Antigen Processing and Presentation: Fiorella Kotsias, Ignacio Cebrian, Andr Es Alloatti

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Antigen processing
and presentation
s Alloattid,*
Fiorella Kotsiasa,b,†, Ignacio Cebrianc,†, Andre
a
Cátedra de Virologı́a, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires (UBA), Buenos Aires,
Argentina
b
Instituto de Investigaciones en Producción Animal (INPA), Consejo Nacional de Investigaciones Cientı́ficas y
Tecnicas (CONICET)—Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
c
Facultad de Ciencias Medicas, Instituto de Histologı́a y Embriologı́a de Mendoza (IHEM)-CONICET/
Universidad Nacional de Cuyo, Mendoza, Argentina
d
Facultad de Ciencias Medicas, Instituto de Inmunologı́a Clı́nica y Experimental de Rosario (IDICER)-
CONICET/Universidad Nacional de Rosario, Rosario, Argentina
*Corresponding author: e-mail address: alloatti@idicer-conicet.gob.ar
Contents
1. Introduction 2
2. Classical MHC class I presentation 7
3. Classical MHC class II antigen presentation 10
3.1 Receptor-mediated endocytosis 14
3.2 Macropinocytosis 15
3.3 Phagocytosis 16
3.4 Autophagy 18
3.5 Cross-dressing 19
4. Cross-presentation 20
4.1 Endo/phagosomal antigen processing for cross-presentation 21
4.2 Translocation of mildly degraded antigens to the cytosol, proteasomal
degradation and transport to the cross-presenting organelle 30
4.3 Intracellular trafficking of MHC class I molecules 33
4.4 Trimming of the antigen within the cross-presenting organelle and loading
onto MHC class I molecules 37
5. Cross-presentation in immunity and cancer. Immunotherapy and beyond 39
Acknowledgments 40
References 40
Abstract
Dendritic cells are at the center of immune responses. They are defined by their ability to
sense the environment, take up and process antigen, migrate to secondary lymphoid
organs, where they present antigens to the adaptive immune system. In particular, they
†
These authors contributed equally to the manuscript.
International Review of Cell and Molecular Biology # 2019 Elsevier Inc. 1

ISSN 1937-6448 All rights reserved.
https://doi.org/10.1016/bs.ircmb.2019.07.005
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2 Fiorella Kotsias et al.
present lipids and proteins from pathogens, which they encountered in peripheral
tissues, to T cells in order to induce a specific effector immune response. These complex
antigens need to be broken down into peptides of a certain length in association
with Major Histocompatibility Complex (MHC) molecules. Presentation of MHC/antigen
complexes alongside costimulatory molecules and secretion of proinflammatory
cytokines will induce an appropriate immune response. This interaction between den-
dritic cells and T cells takes place at defined locations within secondary lymphoid
organs. In this review, we discuss the current knowledge and recent advances on
the cellular and molecular mechanisms that underlie antigen processing and the
subsequent presentation to T lymphocytes.
1. Introduction
Dendritic cells (DCs) are considered the most potent professional
antigen-presenting cells (APCs) that play a central role in linking innate sens-
ing of pathogens and antigen processing to adaptive immune responses.
Although they are now considered to be at the center of immune responses,
they were only discovered late in the history of immunology, first described
by Steinman and Cohn (1973). They reported the presence of a cell type
with long cytoplasmic projections in the spleen and other secondary lym-
phoid organs of mice (and later other mammals) and proposed to call them
“dendritic cells” based on their morphology. However, their precise role in
the immune system was unclear. Years later, Steinman published a model
that set the wheels turning, and ignited active research in the field of DC
biology (Steinman, 1991). He proposed that DCs pick up and process anti-
gens from the periphery while migrating into lymphoid organs where they
initiate adaptive immune responses. In parallel, the process of maturation,
meaning a change in the cellular phenotype in response to the original path-
ogen encounter, had been reported in dermal Langerhans cells, closely
related to DCs, and was associated with an increase in immunostimulatory
function (Heufler et al., 1988).
DCs represent a large group of cells and their classification, ontogeny and
functions have been the subject of intense debate. Initially, the presence of
different lymphocytic markers on the cell surface of murine DCs, especially
cluster of differentiation (CD)8α, caught the attention of scientists. It gave
rise to the idea of different DC subtypes with possibly different functions and
a first classification of DCs into CD8α+ and CD8α (Vremec et al., 1992).
Later, a DC population that secreted large amounts of type I interferons in
response to viral infections was described in human blood (Siegal et al., 1999)
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Antigen processing and presentation 3
and in mice (Asselin-Paturel et al., 2001) and was termed plasmacytoid DCs
(pDCs). This population was distinct from the conventional CD8α+
and CD8α DCs (cDCs) (Shortman and Liu, 2002). The existence of a
group of a CD8α cDCs found in the periphery led to the definition of
migratory DCs (as opposed to the lymphoid-organ resident DCs). They were
further subdivided according to the expression of CD103 and CD11b
( Johansson-Lindbom et al., 2005) encompassing CD103+ CD11b+,
CD103 CD11b+ and skin Langerhans cells. These DCs are present in most
mucosal tissues and migrate to the draining lymph nodes upon stimulation
(Ginhoux et al., 2009).
Until recently, both cDCs and pDCs were believed to derive from a
common myeloid dendritic cell precursor (CDP) (Liu et al., 2009; Naik
et al., 2007) although there was evidence of some pDCs arising from a lym-
phoid precursor (Pelayo et al., 2005). In fact, recent work suggests that pDCs
can be divided into two populations, one arising from the CDP and
the other from a lymphoid precursor. While, the CDP-derived pDC subset,
termed pDC-like cells, is superior in processing and presenting antigens,
lymphoid-derived pDCs constitute the majority of pDCs and excel in
producing type I interferons (Rodrigues et al., 2018).
The cytokine FMS-like tyrosine kinase 3 (Flt3L) drives the development
of DC subsets in the bone marrow (D’Amico and Wu, 2003; McKenna
et al., 2000; Waskow et al., 2008) but their differentiation depends on
the expression of different transcription factors. While CD8+ and
CD103+ DCs rely on the transcription factor Baft3 and IRF8 (Hildner
et al., 2008; Schiavoni et al., 2002; Tamura et al., 2005), CD11b+ DCs
are controlled by IRF4 (Suzuki et al., 2004; Tamura et al., 2005).
Adding to the complexity of DC subsets at steady-state conditions, tissue
inflammation has been shown to drive the differentiation of monocytes into
DCs, hence termed inflammatory DCs. The first evidence came from sem-
inal work by Sallusto and Lanzavecchia who generated DCs from human
blood monocytes (Sallusto and Lanzavecchia, 1994). These DCs originate
at the site of inflammation and can be later found in the draining lymph
nodes in response to different pathogens such as bacteria (Serbina et al.,
2003), virus (Nakano et al., 2009), fungus (Hohl et al., 2009), parasites
(León et al., 2007) as well as non-infectious causes (Kool et al., 2008).
Recently, a new, ontogeny-based nomenclature for DCs and other cells
of the mononuclear phagocyte system was proposed (Guilliams et al., 2014).
Based on their CDP-origin and Flt3L dependency, steady-state DCs are
grouped separately from macrophages, monocytes and monocyte-derived
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cells. Further, DCs are divided into three groups based on the requirement
of transcription factors necessary for their differentiation: Batf3-dependent
DCs (cDC1), IRF4-dependent DCs (cDC2) and E2-2-dependent pDCs
(pDCs). This classification reunites cells with similar developmental pro-
grams but from different locations, and proposes that their anatomical and
phenotypic characteristics (e.g., lung CD103+, spleen CD8+) be mentioned
afterward. Inflammatory monocyte-derived DCs are classified on a different
branch and group with other monocyte-derived cells such as monocyte-
derived M1 and M2 macrophages (Guilliams and van de Laar, 2015). How-
ever, what unites DCs in a common functional group is their capacity to
sense the environment, to engulf, process and present antigens and to initiate
T cell responses to direct an adequate immune effector function.
Extracellular antigens are presented by APCs following internalization,
processing and loading of the resulting peptides onto Major Histocompat-
ibility Complex (MHC) class II molecules, which are exposed on the plasma
membrane to activate CD4+ T cells. This process is part of the endocytic
pathway of APCs and has been characterized extensively. However, recent
novel evidence has fuelled to new concepts in MHC class II presentation,
such as the presentation of intracellular antigen from non-canonical sources.
Traditionally, intracellular antigens, such as intracellular bacteria, para-
sites, viruses or tumor antigens, can be presented by all cells after cytoplasmic
proteolysis. The resulting peptides are loaded onto MHC class I molecules in
the endoplasmic reticulum (ER) which are then transported to the plasma
membrane for presentation to CD8+ T cells. However, for a cytotoxic
immune response to develop, antigen-specific CD8+ T lymphocytes first
have to be primed by APCs.
When APCs are not directly infected by pathogens, antigens from intra-
cellular compartments of surrounding cells are acquired from the environ-
ment and presented on MHC class I molecules by “cross-presentation,” a
process unique to a few cell types. This phenomenon was first reported
by Bevan et al. in 1976, soon after the first report on DCs was published
(Bevan, 1976a). Working in vivo, the author detected development of a spe-
cific cytotoxic response toward minor histocompatibility antigens from an
allogeneic donor following adoptive transfer. They concluded that these
antigens must have been transferred from the injected cells into the recipi-
ent’s APCs which presented them on their MHC class I to prime cytotoxic
CD8 + T cells, proposing the term “cross-priming.” This process and its
mechanism remained poorly understood and was object of several contro-
versies throughout the years. Even though there are still many unanswered
questions, our understanding of cross-presentation has increased over the
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years thanks to the development of specific tools which enabled to study it in

more detail. Today it is widely believed to have a central role in antitumor
and antimicrobial immunity as well as the induction of tolerance to self.
A scheme representing the different routes of antigen presentation is
depicted in Fig. 1.
The induction of a cytotoxic CD8+ T cell response, however, requires
more than the recognition of the peptide/MHC class I complexes on the
surface of a DC. Following DC activation by the antigen and the environ-
ment in a process termed “maturation,” “cross-priming” APCs also deliver
additional signals to T cells, both in the form of secreted cytokines and
upregulation of costimulatory molecules. During DC maturation, pattern
recognition receptors (PRRs) play a crucial role. DCs display a large array
of PRRs that were predicted boldly by Janeway in 1989, giving rise to the
theory of “nonclonal recognition of nonself patterns” ( Janeway et al., 1989).
These predictions were confirmed, and many families of different nonself-
sensing receptors have been discovered and characterized, providing a cru-
cial link between the innate and adaptive immune systems (Akira et al.,
2006; Medzhitov, 2001). PRR families include Toll-like receptors
(TLRs), Rig-like receptors (RLRs), Nod-like receptors (NLRs), C-type
lectin receptors (CLRs), and DNA/RNA sensors. These receptors can
either be cytosolic, associated with plasma or endosomal membranes, or
even reside inside the cell nucleus. They are often associated with different
adaptor molecules and signal through complex, multimolecular pathways.
These receptors sense microbial stimuli, known as pathogen-associated
molecular patterns (PAMPs), or endogenous stress signals, termed danger-
associated molecular patterns (DAMPs), the latter originating from the
danger theory developed by Matzinger (1994).
While it had been believed that DC maturation was a single process,
evidence suggests that the maturation program strongly depends on
the PAMP/DAMP stimulus and shapes the resulting immune response.
Maturation induces morphological changes in DCs, as they develop cellu-
lar projections or dendrites and enhances the migratory properties of DCs
(Vargas et al., 2016). More importantly, DCs maturation also results in
an increased surface expression of many costimulatory molecules such
as CD40, CD80, CD86, MHC class II and the secretion of different
chemokines and cytokines. Additionally, while maturation initially enhances
the ability of DCs to internalize antigens, this capacity is decreased as the
maturation program continues (West et al., 2004). All these effects are
required for DCs to trigger appropriate T cell activation and the ensuing
adaptive immune response.
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Fig. 1 Schematic representation of different pathways for antigen processing and

