafficking adaptors like PACS-1 and AP-1, thereby impairing recognition. Similarly, resides within macrophages, the primary APCs for mycobacterial antigens, and inhibits MHC class II-mediated through multiple mechanisms, including diversion of antigens away from lysosomal compartments and suppression of invariant chain processing. This allows the bacterium to persist in phagosomes while limiting + T cell activation essential for formation and bacterial containment. Viral pathogens further demonstrate APC exploitation, with lymphocytic choriomeningitis virus (LCMV) clone 13 infecting dendritic cells (DCs) and inhibiting their maturation by blocking upregulation of co-stimulatory molecules and cytokine production, resulting in impaired priming of antiviral T cells and chronic infection. In severe COVID-19 cases, APCs including monocyte-derived macrophages hyperactivate, contributing to cytokine storms characterized by excessive IL-6, TNF-α, and IL-1β release, which drives systemic inflammation and multi-organ damage. This hyperinflammation arises from dysregulated APC responses to SARS-CoV-2, impairing effective antigen presentation and exacerbating T cell exhaustion. Bacterial pathogens like also target APCs for survival and immune modulation. invades macrophages and DCs, residing in Salmonella-containing vacuoles that alter endosomal trafficking to enhance of antigens and evade presentation, thereby limiting CD4+ T cell responses and facilitating chronic carriage. Vaccine strategies counter this by using adjuvants that enhance APC uptake and activation; for instance, alum-based adjuvants promote antigen delivery to DCs via , boosting on and eliciting robust CD8+ T cell immunity against intracellular bacteria like . Therapeutic modulation of APC activity is crucial in managing autoimmune diseases like (). (DMF), an approved oral therapy for relapsing-remitting , dampens APC function by inhibiting DC maturation through activation of the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway, reducing expression of , , and , as well as pro-inflammatory cytokines like IL-12 and IL-6. This suppression limits autoreactive T cell priming in the , contributing to DMF's efficacy in reducing lesion formation and relapse rates in patients.

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