presentation. (A) Classical MHC class I antigen presentation, also known as direct
presentation. (1) Antigen synthesis in the cell cytosol (can be self or non-self ); (2) cyto-
solic antigen degradation by the proteasome; (3) peptide translocation mediated
by TAP; (4) ERAAP/ERAP1-mediated peptide trimming and peptide loading onto
MHC class I molecules; and (5) MHC class I/peptide complex delivery to the cell surface.
(B) Cytosolic antigen cross-presentation. (1) Internalization of antigens (mac-
ropinocytosis, endocytosis or phagocytosis) and formation of the cross-presenting
organelle, GILT-promoted mild degradation of the antigen; (2) export to cytosol (dashed
line, no clear evidence for a preferred mechanism); (3) further degradation by the
proteasome; (4) antigens are transported back to phagosomes by TAP, or (?) transported
to the ER for additional processing therein; (5) Once back to the cross-presenting organ-
elle, antigens are trimmed by IRAP, and loaded onto MHC class I molecules; and (6) MHC
class I/peptide complex transfer to the cell membrane. (C) Vacuolar antigen cross-
presentation. (1) Internalization of antigens (macropinocytosis, endocytosis or phago-
cytosis) and formation of the cross-presenting organelle. (2) Antigen degradation by
Cathepsin S and other phagosomal/endosomal proteases. (3) Potential trimming by
aminopeptidases and (4) loading onto MHC class I molecules. (5) MHC class I/peptide
complex transport to the plasma membrane. (D) Classical MHC class II antigen presen-
tation. (1a) Internalization of antigens, and fusion of the early endosome/phagosome
with MIIC organelle. Alternatively, (1b) autophagosomes might fuse with MIIC in order
to release antigens; (2) Antigens are degraded by different cathepsins and other lyso-
somal proteases; (3) Resulting peptides are loaded on MHC class II molecules; and (4)
Transported to the cell membrane, either by tubule formation or through the Golgi
apparatus.
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In the following, we describe the different antigen presentation pathways

used by DCs and discuss the current knowledge about their underlying
molecular mechanisms. Classical pathways include presentation of intracel-
lular antigen on MHC class I and exogenous antigen on MHC class II mol-
ecules. As both pathways are shared with other cell types, we will give special
emphasis to “cross-presentation,” for which DCs are the most efficient
APCs. Further, we will discuss its impact on the field of immunotherapy.
2. Classical MHC class I presentation

Classical MHC class I presentation (or direct presentation) refers to the
(a) generation of antigenic peptides (self or non-self ) within the cytosol by
the proteasome, (b) the translocation of the resulting peptides to the ER,
(c) their trimming by aminopeptidases, (d) loading of peptides onto newly
synthetized MHC class I molecules to be (e) presented to CD8+
T lymphocytes on the cell surface (Fig. 2). Such endogenous antigens can
either be self-derived or generated following viral infections (with the asso-
ciated synthesis of viral proteins). If self-peptides are produced by tumor
cells, they represent a potential target to elicit antitumor responses, whereas
if they are generated in normal host cells, they can lead to tolerance or
autoimmunity.
MHC class I molecules are expressed in most nucleated cell types. In
mice, three genes encode classical MHC class I molecules (H2-D, H2-K
and H2-L) whereas in human three different genes encode for such mole-
cules (HLA-A, HLA-B and HLA-C) (Blum et al., 2013). There are also
other non-classical MHC class I genes both in human and mice, often
referred to as MHC class Ib (Adams and Luoma, 2013). Several studies have
documented the structure of MHC class I molecules, which are comprised
of two separate proteins: a heavy chain (α), anchoring the molecule to the
cell by a transmembrane domain; and a soluble protein β2-microglobulin
(β2m). Although MHC class I molecules are subject to vast allelic polymor-
phisms, most of the protein coding sequence is strictly conserved among dif-
ferent class I alleles. Thus, the impressive variation in amino acid sequence is
confined to a critical region in the heavy chain that interacts with peptides
generated from proteolyzed antigens. This peptide-binding structure forms a
groove constituted by two antiparallel α helices settled over an eight-strand
β-sheet.
The peptides that bind to MHC class I molecules are generated by a two-
step proteolytic mechanism: peptide generation by the cytosolic proteasome
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Fig. 2 Classical MHC class I antigen presentation. (1) Following viral infection, viral pro-
teins are translated in the cytosol. Alternatively (not shown) host proteins can also be
generated endogenously and follow the same route; (2) degradation of proteins—from
either origin—by the proteasome; (3) TAP-dependent translocation of the resulting
peptides into the ER; (4) PLC (Peptide Loading Complex, composed of TAP, calreticulin,
ERp57 and tapasin) assembles and drive MHC class I folding, as well as peptide loading
after ERAAP/ERAP1 (Endoplasmic Reticulum Aminopeptidase)-mediated trimming; (5)
high affinity peptides loaded onto MHC class I molecules are released from the PLC;
and (6) selected for transport to the cell surface.
and peptide trimming by aminopeptidases in the ER lumen (described

below). Briefly, the proteasome is responsible for most of the non-lysosomal
degradation of intracellular proteins (Rock and Goldberg, 1999). Its catalytic
activity determines, at least in part, the antigenic peptide repertoire that will
bind to MHC class I molecules and will be presented on the cell surface to
T lymphocytes (Maupin-Furlow, 2012). The proteolytic activity of the
proteasome is exerted by three of the seven β subunits, namely, β1, β2,
and β5, which are part of the two identical inner rings of the four ringed
proteasomal 20S core complex (Dick et al., 1998; Guillaume et al.,
2010). Under inflammatory conditions, when cells are exposed to IFNγ,
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the three catalytic subunits can be replaced by their IFNγ inducible homo-
logs, LMP2 (β1i), MECL1 (β2i) and β5i, resulting in the formation of the
immunoproteasome (IP) (Guillaume et al., 2010; Rock and Goldberg,
1999). Two additional forms of IPs exist, which contain a mixture of stan-
dard and immune catalytic subunits: either only expressing the β1i subunit or
expressing both β1i and β5i subunits. Each of these proteasomes has different
cleavage specificities generating a distinct set of antigenic peptides to be
bound to HLA on the cell surface (Chen et al., 2001). DCs can express both
proteasome and immunoproteasome at different stages of maturation (Morel
et al., 2000).
Following cytosolic proteolysis, antigenic peptides are recruited to the
ER and translocated to its lumen by the Transporter associated with Antigen
Processing (TAP). It is constituted of two subunits: TAP1 and TAP2 which
both comprise a main domain of six transmembrane α-helices (the channel)
adjacent to its nucleotide-binding domain (Hinz and Tampe, 2012).
Together with TAP, the proteins ERp57, tapasin and the calnexin-
calreticulin system constitute the peptide-loading complex (PLC). This
transient ER multimeric complex mediates translocation of proteolyzed
antigens to the ER, as well as trimming and loading of peptides on MHC
class I molecules. In DCs, calnexin chaperones newly synthesized MHC
class I heavy chains once they reach the ER, keeping them in a partially
folded state (Rajagopalan and Brenner, 1994). Subsequently, chaperoned
MHC class I heavy chains assemble with β2m to form empty MHC class
I molecules that will be recruited to the PLC by calreticulin (Ortmann
et al., 1994). Once in the PLC, MHC class I molecules are further stabilized
by tapasin and the thiol oxidoreductase ERp57 which promotes efficient
peptide loading (Blees et al., 2017; Blum et al., 2013; Ortmann et al.,
1997; Sadasivan et al., 1996). The exact structure and conformation of
the human PLC have been recently elucidated using electron cryo-
microscopy. The complex is made up of two multimeric units of cal-
reticulin, tapasin, ERp57, and MHC class I that are centered around
TAP in a symmetric orientation (Blees et al., 2017). Genetic silencing or
the use of negative dominants of TAP, tapasin, ERp57 and calreticulin have
shown to decrease (to different extents) surface expression of MHC class
I molecules, and hence decrease MHC class I antigen presentation (Gao
et al., 2002; Garbi et al., 2000, 2006; Grandea et al., 2000; Peh et al.,
2000; Purcell et al., 2001; Williams et al., 2002).
Another ER luminal protein plays a critical role in peptide processing
and loading, although it is not physically associated with the PLC: The
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ER aminopeptidase associated with antigen processing (ERAAP in mice), or

ER aminopeptidase-1 (ERAP-1 in human) (Saric et al., 2002; Serwold et al.,
2002). ERAP-2 is only present in human but might also play a role in pep-
tide processing (Saveanu et al., 2005). While peptides loaded onto MHC
class I molecules are 8–11 amino acid residues long (a restriction based on
the size and conformation of the peptide-binding groove of MHC class
I molecules), peptides translocated by TAP can be significantly longer
(Koopmann et al., 1996). These peptides will be trimmed to the correct
length by ERAAP. When ERAAP was silenced in mice, peptides associated
with MHC class I molecules were longer than 8–11 residues, and the
resulting MHC class I heterodimers were unstable.
Depending on the affinity of the loaded antigenic peptide, MHC class
I molecules will be either transported to the cell membrane, or recycled by
a mechanism dependent on UDP-glucose glycoprotein transferase-1
(UGT1) that allows MHC class I/suboptimal peptide complexes to regain
access to the PLC for further rounds of tapasin-mediated peptide loading
(Caramelo et al., 2004; Ritter et al., 2005). High-affinity peptide/MHC class
I complexes that successfully pass the aforementioned “quality controls” will
be transported through the Golgi apparatus to the cell membrane to elicit
antigen-specific CD8+ T cell responses.
3. Classical MHC class II antigen presentation

In contrast to MHC class I molecules which are expressed in most
nucleated cell types, MHC class II molecules are constitutively expressed
in few immune cells, such as DCs, macrophages and B lymphocytes. Under
inflammatory conditions, MHC class II molecules can also be expressed in
restricted types of endothelial and epithelial cells. In humans, MHC class II
molecules are encoded by three polymorphic genes (HLA-DP, HLA-DQ
and HLA-DR) and in mice by two (I-A and I-E). The transcriptional con-
trol of the MHC class II locus depends on the activity of the MHC class II
transactivator (CIITA), the master regulator of MHC class II molecule
expression (Choi et al., 2011). In turn, the activity of CIITA is regulated
by post-translational modifications and the interaction with multiple
DNA-binding proteins that are mainly active in APCs.
Nevertheless, during inflammation or infection, different signaling
events and chromatin modifications lead to the activation of CIITA and
expression of MHC class II molecules in other types of non-immune cells
(Neefjes et al., 2011). IFNγ is the main cytokine driving the synthesis of
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CIITA and the induction of MHC class II expression. Other important

immunological molecular stimuli, such as TLR or TGFβ signaling, can also
contribute to this process. Experimental evidence shows that in mice lacking
the master regulator CIITA, the expression of MHC class II molecules is
drastically reduced or absent (Chang et al., 1996).
MHC class II molecules share strong similarities with MHC class
I molecules with regards to their three-dimensional structure. Polymorphic
amino acid residues near the peptide-binding groove and nonpolymorphic
Ig-like domains that contact the CD4+ and CD8+ T cell molecules are con-
served. However, the peptide-binding groove of MHC class II molecules is
open, and hence peptides that can be bound in these molecules are longer
(10–30 residues long for MHC class II vs 8–11 for MHC class I). Once they
are formed, peptide/MHC class II molecules complexes are very stable and
allow for sustained antigen presentation increasing the chances to encounter
the matching CD4+ T lymphocytes. Once CD4+ T cells have become acti-
vated, they in turn trigger macrophages to eliminate pathogens that have
been previously internalized, and B lymphocytes to produce pathogen-
specific antibodies.
MHC class II molecules are composed of two integral membrane chains,
α and β, which are synthesized and assembled in the ER. There, they asso-
ciate with the invariant chain (Ii) protein that acts as a pseudopeptide and
allows for the stabilization of the MHC class II heterodimer. The association
with Ii also provides spatial restriction of peptide loading to a late endosomal
compartment, termed MHC class II compartment (MIIC) (Cresswell, 1996;
Mantegazza et al., 2013). It is still controversial whether the Ii/MHC II
complexes travel to the endocytic pathway through the Golgi apparatus
(Warmerdam et al., 1996) or directly via the cell surface (McCormick
et al., 2005; Roche et al., 1993) (Fig. 3). Once in the MIIC, Ii is digested
by resident proteases termed cathepsins, and replaced by a 24 amino acid
residual fragment called CLIP (Class II-associated Invariant chain Peptide).
In the same compartment, extracellular protein antigens are degraded by
endo-lysosomal proteases to allow for peptide loading. For this step,
MHC class II molecules require the peptide exchange factor HLA-DM
(H2-M in mice) that catalyzes the removal of CLIP from the peptide-
binding groove and its exchange with specific antigen-derived peptides.
HLA-DM also helps select peptides with optimal affinity for MHC
class II molecules ( Jurewicz and Stern, 2019). Another relevant molecule
in this process is HLA-DO (H2-O in mice), which tightly associates
with HLA-DM in the ER and throughout the endocytic pathway, thus
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Fig. 3 Classical MHC class II antigen presentation. (A) MHC class II recruitment to the
MIIC organelle (left pathway, dashed blue lines). (1) Expression of MHC class II molecules
promoted by the transactivator CIITA (class II, major histocompatibility complex, trans-
activator). MHC class II heterodimers are stabilized in the ER through interaction with the
Ii pseudopeptide; (2) MHC class II/Ii complexes are transported to the plasma mem-
brane; (3) internalized by endocytosis and (4a) recruited to the MIIC (MHC class II com-
partment) organelle. Alternatively, (4b) MHC class II/Ii complexes might be transported
to MIIC throughout the Golgi apparatus and the endocytic pathway. Independently of
how they arrive to the MIIC, (5) Ii is proteolyzed by cathepsins and a 24 residues-long
peptide named CLIP stays associated to MHC class II molecules. (B) Antigen uptake and
processing (right pathway, solid black lines). (1) Internalization of antigens (mac-
ropinocytosis, endocytosis or phagocytosis); (2) the antigen is partially degraded in
the endosome/phagosome; (3a) membrane fusion allows delivery of endosomal cargo
to the MIIC organelle. Alternatively, (3b) endogenous proteins within autophagosomes
can also reach MIIC to be presented in MHC class II molecules; (4) degradation of pep-
tides by cathepsins and other lysosomal proteases; (5) CLIP is released and replaced by
the peptide, a process mediated by H2-M; and (6) MHC class II/peptide complexes are
delivered to the cell surface through (6a) direct contact of the MIIC organelle or (6b)
formation of tubular intermediates. Steps with unclear or conflicting evidence are
showed in arrows with dashed lines.
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restricting HLA-DM activity to more acidic compartments (Denzin et al.,

2005). Finally, peptide/MHC class II complexes are transported to the
plasma membrane and trigger CD4+ T lymphocyte activation and
T helper cell-mediated immune responses.
The molecular mechanisms that regulate the trafficking of
peptide/MHC class II molecules complexes to the cell surface are poorly
understood and a current matter of debate (Fig. 3). After antigenic peptide
loading, peptide/MHC class II complexes can be delivered to the plasma
membrane through direct contact of MIIC compartments with the cell sur-
face (Pond and Watts, 1997; Wubbolts et al., 1996) or via vesiculotubular
intermediates (Rocha and Neefjes, 2008; Vyas et al., 2007). It has been
shown that MIIC can move bidirectionally along microtubules thanks to
the activity of the motor protein dynein (inward transport) and kinesin (out-
ward transport) (Wubbolts et al., 1999). Also, intraluminal vesicles of the
multivesicular MIIC compartment can fuse with the plasma membrane
for the release of peptide/MHC class II molecules complexes on nanometer
sized vesicles, so-called exosomes (Kleijmeer et al., 2001; Raposo et al.,
1996). In DCs, maturation stimuli induce the formation of peptide/MHC
class II complexes and their transport to the cell surface (Cella et al., 1997;
Pierre et al., 1997). Indeed, DC maturation also rearranges the endocytic
pathway and contributes to the transition of MIIC compartments from
vesicular to tubular structures (Boes et al., 2002; Chow et al., 2002), which
could function as carriers of the peptide/MHC class II molecules complexes
(Vyas et al., 2007). Several factors, including cholesterol, cytosolic pH,
kinases and GTPases of the Rab and Arl family, have been studied as critical
regulators of peptide/MHC class II complex formation and trafficking.
Here, the small GTPase Rab7 controls the transition from early to late endo-
somes and contributes to MHC class II antigen presentation (Bertram et al.,
2002; Chavrier et al., 1990). Rab7 most likely regulates the export of
peptide/MHC class II complexes to the plasma membrane through the
recruitment of dynein ( Jordens et al., 2001). Another well characterized
molecular actor is the small GTPase ADP-ribosylation factor-like protein
14 (ARL14). It localizes to MIIC in DCs and promotes the activity of
the actin-based motor protein myosin 1E and thus regulates MHC class
II transport to the plasma membrane (Paul et al., 2011).
As mentioned earlier, the peptide/MHC class II complexes are stable at
the plasma membrane and the half-life of MHC class II molecules strongly
increases after DC maturation (Cella et al., 1997; Pierre et al., 1997). Nev-
ertheless, MHC class II molecules need to be degraded eventually, possibly
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via polyubiquitylation. The E3 ubiquitin ligase MARCH1 can ubiquitylate

MHC class II complexes leading to their down-regulation at the cell surface
(De Gassart et al., 2008). Although it is not completely defined how MHC
class II down-regulation is accomplished, some studies suggest that
ubiquitylation drives the endocytosis of peptide/MHC class II complexes
(Matsuki et al., 2007; Shin et al., 2006). Others support the notion that
MHC class II molecules are constitutively internalized and are degraded
within acidic compartments of the endocytic pathway (Walseng et al.,
2010). Of note, while IL10 down-regulates the expression of MARCH1
and MHC class II molecules at the cell surface (Koppelman et al., 1997;
Thibodeau et al., 2008), the costimulatory molecule CD83 inhibits the
interaction between MARCH1 and MHC class II molecules, controlling
their half-life in DCs (Tze et al., 2011).
MHC class II molecules present peptides derived from exogenous anti-
gens and from self-antigens degraded within the endocytic pathway. Differ-
ent cellular processes allow APCs to sample the external environment and
detect potential threats for the organism. Contrary to initial believes, many
studies have shown that the MHC class II peptidome is mainly composed of
peptides derived from endogenous, rather than exogenous proteins
(Bergseng et al., 2015; Sofron et al., 2016), and this predominance of endog-
enous peptides persists under inflammatory conditions (Draheim et al.,
2017; Fugmann et al., 2017). In order to understand the many sources of
available antigen for MHC class II peptide loading, a clear definition
of the different antigen uptake mechanisms in APCs is needed.
3.1 Receptor-mediated endocytosis

This process, also called clathrin-mediated endocytosis, is highly specific and
extremely efficient, as it allows for internalization of soluble material that is
present in the extracellular milieu even at very low doses. It is highly evo-
lutionary conserved and was likely present in a common eukaryotic ancestor
more than a billion years ago (Wideman et al., 2014). The molecular
machinery that coordinates this process is assembled at the plasma membrane
by the sequential recruitment of endocytic proteins from the cytosol. Here,
>50 proteins have been involved for the generation of clathrin-coated ves-
icles as part of the molecular machinery that drives this endocytic process.
Receptor-mediated endocytosis consists of sequential and partially over-
lapping steps, starting with cluster-formation of endocytic coat proteins at
the inner side of the plasma membrane. This first endocytic module assures
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the assembly of the clathrin coat, further consisting of other components

such as clathrin-adaptor proteins and scaffold proteins. Cargo recruitment
concentrates foreign antigens in the coated region at the cell surface and
induces membrane bending, which changes the flat plasma membrane into
a clathrin-coated pit. Although receptor-mediated endocytosis is normally
considered an actin-independent process, it has been described that actin
polymerization cooperates with the coat and scission proteins to promote
membrane shaping. This includes the activation of regulatory components,
such as proteins of the Wiskott-Aldrich syndrome protein (WASp) family,
and the actin filament network composed of different actin-binding
proteins, such as the complex of actin-related protein 2 (ARP2). Finally,
the invagination neck is constricted and cut, separating the clathrin-coated
vesicle from the plasma membrane. This scission process is mostly mediated
by BAR domains of different proteins that cooperate with dynamin.
Complex molecular machinery composed of chaperones, kinases and phos-
phatases, are in charge of the disassembly of endocytic proteins leading
to uncoating of the clathrin-vesicle and the release of cargo-associated
material into the endosomal network (Kaksonen and Roux, 2018). Thus,
exogenous antigens engulfed by APCs via receptor-mediated endocytosis
arrive at early endosomes. They transit toward more acidic compartments,
stopping at tubular sorting and recycling endosomes or directly passing to
late endosomes/lysosomes where antigenic processing takes place.
3.2 Macropinocytosis
Macropinocytosis is a non-specific and actin-dependent endocytic process
that allows for the internalization of exogenous antigens present in fluid-
phase at high concentrations in the extracellular milieu. It is initiated by
the formation of plasma membrane ruffles and the subsequent invagination
of soluble antigens. Once macropinosomes are formed by the sealing plasma
membrane ruffles, they undergo a maturation process and establishing
dynamic interactions with other compartments of the endocytic network.
Here, macropinosomes first fuse with early, then late endosomal compart-
ments and finally with lysosomes to generate a tubular structure known
as the macropino-lysosome, which exhibits acidic pH and a degradative
environment (Canton, 2018). Mechanistic-wise, the formation of mac-
ropinosomes requires essential signaling from the cell surface that converges
in an actin-driven closure process of membrane ruffles. Ras-GTPases
recruit and activate PI3Ks to generate patches of phosphatidylinositol
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3,4,5-trisphosphate [PtdIns(3,4,5)P3] at the plasma membrane. The nega-

tively charged head groups of PtdIns(3,4,5)P3 induce an electrostatic inter-
action with the polybasic domains present in Rac1/2 and Cdc42. These
Rho family GTPases coordinate actin polymerization via the activation of
actin-nucleation-promoting factors, such as the SCAR/WAVE complex
and WASp/N-WASp. Further maturation of macropinosomes depends
on a critical switching step from Rab5 to Rab7 that facilitates the trafficking
of this compartment and its fusion with late endosomes/lysosomes (Marques
et al., 2017). Constitutive macropinocytosis is efficiently achieved by imma-
ture DCs (Sallusto et al., 1995) and macrophages (Yoshida et al., 2009), but is
also induced in other cell types in response to growth factor, chemokine or
TLR stimulation (Canton, 2018).
3.3 Phagocytosis
Phagocytosis is the process by which large foreign particulate antigens
(0.5 μm) are recognized, internalized and finally degraded by professional
phagocytes. It was first observed by the Russian E lie Metchnikoff in the
1880s. Since then phagocytosis has been widely studied as the main mech-
anism to ingest and eliminate microbes, but also to clear apoptotic cells as
part of fundamental tissue homeostasis. In brief, phagocytosis can be divided
into four general steps: (i) recognition of the target particle, (ii) activation of
a signaling cascade to induce particle internalization, (iii) formation of the
phagosome, and (iv) maturation of the phagosome toward the
phagolysosome (Rosales and Uribe-Querol, 2017). Particle recognition is
achieved by the presence of a wide variety of opsonic and non-opsonic
receptors on the cell surface of professional phagocytes. The former category
includes Fcγ receptors, that recognize the Fc fragment of IgG-coated parti-
cles, and complement receptors, which recognize antigen coated with com-
ponents of the complement cascade (C3b, C4b and iC3b). The latter
category are Mannose receptors that bind mannan; Scavenger receptors
and CD14 that recognize lipopolysaccharide (LPS) and lipoteichoic acid;
Dectin-1 that binds LPS from some yeasts; and Apoptotic receptors, such
as TIM-1 or TIM-4, which recognize phosphatidylserine from the dying
cell. Foreign antigens can also be recognized by TLRs through their con-
served structural motifs (PAMPs). Nevertheless, TLRs do not function as
phagocytic receptors, although they often contribute to other non-opsonic
receptors to stimulate particle ingestion (Freeman and Grinstein, 2014).
Similar to macropinocytosis, the phagocytic uptake largely depends on actin
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polymerization. After receptor-mediated antigen recognition, different sig-

naling events trigger drastic membrane remodeling changes at the cell sur-
face. In this way, the actin cytoskeleton leads to the formation of the
phagocytic cup, which consists of pseudopods that cover the particle and
allow for its internalization. The extracellular antigen is now surrounded
by membrane in a new compartment termed the phagosome, that contains
and isolates dangerous material from the rest of the cell. The signaling cas-
cade initiated by the phagocytosis receptors activates the PI3K-Rac/
Cdc42 SCAR/WAVE-WASp axis in order to initiate actin polymeriza-
tion (Prehoda et al., 2000).
Newly formed early Rab5+/EEA1+ phagosomes progress through a
maturation process and become intermediate phagosomes that are still
Rab5+, but no longer EEA1+ compartments. Instead, these intermediate
phagosomes recruit components of the endosomal sorting complexes
required for transport (ESCRT) thanks to the fusion with multivesicular
bodies (MVBs). Also here, the critical transition during phagosomal matu-
ration involves the replacement of Rab5 for Rab7 through the interaction
with late endosomes. Finally, Lamp1+/Lamp2+ compartments, called
phago-lysosomes and fully equipped with proteolytic enzymes such as
cathepsins and hydrolases contributes to antimicrobial activity through
the production of reactive oxygen species (ROS) by the action of the
NADPH oxidase complex. Phagosomal maturation is tightly controlled
by the formation of specific trans-SNARE complexes that are in charge
of all membrane fusion events within the cell (Fairn and Grinstein, 2012).
These general steps for phagocytosis have been established under
“regular” conditions and using model antigens, such as inert microparticles.
The situation is certainly much more complex under inflammatory scenarios
where several microbes drastically alter one or more steps of phagocytosis.
Furthermore, many pathogenic microorganisms induce active invasion-
mediated processes and dispose of sophisticated molecular mechanisms that
drive the entry, survival and replication inside the host cell. For an in-depth
revision of this issue, please refer to Uribe-Querol and Rosales (2017).
Neutrophils mainly work to eliminate pathogens as quickly and efficient
as possible. To achieve this, neutrophils are characterized by a very aggres-
sive early phagosomal response known as the oxidative burst (or respiratory
burst), a fast and strong activation of NADPH oxidase that elevates the lumi-
nal pH until around 8. After 10–15 min post-engulfment, the phagosomal
pH decreases abruptly thanks to attenuation of the NADPH oxidase activity
and recruitment of the v-ATPase (and likely other proton channels), causing
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drastic acidification of the phagosomal lumen. In macrophages, phagosomes

become progressively acidic and display a high proteolytic activity to destroy
the internalized microbes. Although macrophages are also able to trigger an
oxidative burst, phagosomal pH is regulated differently as compared to neu-
trophils. While, macrophage phagosomes recruit the v-ATPase very fast and
strongly, their NADPH oxidase phagosomal activity is almost insignificant.
Thus, a few minutes post-internalization, phagosomal pH decreases from 7.4
to 6.5, reaching values below 6 and 5 after 20 and 60 min of phagocytosis,
respectively. In contrast, DC phagosomes maintain an alkaline luminal pH
and a relatively non-degradative environment for several hours post-
engulfment thanks to efficient recruitment and activity of the NADPH oxi-
dase, and a very limited acquisition of the v-ATPase toward the phagosomal
membrane (Savina and Amigorena, 2007). This enables DCs to preserve
important antigenic peptides for efficient antigen presentation to
T lymphocytes. In DCs, these organelles display many additional, sophisti-
cated characteristics, such as the recruitment of ER-derived components and
MHC class I molecules. They may thus function as competent cross-
presenting compartments adapted to promote efficient cross-priming. All
these special features of DC phagosomes will be further discussed in detail
later in this chapter.
3.4 Autophagy
Some non-conventional pathways allow for presentation of endogenous
antigens in the context of MHC class II molecules in APCs. Presentation
of endogenous proteins in MHC class II molecules was first reported 30 years
ago, and to date the involvement of the proteasome, as well as the TAP
transporter in antigen processing have been well documented (Dani et al.,
2004; Lich et al., 2000; Malnati et al., 1992; Mukherjee et al., 2001).
Although is not clear how endogenous peptides are loaded onto MHC class
II molecules, or why some peptides are presented more efficiently than
others, autophagy is believed to be the main intracellular pathway involved
in this type of non-conventional antigen presentation. Indeed, antigenic
processing via autophagy has been reported to be important in DCs for
the presentation of both self and foreign antigens (Crotzer and Blum, 2009).
Autophagy is a ubiquitous process in eukaryotic cells where cytoplasmic
components are processed and degraded. First, a phagophore sequesters
nuclear, microsomal and cytoplasmic material destined to degradation.
Then, the phagophore expands into a double-membrane limited compart-
ment known as the autophagosome that encapsulates the invaginated material.
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Autophagosomes can then fuse with endosomes to generate a new organelle

termed the amphisome, which in turn fuses with lysosomes equipped with
degradative enzymes, such as cathepsins and hydrolases. Additionally, the
autophagosome can directly intercept lysosomes without a previous pass
through the amphisomal stage. In both scenarios, the result is a strongly acidic,
degradative structure referred to as the autolysosome. Finally, the engulfed
material is digested within the autolysosome, and the inner membrane of this
compartment disintegrates. The resulting macromolecules may be released
into the cytosol for further recycling thanks to the presence of permeases
in the remaining autolysosomal membrane (Klionsky, 2007).
Autophagy plays fundamental roles in diverse processes like inflamma-
tion, neurodegenerative disorders, intracellular trafficking of several patho-
gens and homeostasis (among others), and is directed by the evolutionary
conserved autophagy-related (ATG) genes. Key molecules involved in clas-
sical autophagy are ATG13 for the initiation; ATG14 and Beclin-1 for
phagophore formation; ATG7, ATG3, ATG5, ATG12 and ATG16L1
for phagophore elongation and autophagosome formation. At this point,
autophagosomes are decorated with a widely used marker known as
LC3-II. Lysosomal fusion and steps of autolysosome formation are regulated
by LC3/GABARAP, the HOPS complex and Rab7. Membrane fusion
events are commonly mediated by the SNARE proteins STX17, SNAP29
and VAMP8 (Levine and Kroemer, 2019).
3.5 Cross-dressing
The first evidence of transfer of MHC class II-peptide complexes from
B to T cells was postulated >40 years ago (Cone et al., 1972). It has become
now clear that such process of intercellular transfer can be used by T cells to
acquire MHC molecules from donor APCs after synapse formation, a
process referred to as trogocytosis (Arnold and Mannie, 1999; Hudrisier
et al., 2001; Joly and Hudrisier, 2003). Later, it has been shown that mem-
brane transfer can also occur between APCs by means of trogocytosis,
exosomes or tunneling nanotubes (Andre et al., 2004; Davis, 2007;
de Heusch et al., 2007; Herrera et al., 2004; Smyth et al., 2007). More
recent studies showed that DCs can acquire fully functional MHC/peptide
complexes that can elicit CD8+ T cell responses both in vivo and in vitro
(Dolan et al., 2006; Li et al., 2012; Wakim and Bevan, 2011). Still, the sig-
nificance of this process in vivo is a matter of debate, and further experi-
mentation is needed. For a more detailed revision, please refer to Campana
et al. (2015).
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4. Cross-presentation
Among the “non-classical” routes for antigen processing and presen-
tation, antigen cross-presentation has received the most attention during the
last 20 years. In 1976, a seminal study by Bevan et al. demonstrated that
transplantation of allogeneic cells elicited a donor specific CD8+ T cell
response in mice (Bevan, 1976a,b). Previously, it was believed that MHC
class I molecules only presented peptides generated within the cell, e.g.,
those resulting from intracellular viral infections (Zinkernagel and
Doherty, 1974) and that macrophages were the most important APCs.
However, following their discovery by Steinman and Cohn (1973), DCs
have proven to be the most competent cells for priming cytotoxic T cell
responses in vivo ( Jung et al., 2002).
In particular, DCs are considered the most efficient cross-presenting cell
type, although the ability to cross-present varies among different DC subsets.
Early work from the labs of Bevan and Shortman demonstrated that CD8+
resident DCs cross-presented both soluble as well as cell-associated ovalbu-
min (OVA), a widely used model antigen (den Haan et al., 2000; Pooley
et al., 2001) in vivo. All splenic DC subsets were equally potent in ingesting
both soluble and bead-associated OVA thus excluding that differences in
antigen uptake were responsible for the differences in cross-presentation
between CD8+ and CD8 DCs (Schnorrer et al., 2006). However, since
the route of antigen uptake impacts on their processing and presentation,
more variables have to be considered when investigating differences in
cross-presentation efficiency (Kamphorst et al., 2010). In line with this,
CD8 DCs can cross-present antigens when these are targeted to specific
receptors (den Haan and Bevan, 2002) or when they are delivered together
with stimuli such as a TLR ligands (Neubert et al., 2014). Among migratory
DCs, CD103+ cells are considered to be the main subset cross-presenting
antigens from peripheral tissues such as skin, lung and intestine (Bedoui
et al., 2009; Henri et al., 2010; Houston et al., 2016; Kim and Braciale,
2009). Plasmacytoid DCs have traditionally been excluded from the list
of cross-presentating DCs since absence of pDCs did not interfere with
cross-presentation of peptides from influenza virus (GeurtsvanKessel
et al., 2008, reviewed in Villadangos and Young, 2008). However, some
studies report priming of CD8+ T cell by pDCs following TLR stimulation
(Mouries et al., 2008). A recent work describing two different subsets of
pDCs, one of them ontogenetically closer to cDCs and with enhanced
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antigen presentation properties, could explain the heterogeneity in the abil-

ity of pDCs to cross-present antigens (Rodrigues et al., 2018). Monocyte-
derived DCs are very efficient cross-presenters under inflammatory condi-
tions, however, the underlying mechanism seems to differ from that of cDCs
(Cheong et al., 2010; Segura et al., 2009).
To date, two major pathways of antigen cross-presentation have been
described, generally referred to as either the “vacuolar” and “cytosolic”
pathway ( Joffre et al., 2012). The “cytosolic” route is sensitive to
proteasome inhibitors (Kovacsovics-Bankowski and Rock, 1995),
suggesting that endocytosed or phagocytosed proteins have to access the
cytosol, where they are degraded by the proteasome. Whether these
degraded antigens are then transported back to the phagosome or the ER
for further processing and MHC class I loading is still a matter of debate.
However, many studies suggest that phagosomes play an important role
in antigen cross-presentation (Ackerman et al., 2003, 2006; Alloatti et al.,
2017; Cebrian et al., 2011; Guermonprez et al., 2003).
In contrast, cross-presentation through the “vacuolar” pathway is resis-
tant to proteasome inhibitors but sensitive to inhibitors of lysosomal prote-
ases, such as cathepsin S inhibitors (Bertholet et al., 2006; Shen et al., 2004).
This suggests that antigen processing and loading both occur in the
endocytic compartment. It is difficult to assess how both pathways contrib-
ute to antigen cross-presentation, but available evidence points toward a
more important role for the cytosolic route for cross-presentation in vivo
(Kovacsovics-Bankowski and Rock, 1995; Palmowski et al., 2006; Shen
et al., 2004; Sigal et al., 1999).
In the following section, we will discuss how different DC subtypes pre-
serve antigen and regulate MHC class I expression and trafficking to favor
cross-presentation. We will focus our analysis on the “cytosolic” pathway,
that we plan to dissect as follows: (a) antigen phagocytosis and phagosome
maturation, (b) antigen translocation into the cytosol, proteasomal degrada-
tion and rerouting of peptides to phagosomes or the ER, (c) recruitment of
MHC class I to the cross-presenting organelle and (d) delivery of cross-
presentation machinery to the cross-presenting organelle to facilitate antigen
presentation.
4.1 Endo/phagosomal antigen processing for

cross-presentation
Cross-presentation is initiated once DCs internalize extracellular antigens.
As mentioned above, internalization can be achieved by different uptake
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mechanisms: phagocytosis, receptor-mediated endocytosis or mac-

ropinocytosis. The resulting antigen-loaded compartment will become a
dynamic and highly regulated vesicle for antigen-processing and loading
onto MHC class I molecules. Antigen degradation is a complex multistep
process that takes place in different organelles. The nature of the antigen,
the employed antigen-uptake mechanism and the type of cross-presentation
pathway utilized (vacuolar vs cytosolic) govern whether peptide loading
occurs in endo/phagosomes or the ER. The interaction between antigen
and the intra-phago/endosomal milieu changes these organelles which then
fuse sequentially first with early and then with late endosomes and lysosomes
in a process termed “endosome/phagosome maturation.”
One main feature of endo/phagocytic compartments in DCs is their low
degradative capacity. Antigen degradation depends on the activity of prote-
ases which increases during phagosome maturation. Initial experiments on
phagosomal proteolytic activity in APCs used latex beads coupled to active
site-directed probes and found that the cysteine protease Cathepsin S (CatS)
was most enriched in phagosomes from APCs (Lennon-Dumenil et al.,
2002). The main function of CatS is the proteolytic digestion of li molecules
involved in MHC class II antigen presentation to CD4+ T cells (Riese et al.,
1996). Interestingly, CatS was also shown to have a central role in peptide
processing in the vacuolar pathway (Shen et al., 2004). The development of
CatS inhibitors as immunomodulatory drugs to treat autoimmune diseases
has become a promising field of investigation (Gupta et al., 2008).
The notion that DCs regulate their endocytic pathway differently com-
pared to other phagocytes was supported by the observation that DCs
exhibited a slower kinetics of active proteases acquisition compared to mac-
rophages (Lennon-Dumenil et al., 2002). The comparison of lysosomal pro-
tease expression and activity in macrophages, B lymphocytes and DCs
provided further evidence for lower protein degradation capacity in DCs
both in vitro and in vivo (Delamarre et al., 2005). Analysis of murine bone
marrow-derived DCs (BMDCs) and DCs from secondary lymphoid organs
revealed lower expression of proteases in DCs as compared to macrophages.
Assays using different soluble antigens further demonstrated slower proteol-
ysis in DCs, favoring antigen presentation and linking antigen processing to
antigen presentation. These findings were further corroborated by enhanced
cross-presentation of soluble viral antigens in the presence of chloroquine or
ammonium chloride, two agents that prevent endosomal acidification.
Here, antigen presentation in MCH class II was inhibited (Accapezzato
et al., 2005; Belizaire and Unanue, 2009). Both substances increased export
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to the cytosol while no effect was seen following treatment with protease
inhibitors, in a model that was dependent on proteasome (Accapezzato
et al., 2005). These findings led to the hypothesis that limited antigen deg-
radation is linked to enhanced cross-presentation. Further work demon-
strated that limiting the susceptibility of antigens to lysosomal proteolysis
enhanced immunogenicity in vivo (Delamarre et al., 2006). However, it
remained unclear how antigen degradation was regulated differently in DCs.
Endosomal and lysosomal proteases are synthesized as inactive proen-
zymes and become activated at different pH values that are first reached
within the respective compartments. Endo/lysosomal pH is regulated by
two systems: the ATP-dependent vacuolar proton pump (v-ATPase) and
NADPH oxidase 2 (NOX2), that regulate the levels of H+ and ROS,
respectively, within phagosomes and endosomes (see Fig. 4 for a detailed
scheme).
DCs regulate the recruitment and assembly of v-ATPase at membranes.
Upon cell maturation, higher v-ATPase activity was observed, leading to
accumulation of H+, lower pH, increased protein degradation and MHC
class II dependent antigen presentation (Trombetta et al., 2003). At
steady-state, human DCs express lower levels of v-ATPase as compared
to macrophages (Mantegazza et al., 2008). More recently, the transcription
factor TFEB was described as a master regulator of the lysosome biogenesis
pathway (Sardiello et al., 2009; Settembre et al., 2013). TFEB regulates the
transcription of many genes including cathepsins and different subunits of
the v-ATPase (Sardiello et al., 2009) in a network that controls cellular pro-
cesses such as autophagy (Settembre et al., 2011). Not surprisingly, DCs
express lower levels of TFEB compared to macrophages adding evidence
to the differential regulation of protein degradation between phagocytes
(Samie and Cresswell, 2015). Remarkably, TFEB was expressed at even
lower levels in splenic CD8+ DC subsets specialized in cross-presentation.
As expected, overexpression of TFEB in DCs lowers pH and increases pro-
tease activity resulting in decreased cross-presentation due to enhanced anti-
gen degradation.
Nevertheless, high phago/endosomal pH in DCs suggested that mech-
anisms other than the reduction in v-ATPase activity was contributing to the
alkalinization of these organelles. NOX2 is a multiprotein complex con-
sisting of a transmembrane component, gp91phox and p22phox (known
as cytochrome b558) and several cytosolic subunits. When DCs internalize
antigens, cytochrome b558 translocates to phagosomal membranes and
recruits its cytosolic components to become enzymatically active. Active
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Fig. 4 Phagosomal processing of antigens during cytosolic cross-presentation. (1) Inter-

nalization of the exogenous antigen (by macropinocytosis, endocytosis or phagocyto-
sis) and formation of the cross-presenting organelle; (2) in immature DCs, v-ATPase is
incompletely assembled to phagosomes, and thereby acidification is lower than in
other related cells, like macrophages. When DCs mature, v-ATPase is recruited to the
cross-presenting organelle, a process mediated by TFEB. On the contrary, (3) NOX2 is
assembled in phagosomes of cross-presenting DCs. NOX2 cytosolic components are
recruited to the phagosome/endosome driven by Rac2, whereas gp91phox and
p22phox are translocated to the cross-presenting phagosome from lysosomes-related
organelles (LRO). (4) Within the phagosome, the internalized antigens are partially
degraded by Cathepsin S and the GILT complex, a necessary step for further export
to cytosol. (5) In a different mechanism orchestrated by TLR engagement and mediated
by the small GTPase Rab34, lysosomes are prevented to fuse with the phagosome, thus
maintaining the cross-presenting organelle suitable for cross-presentation.
NOX2 consumes protons for ROS production and thus slows down
phagosomal acidification. In line with this, DCs from NOX2-defective
mice had lower phagosomal pH were defective in cross-presentation
(Savina et al., 2006). Although a clear relationship between reduced prote-
olysis and increased NOX2 activity was shown by many different groups
in macrophages (Balce et al., 2016; Rybicka et al., 2010) and DCs
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(Mantegazza et al., 2008; Rybicka et al., 2012; Savina et al., 2006), the role
of phagosomal pH in this outcome remained controversial, with some
papers showing pH-dependency while others involved enzyme regulation
as the underlying mechanism by which NOX2 regulates proteolysis. Exper-
imental conditions, as well as the nature of the antigens utilized, can account
for these differences, as reviewed previously (Ewanchuk and Yates, 2018;
Kotsias et al., 2013; Pauwels et al., 2017; Yates, 2013). The use of opsonized
antigens probably overrides some of the more subtle regulatory effects pre-
sent in phagosomes. Also, the regulation of the activity of different
phagosomal enzymes by NOX2 activity promotes an additional qualitative
control of proteolysis, and shapes the repertoire of peptides to be presented
(Allan et al., 2014), as we will discuss later.
In the last decade, several molecules have been described to recruit
NOX2 to the phagosomal membrane. First, it was demonstrated that the
small GTPase Rab27a facilitates the fusion of vesicles containing the trans-
membrane elements of NOX2 with nascent phagosomes ( Jancic et al.,
2007). Rab27a-deficient ashen mice failed to cross-present antigens due to
increased acidification of the phagosomal lumen and exaggerated antigen
degradation. However, the question remained how NOX2 was differen-
tially regulated in DCs compared to other phagocytes which produce
ROS but do not cross-present antigens, such as neutrophils or macrophages.
The discovery that one of two isoforms of the Rac GTPase was responsible
for the recruitment of the cytosolic subunits of NOX2 (Savina et al., 2009)
provided an answer. Rac1 promotes the assembly of NOX2 at the plasma
membrane in macrophages, while Rac2 directs the cytosolic subunits
toward cytosolic vesicles such as in neutrophils where the oxidative burst
has been extensively characterized. A different scenario was true for DC sub-
types: cross-presenting DCs depend on Rac2 to limit antigen degradation
within endo/phagosomes while splenic CD8 CD11b+ DCs predominantly
express Rac1. Here, NOX2 is absent at the phagosomal membrane, thus
resulting in phagosomes that are less competent in cross-presentation
(Savina et al., 2009). These results were recapitulated in human
monocyte-derived DCs and DCs from patients suffering from chronic gran-
ulomatous disease, a genetic disorder where NOX2 is either absent or non-
functional (Mantegazza et al., 2008). In these cells, decreased cross-
presentation of tumor model antigens coincided with increased phagosomal
acidification.
More recently, vesicle-associated membrane protein 8 (VAMP8), a
t-SNARE protein present in endosomal recycling compartments (ERC),
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was shown to participate in the recruitment of cytochrome b558/NOX2 to

phagosomal membranes. Leishmania donovani, a parasite that had been shown
to interfere with NOX2 assembly at phagosomal membranes and thus
phagosome maturation (Lodge and Descoteaux, 2006), was found to cleave
VAMP8. The resulting change in pH and phagosomal antigen degradation
impaired antigen cross-presentation and thus allowed the parasite to evade
immune recognition (Shio et al., 2013). In human monocytes-derived DCs
NOX2 assembly was not only dependent on VAMP8, but also on SNAP23
and STX7 (Dingjan et al., 2017a).
Besides the effect of NOX2 on endo/phagolysosomal pH, other mech-
anisms have been proposed where ROS alter cross-presentation in a
pH-independent fashion. ROS generated following enzymatic conversion
of superoxides, such as hydrogen peroxide and oxygen radicals, not only
modify enzymes involved in antigen degradation but also the antigen itself.
Oxygen radicals can modify an essential residue in the catalytic center of ser-
ine and cysteine proteases leading to their inactivation resulting in a quan-
titative and qualitative change of proteolysis (Allan et al., 2014; Nagaoka
et al., 2005; Rybicka et al., 2012; Suto et al., 2007). Moreover, oxidative
inhibition of v-ATPase has been reported many years ago (Feng and
Forgac, 1994). Several studies have found that oxidation of antigens can lead
to molecular changes that influence their susceptibility to proteolytic deg-
radation (Prokopowicz et al., 2010). In any case, the actual contribution
of these pH-independent mechanisms of ROS-mediated degradation need
to be investigated further and remain a matter of debate (Kotsias et al., 2013;
Rybicka et al., 2012).
Surprisingly, these studies led to the discovery that NOX2-dependent
ROS oxidized lipids of the endosomal membrane and that this process
was dependent on VAMP8, STX7 and SNAP23 (Dingjan et al., 2016,
2017a,b). This phenomenon was shown to induce membrane instability
and to promote antigen release to the cytosol, thus enhancing antigen
cross-presentation. These studies offered an alternative hypothesis for
antigen export to the cytosol that will be discussed below (Gros and
Amigorena, 2019).
In conclusion, cross-presentation requires low antigen degradation to
preserve epitopes for presentation on MHC class I molecules. In DCs, this
is achieved through specialized endocytic compartments which are regu-
lated differently as compared to other phagocytes.
However, DCs also present antigens to CD4+ T lymphocytes in the con-
text of MHC class II molecules, a process that involves increased antigen
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degradation and thus seems to oppose cross-presentation. How is antigen

processing balanced for cross-presentation or MHC class II presentation?
Evidence points to differential delivery of antigen to different intracellular
compartments based on uptake receptor. Endocytosis of the model antigen
OVA through the mannose receptor (MR) was found to be delivered to
early endosomes leading to cross-presentation. DCs from MR-deficient
mice failed to cross-present soluble OVA, but efficiently presented antigens
to CD4+ T cells (Burgdorf et al., 2007). Antigen presentation on MHC class
II could be inhibited by pharmacologically blocking macropinocytosis, leav-
ing cross-presentation unaffected. Internalized antigen by macropinocytosis
was shown to be targeted toward late endosomes and lysosomes. This data
suggested that the internalization mechanism dictated intracellular routing of
antigens. Thus, the array of endocytic receptors present on particular cells
would define which presentation pathway is favored.
Based on this evidence, a model in which separate compartments are
dedicated to either cross-presentation or presentation on MHC class II
was proposed (Burgdorf and Kurts, 2008). Analysis of endosomes following
clathrin-mediated endocytosis of different ligands revealed the presence of
two distinct populations of endosomes: one being more mobile, quickly
maturing into endolysosomes, and a second one with slower maturation
kinetics (Lakadamyali et al., 2006). This model was further supported by data
using modified liposomes to target soluble hen-egg white lysozyme (HEL)
to different compartments (Belizaire and Unanue, 2009). Antigens delivered
to early endosomes were cross-presented more efficiently than proteins that
were macropinocytosed or targeted toward late, acidic and degradative
organelles. Several studies have determined antigen routing for different
receptors expressed on DCs and thus their preferential presentation on either
MHC class I or class II molecules. DEC-205, DC-SIGN and scavenger
receptors belong to a class of receptors that target antigens toward lysosomes,
promoting CD4 T cell responses by enhancing MHC class II-dependent
antigen presentation (Burgdorf and Kurts, 2008; Burgdorf et al., 2007;
Chatterjee et al., 2012; Mahnke et al., 2000). Interestingly, engaging two
different regions of the extracellular portion of DC-SIGN directed antigens
into different compartments. This provides evidence that the nature of the
antigen is important and might be exploited to manipulate the type of
ensuing immune response (Tacken et al., 2011). Specific changes in the gly-
can composition of OVA leads to its uptake by MGL-1, a c-type lectin
receptor, instead of MR. This was followed by increased cross-presentation
and prolonged intracellular storage of OVA within early endosomes
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(Streng-Ouwehand et al., 2016). Coadministration of the inert particulate

antigen monosodium urate with soluble OVA, redirected OVA toward less
degradative endosomes and favored cross-presentation (Hari et al., 2015).
It is still unclear whether there are two distinct types of compartments ded-
icated to presentation either on MHC class II molecules or cross-presentation
of soluble antigens, or whether these compartments reflect different matura-
tion status of a population of heterogeneous vesicles. A sequential model has
been widely accepted for particulate antigens, which are internalized through
phagocytosis (Amigorena and Savina, 2010; Burgdorf and Kurts, 2008). As
described above, the activation of NOX2 and subsequent increase in pH upon
phagocytosis slows down protein degradation. This allows peptides to be
mildly processed and to proceed through the cross-presentation pathway.
As phagosome maturation proceeds, elements of ER/ERGIC detach from
the phagosomal membrane and subsequent fusion with acidic lysosomes ren-
ders the compartment more degradative, prone for peptide loading onto
MHC class II molecules.
In line with this sequential model, TFEB activation induces phagosome
acidification and enhanced degradation of particulate antigen, abrogates
cross-presentation and induces MHC class II presentation in DCs exposed
to LPS for 24 h. Indeed, LPS leads to TFEB translocation to the nucleus
(Samie and Cresswell, 2015). Interestingly, TFEB does not affect the high
capacity to cross-present antigens of immature DCs or cells exposed to
LPS for short periods. This indicates that TFEB does not modulate
phagosome maturation in the first hours following antigen encounter and
suggests that other mechanisms regulate cross-presentation, as discussed
below. TFEB activation leads to phagolysosomal fusion first at later time
points, allowing for MHC class II-dependent antigen presentation to
CD4+ T cells.
How cross-presentation is regulated upon DC maturation has generated
controversy, as studies have reported conflicting results. Studies suggest that
regulation occurs at different levels and follows stimulation in a
time-dependent manner. We have recently reviewed this in detail and will
briefly mention the specific mechanisms regulating antigen degradation
during DC maturation (Alloatti et al., 2016).
DC maturation can be divided into three phases. At early time points
following activation by DAMPs or PAMPs, DCs are characterized by high
levels of cross-presentation. This increase during early phases can be attrib-
uted to enhanced antigen uptake (Granucci et al., 1999; West et al., 2004),
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export of antigens to the cytosol (Delamarre et al., 2003; Gil-Torregrosa

et al., 2004), and changes in the intracellular trafficking of MHC class
I molecules (Nair-Gupta et al., 2014). Slower recruitment of lysosomal
proteases, measured shortly after internalization, possibly contributes to
decreased degradation and allows for antigen export to the cytosol
(Lennon-Dumenil et al., 2002). It is noteworthy that in a scenario where
DCs take up antigens in conjunction with a DAMP/PAMP, phagosomal
autonomy was described (Hoffmann et al., 2012). This ensures that specific
modulation of a given phagosome does not extend to other phagosomes.
This allows for discrimination of different cargoes within the same cell
and hence regulates the antigen presentation pathway for each antigen
individually.
Up until 16–20 h after maturation, DCs efficiently cross-present antigens
despite a decrease in internalization efficiency (Alloatti et al., 2015; Drutman
and Trombetta, 2010; Vega-Ramos et al., 2014). A delay in phagolysosomal
fusion and subsequent recruitment of proteases was responsible for the
increase in cross-presentation (Alloatti et al., 2015). Lysosomes formed
perinuclear clusters and were spatially segregated from phagosomes which
in turn were moving at decreased speed compared to resting DCs. Silencing
of the small GTPase Rab34 prevented lysosomal clustering, favored
phagolysosome fusion and decreased cross-presentation. Comparing the
proteome of phagosomes from resting and LPS-stimulated DCs, the latter
contained fewer proteins of lysosomal origin, including v-ATPase subunits
and cathepsins, but were enriched in proteins associated with cross-
presentation, e.g., MHC class I, proteasome subunits and TAP (Pauwels
et al., 2019). Additionally, maturing DCs expressed decreased levels of
VAMP8, suggesting that NOX2 recruitment is not the central mechanism
for decreased antigen degradation in these cells.
Fully matured DCs are possibly the most studied cells, and cross-
presentation is completely shut down 20–24 h after activation. Recruitment
of v-ATPase and acidification of endosomes after prolonged exposure to
LPS has been known for many years (Trombetta et al., 2003). However,
the underlying mechanism has only been described recently. Exposing
DCs to LPS (or other TLR ligands) increases expression of TFEB and
induces its nuclear translocation, leading to phagosomal acidification, pro-
teolysis and inhibition of cross-presentation. Silencing TFEB partially
restored the ability of mature DCs to cross-present by increasing the
phagosomal pH (Samie and Cresswell, 2015).
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4.2 Translocation of mildly degraded antigens to the cytosol,

proteasomal degradation and transport to the cross-
presenting organelle
While it is accepted that antigens are exported to the cytosol after internal-
ization (Ackerman et al., 2006; Cebrian et al., 2011; Kovacsovics-
Bankowski and Rock, 1995; Norbury et al., 1997; Rodriguez et al.,
1999), the exact mechanism has not been fully characterized thus far. Avail-
able evidence suggests the involvement of the retrotranslocation machinery
for misfolded proteins from the ER to the cytosol (ERAD machinery). The
ERAD proteins Sec61 and p97 are indeed necessary for antigen export to
the cytosol (Fig. 5), as well as antigen cross-presentation (Ackerman
et al., 2006).
Sec61 has been proposed as an important channel for antigen export to
the cytosol (Zehner et al., 2015) as siRNA-mediated silencing of Sec61 or
treatment with ExoA (a bacterial Sec61-binding toxin, closing the channel)
inhibits cross-presentation (Ackerman et al., 2006; Goldszmid et al., 2009;
Zehner et al., 2015). Furthermore, using intrabodies against Sec61, Burgdorf
et al. sequestered Sec61 in the ER, preventing its transport to the
phagosome, inhibiting antigen export to the cytosol and OVA cross-
presentation in BMDCs. However, a recent study inhibiting Sec61 with
a specific toxin, mycolactone, did not interfere with antigen translocation
to the cytosol (Grotzke et al., 2017). Of notice, mycolactone is not highly
specific in Sec61 inhibition, as it might also targets different receptors
(Marion et al., 2014). Hence, the proposed function of Sec61 as a peptide
transporter during antigen cross-presentation awaits further clarification.
A different model for antigen export to the cytosol has been proposed by
Ploegh and Rapoport et al. The authors demonstrated that Derlin-1, and not
Sec61, mediates antigen transport to the cytosol (Lilley and Ploegh, 2004;
Ye et al., 2004). However, genetic silencing of Derlin-1 in BMDCs
(Zehner et al., 2015) and human monocyte-derived DCs (Menager et al.,
2014) had no effect on antigen export to the cytosol or antigen cross-
presentation, questioning its role in cross-presentation in DCs. The protein
Hdr1, an ER-resident ubiquitin ligase, has also been proposed as a candidate
for antigen transport to the cytosol, as its siRNA-mediated silencing
impaired both antigen translocation and cross-presentation in DCs
(Zehner et al., 2015). However, MHC class II-dependent antigen presen-
tation is changed as well, suggesting a general effect on antigen presentation,
possibly associated with ER stress.
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Fig. 5 Antigen translocation to the cytosol. (1) By a yet unknown mechanism, possibly
mediated by Sec22b, different protein complexes from the ER reach phagosomes
(Sec61, Derlin-1, p97 and others have been proposed and may contribute differentially
to the process); (2) antigen can be exported to the cytosol by different means, such as
(2a) through the p97 channel, (2b) the ER protein Derlin-1, (2c) the translocon complex
Sec61 or (2d) by membrane disruption. (3) Cytosolic degradation of antigens exported
to the cytosol, mediated by the proteasome, and transport back to the phagosomes
through TAP transporter. Otherwise, (?) peptides digested by the proteasome might
be translocated to the ER. Steps not fully characterized, with unclear or conflicting
evidence, are showed in arrows with dashed lines.
Thus far, the most convincing evidence for the involvement of ERAD in
antigen translocation comes from the ATPase p97, which forms a hexameric
ring and acts as a retrotranslocation channel, likely by providing necessary
energy for proteins passage (Zehner et al., 2011). Genetic silencing of p97
and overexpression of wild-type or dominant negative alleles helped establish
this protein as an important player in antigen export to the cytosol and cross-
presentation, at least for model antigens MelanA and OVA (Ackerman et al.,
2006; Imai et al., 2005; Menager et al., 2014; Zehner et al., 2011).
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Although different mechanisms of antigen translocation to the cytosol

have been proposed, all studies mentioned rely on the ERAD machinery,
which is known to have a high substrate selectivity (R€ omisch, 2017). While
there is considerable evidence for the involvement of the ERAD machinery in
antigen export, the use of only few transporters for such variety of substrates
seems unlikely and suggest the existence of alternative mechanisms. An alter-
native theory considers that the antigen might leak from the endocytic com-
partment as a consequence of membrane disruption. Evidence supporting this
hypothesis has recently been published by Dingian et al. who demonstrated
that following LPS treatment, NOX2 is recruited to endosomes by a
VAMP8-dependent mechanism. The concomitant production of ROS leads
to peroxidation of endosomal lipids and affects the membrane stability favor-
ing antigen release to the cytosol and increasing antigen cross-presentation
(Dingjan et al., 2016, 2017b). In addition, enrichment of sphingosine in
endosomal membranes during the formation of lipid bodies, especially in
cross-presenting DCs, could also facilitate membrane disruption (Bougnères
et al., 2009; Ploegh, 2007). For a detailed review regarding antigen export
to the cytosol, please see Gros and Amigorena (2019).
Once antigens reach the cytosol, they are either degraded by the
proteasome (Fonteneau et al., 2003; Guermonprez et al., 2003;
Kovacsovics-Bankowski and Rock, 1995) or the immunoproteasome
(Kincaid et al., 2012; Palmowski et al., 2006) and subsequently transported
to the cross-presenting organelle. Whether proteolyzed antigens are
processed and loaded onto MHC class I within the ER, the phagosome
or other endocytic compartments is still a matter of debate. However, there
is no direct evidence of peptide loading within the ER, and most of the
available data point toward phagosomal processing and loading.
Independent of the site of antigen processing and loading, peptides need
to be transported into the cross-presenting organelle, likely via one (or sev-
eral) transporter(s). As mentioned previously, translocation of peptides to the
ER during classical MHC class I antigen presentation relies on the TAP
transporter. As per cross-presentation, the vacuolar mechanism is considered
TAP-independent (Bertholet et al., 2006; Shen et al., 2004), whereas the
cytosolic route is mainly TAP-dependent (Burgdorf et al., 2008;
Guermonprez et al., 2003; Houde et al., 2003), although a TAP-
independent cytosolic cross-presentation has been reported (Lawand
et al., 2016; Merzougui et al., 2011). How TAP and other relevant proteins,
such as MHC class I molecules, calnexin and calreticulin reach phagosomes
will be discussed in the following sections.
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4.3 Intracellular trafficking of MHC class I molecules

The intracellular transport of MHC class I molecules needs to be tightly reg-
ulated by DCs in order to guarantee the efficacy of antigen loading and pre-
sentation. The different quality control steps that are required for proper MHC
class I molecule folding have been extensively characterized in recent years and
are reviewed elsewhere (Blees et al., 2017; Neerincx and Boyle, 2017;
Springer, 2015; Thomas and Tampe, 2017). However, endocytic trafficking
of MHC class I molecules and its potential impact on loading with exogenous
antigens in post-ER compartments has only recently gained attention.
Besides being present at the plasma membrane and the classical secretory
pathway, MHC class I molecules are also found throughout the endocytic
network, either as fully conformed trimolecular complexes and as open
forms. Open MHC class I conformers in the plasma membrane are present
in lower numbers than their fully conformed counterparts. Both forms distrib-
uted in separate regions of the plasma membrane and can be efficiently inter-
nalized in different endocytic invaginations by a mechanism independent of
clathrin and dynamin (Donaldson and Williams, 2009; Mahmutefendic et al.,
2011; Zagorac et al., 2012). Following internalization, both conformers are
transported to the same early endosomes, and further distributed into non-
degradative membranous compartments, such as early and sorting endosomes,
but also in acidic organelles, such as multivesicular bodies, late endosomes and
lysosomes. However, most MHC class I molecules are concentrated in a
defined perinuclear region known as the endocytic recycling compartment
(ERC) (Blander, 2016; Mahmutefendic et al., 2013). Thus, MHC class
I molecules can be potentially loaded with exogenous antigens within the
many endocytic compartments during cross-presentation by DCs.
Moreover, MHC class I molecules are transported to the endo/lysosomal
system either from the plasma membrane after their internalization or
directly from the ER, chaperoned by the li, also known as CD74 (as
described above). CD74 has been described to determine the intracellular
fate of MHC class I in endo-lysosomes, but does not interfere with the inter-
nalization of MHC class I molecules from the cell surface (Basha et al., 2012;
Sugita and Brenner, 1995). Indeed, upon depletion of CD74, MHC class
I loses its localization at Lamp1+ compartments and cross-presentation of
exogenous antigens by DCs is hampered (Basha et al., 2012). Whether exog-
enous antigen-derived peptides are loaded onto MHC class I molecules
within these Lamp1+ compartments is still unknown. So far, experimental
evidence suggests that loading of MHC class I takes place within the
endocytic system, rather than in the ER, from where peptide/MHC class
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Fig. 6 MHC class I molecules transport to phagosomes. (1) plasma membrane MHC class
I molecules are endocytosed and delivered to sorting endosomes; (2) MHC class
I heterodimers are subsequently targeted to endocytic recycling compartments (ERC)
with the participation of the small GTPases Rab22a and Rab11a; and (3) TLR engage-
ment triggers the phosphorylation of SNAP23, allowing the recruitment of MHC class
I molecules to the cross-presenting organelle.
I molecules complexes travel to the cell surface (Burgdorf et al., 2008;

Cebrian et al., 2016; Nair-Gupta et al., 2014) (Fig. 6). The recruitment
of relevant ER components to DC endosomes and phagosomes through
a Sec22b-mediated transport further support to this concept (Cebrian
et al., 2011). It is now evident that recycling of MHC class I molecules
by DCs plays a pivotal role in order to achieve efficient cross-presentation
(Montealegre and van Endert, 2018; van Endert, 2016).
Most information about recycling of MHC class I molecules has been
obtained from nonimmune cell types, with experimental evidence in APCs
being very limited. Current evidence suggests that once a cargo enters the
recycling route, it can either return to the plasma membrane via the fast
recycling pathway, or it can pass through the ERC in what is known as
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the slow recycling pathway. While the former is the typical route utilized
by, e.g., the transferrin receptor, the latter is the main recycling route for
MHC class I molecules.
Following their internalization, MHC class I molecules are stored in
Rab5+/EEA1+ early endosomal compartments with a pH ranging from 6.3
to 6.8 ( Jovic et al., 2010). From these early endosomes, MHC class
I molecules can enter into the fast recycling pathway, a process driven by
the activity of the small GTPase Rab4 (Daro et al., 1996; van der Sluijs
et al., 1992) or through a Rab35-dependent mechanism (Allaire et al.,
2010). In contrast, the slow recycling pathway involves an intermediate transit
through recycling endosomes, tubulovesicular structures exhibiting a luminal
pH close to 7, which sort internalized cargo to the cell surface (Goldenring,
2015). Three small GTPases were very well described as key regulators of the
MHC class I molecules slow recycling pathway; Rab11a (Ullrich et al., 1996),
Rab22a (Weigert et al., 2004) and the ADP-ribosylation factor 6 (Arf6). In
addition, Arf6 is important for the endocytosis of MHC class I molecules from
the plasma membrane in a clathrin-independent mediated transport
(Radhakrishna and Donaldson, 1997).
A pioneering study in APCs on recycling of MHC class I and
endosomal peptide loading that involved cell fractionation, identified an
acidic, potential MHC class I and class II loading compartment
(Gromme et al., 1999). In a different experimental setting, TAP1-deficient
macrophages were preincubated with peptide ligands which enhanced the
stabilization of intracellular peptide/MHC class I molecules complexes and
cross-presentation capacity of E. coli-derived OVA. This experiment sug-
gests that peptide dissociation/exchange takes place within an endocytic
compartment of controlled pH (Chefalo and Harding, 2001). A study
using the DC-like murine cell line DC2.4 and performing a siRNA-based
screen of 57 Rab GTPases revealed that 12 of them are potentially involved
in antigen cross-presentation. The authors characterized Rab3b/3c+ ves-
icles that colocalize with MHC class I molecules and transferrin at a
perinuclear tubular structure. Moreover, Rab3b/3c+ vesicles were
observed at a juxtaposition with E. coli-containing phagosomes and col-
ocalized with Rab27a. Although the depletion of Rab3b/3c significantly
reduced the fast recycling of the transferrin receptor, a precise role for these
GTPases in the slow recycling pathway of MHC class I molecules has not
been addressed (Zou et al., 2009).
Two recent studies conducted in DCs shed light on the molecular basis
that may govern intracellular recycling of MHC class I molecules which
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might have implications for cross-presentation. The first one addresses the role
of Rab11a in phagosomal recruitment of MHC class I molecules and antigen
cross-presentation by DCs (Nair-Gupta et al., 2014). This small GTPase is a
widely used ERC marker and controls the slow recycling pathway of MHC
class I molecules in several cell types (Ullrich et al., 1996). Rab11a is localized
in the trans-Golgi network and other dynamic post-Golgi vesicles, regulating
critical intracellular trafficking steps at the interface of endocytic and exocytic
pathways (Welz et al., 2014). In this novel study, Nair-Gupta et al. show that
MHC class I molecules are selectively delivered to DC phagosomes following
TLR signaling in a Rab11a-dependent and Sec22b-independent mechanism.
The authors observed that DCs store a large intracellular reserve of MHC class
I molecules in the ERC, defined as Rab11a+/VAMP3+/VAMP8+ endo-
somes devoid of ERGIC and ER markers. Upon silencing Rab11a in
DCs, phagosomal enrichment of MHC class I molecules was lost and the
cross-presenting ability was strongly reduced. The authors further demon-
strated that TLR signals are important to trigger phosphorylation of SNAP23
in phagosomes, thus stabilizing the SNARE complexes that mediate ERC-
phagosome fusion and allowing for the delivery of MHC class I molecules
to DC phagosomes (Nair-Gupta et al., 2014).
The second study focused on Rab22a, which interestingly also colo-
calizes at Rab11+/MHC class I+ endosomal recycling compartments
(Cebrian et al., 2016). In different cell types, Rab22a is distributed in early
and sorting endosomes, associates with tubular recycling structures and is
required for endosomal sorting and recycling of cargo (reviewed extensively
in Mayorga and Cebrian, 2018). In DCs, Rab22a is found in similar subcel-
lular compartments, but is recruited to DC endosomes and phagosomes with
kinetics characteristic for early endosomal markers. After silencing Rab22a
in DCs, the intracellular pool of MHC class I in the ERC was drastically
reduced, and these molecules were no longer efficiently recruited to
phagosomes or recycled to the plasma membrane. As a result, Rab22a
KD cells failed to cross-present soluble, particulate and Toxoplasma gondii-
associated exogenous antigens. Nevertheless, endogenous MHC class
I antigen presentation was not disrupted by the silencing of Rab22a, indi-
cating a functioning ER to Golgi transport (Cebrian et al., 2016). Interest-
ingly, Rab22a does not play a relevant role during the delivery of ER
components to DC phagosomes, but it does interfere with the normal
recruitment of ER-derived proteins to DC endosomes. In line with this,
endosomal maturation but not phagosomal maturation of internalized latex
beads was altered following silencing of Rab22a (Croce et al., 2017).
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In summary, while the existing evidence points to a major role for

recycling of MHC class I molecules in cross-presenting DCs additional
investigations are needed in order to better understand its role in cross-
presentation. More studies might help to identify new molecular targets
and develop helpful tools to further study this process.
4.4 Trimming of the antigen within the cross-presenting

organelle and loading onto MHC class I molecules
In order to optimize proteasome-degraded antigenic peptides in phago/
endosomes, the PLC (as described above) must be recruited to the cross-
presenting organelle. Although such recruitment is subject to debate, many
studies have addressed and corroborated the presence of ER-derived pro-
teins, as well as MHC class I molecules, within phagocytic compartments.
The first studies demonstrated the presence of ER-resident proteins in
phagosomes of macrophages and Dictyostelium discoideum (Gagnon et al.,
2002; Muller-Taubenberger et al., 2001). While a separate study failed to
detect ER-resident proteins in phagosomes (Touret et al., 2005), many
groups have reported the presence of ER proteins within phagosomes using
different methods such as optical and electron microscopy. The first solid
evidence of an interaction between the ER and phagosomes was published
by Cresswell et al., who demonstrated that N-glycosylation, a specific
feature of the ER, could also occur within phagosomes of human
DCs (Ackerman et al., 2006), a result later corroborated in mouse DCs
(Cebrian et al., 2011).
Amigorena’s laboratory further demonstrated a missing link between ER
and phagosomes. The SNARE protein Sec22b (resident in the ER-Golgi
intermediate compartment, ERGIC) and its partner STX4 promote the
fusion of vesicles containing ER cargo with phagosomes, and further recruit
TAP and the PLC to the cross-presenting organelle (Cebrian et al., 2011)
(Fig. 7). Genetic silencing of Sec22b impairs the recruitment of the PLC,
decreases antigen export to the cytosol, accelerates phagosomal maturation
and thereby inhibits cross-presentation. Of notice, classical MHC class I and
II pathways are not affected by silencing of Sec22b. The importance of
phagosomal maturation for cross-presentation has also been established in
other articles (Alloatti et al., 2015, 2016; Samie and Cresswell, 2015). Fur-
thermore, a mice with a DCs specific deletion of Sec22b demonstrated
a defect in cross-presentation in vivo, while classical MHC class I and II
presentation remained unaffected (Alloatti et al., 2017).
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Fig. 7 Delivery of ER-resident proteins to the phagosome and peptide processing and
loading. (1) the constituents of the PLC (calreticulin, ERp57, tapasin, TAP1 and 2) are rec-
ruited to the cross-presenting organelle in a mechanism mediated by the SNARE protein
Sec22b, an ERGIC-resident protein. The interaction of Sec22b and its partner, Stx4 pro-
motes membrane fusion of the vesicles containing Sec22b with the phagosome, and
hence ER cargo is delivered to the organelle; (2) antigens degraded by the proteasome
are translocated to the phagosomes by TAP, and (3) associated with the PLC are further
trimmed by the aminopeptidase IRAP; (4) the MHC class I/peptide complex is released
from the PLC and (5) transported to the cell surface where is recognized by CD8+ T cells
and prime specific immune responses. Steps not fully characterized, with unclear or
conflicting evidence, are showed in arrows with dashed lines.
The presence of aminopeptidases in phagosomes, such as IRAP (a close

relative of ERAP1) also validates the hypothesis of phagosomal loading of
antigenic peptides. Silencing of ERAP1 and IRAP inhibit antigen cross-
presentation (Saveanu et al., 2005, 2009; Weimershaus et al., 2012). Finally,
OVA-derived peptides loaded onto MHC class I molecules have been
detected in phagosomes (Ackerman et al., 2006; Basha et al., 2008;
Burgdorf et al., 2008; Crespo et al., 2013; Guermonprez et al., 2003). These
data strengthen the idea that the phagosome (or endosome) itself constitutes
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a cross-presenting organelle and current evidence favors phagosomal loading

over ER loading. Still, many features remain partially or completely uni-
dentified such as the role of the “vacuolar” route in vivo, the mechanisms
involved in antigen export to cytosol, TAP-independent “cytosolic” route,
and he identification of other key participating proteins, while some of the
existing data remains ambiguous (Touret et al., 2005; Wu et al., 2017). Hence
more research is needed in order to understand and clarify the pathway.
5. Cross-presentation in immunity and cancer.

Immunotherapy and beyond
Cross-presentation has been implicated in immune responses against
multiple pathogens. However, CD8+ T cell responses can be generated
either by direct- or cross-presentation, which depends on the nature of
the microbe. For instance, anti-vaccinia CD8+ T cell responses are mainly
a result of direct-presentation (Hickman et al., 2008; Xu et al., 2010), as
demonstrated by dynamic intravital imaging. CD8+ T cell responses to
Toxoplasma gondii, however, are mainly generated by cross-presentation of
antigens captured from their surroundings by uninfected DCs ( John
et al., 2009). Several other reports have suggested the relevance of antigen
cross-presentation in the control of viral, bacterial or parasitic infections
(Allan et al., 2003, 2006; Belz et al., 2004; Shio et al., 2013; Wilson
et al., 2006). The most relevant evidence was generated by Hildner et al.,
who demonstrated that mice genetically silenced for Batf3, lacking the
two most important cross-presenting DCs subsets (resident CD8+ DCs
and migratory CD103+ DCs), mount weak immune responses against
Sendai and West Nile viruses (Hildner et al., 2008). However, the lack of
cross-presenting DC subtypes could also affect direct antigen presentation
and in following studies, several groups demonstrated that the absence of
such DCs subtypes promotes a marked decrease in IL-12 production, which
can have significant impact on the ensuing immune response (Ashok et al.,
2014; Iborra et al., 2015; Mashayekhi et al., 2011). This study addressed
the relevance of cross-presentation and cross-presenting cells for the first
time in vivo.
The role of antigen cross-presentation in priming antitumor immune
responses is, however, less clear, but evidence highlighting the relevance of
such a mechanism is accumulating. In 2003, Nowak et al. showed that the
induction of apoptosis in tumor cells increased antigen cross-presentation
and cross-priming of specific CD8+ T cells against tumor antigens, thus
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controlling tumor growth (Nowak et al., 2003). More importantly, Batf3 KO

mice were found to be deficient in eliciting CD8+ cytotoxic responses
against syngeneic tumors (Hildner et al., 2008). Additionally, the group of
Dr. Krummel identified a particular subset of DCs batf3-dependent with
the capacity to infiltrate solid tumors and cross-present tumor antigens in order
to prime or reprime specific CD8+ T cells (Broz et al., 2014). However, other
batf3-independent DC subsets have been implicated in the immune system-
dependent antitumor activity of anthracyclines (Ma et al., 2013) and mediate
tumor control under activating conditions in batf3-deficient mice (Tussiwand
et al., 2012). In order to isolate the role of antigen cross-presentation for this
finding, the group could further demonstrate that mice, deficient in the
WDFY4, a protein thought to participate during the translocation of dead-cell
antigen to the cross-presenting organelle, were deficient controlling tumor
growth, as well as eliciting anti-viral CD8+ T cell immune responses
(Theisen et al., 2018). In accordance with this, mice with a DC specific dele-
tion of Sec22b also failed to elicit CD8+ T cell responses against dead cell-
derived antigens and failed to control EG7-OVA tumor growth (Alloatti
et al., 2017). Importantly, Sec22b-dependent antigen cross-presentation
proved to be important for anti-PD-1 treatment efficacy. Melero et al. also
showed that both cross-presenting DC subsets, migratory CD103+ DCs
and resident CD8+ DCs, are required for efficient anti-PD-1 treatment and
radiotherapy of tumors (Sanchez-Paulete et al., 2016). In summary, cross-
presentation seems to play a critical role not only by eliciting antitumor
CD8+ cytotoxic responses, but also by regulating the outcome of anti-immune
checkpoint therapies.
Acknowledgments
We would like to thank Dr. Ulf Ghermann for critical reading of the manuscript and valuable
scientific and grammar suggestions. This work was supported by the “Agencia Nacional de
Promoción Cientı́fica y Tecnológica” in Argentina throughout the grants PICT 2016-1089
and PICT 2016-201-0227 (Dr. Kotsias); PICT 2016-0013 (Dr. Cebrian) and PICT 2017-
1367 (Dr. Alloatti).
We appreciate the impulse that science received in our country as per the period
2003–2015. The authors would also like to mention the current economic crisis that
is collapsing the scientific system in Argentina.
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ARTICLE IN PRESS

International Review of Cell and Molecular Biology # 2019 Elsevier Inc. 1

2 Fiorella Kotsias et al.

Antigen processing and presentation 3

4 Fiorella Kotsias et al.

Antigen processing and presentation 5

years thanks to the development of specific tools which enabled to study it in

6 Fiorella Kotsias et al.

Fig. 1 Schematic representation of different pathways for antigen processing and

Antigen processing and presentation 7

In the following, we describe the different antigen presentation pathways

2. Classical MHC class I presentation

8 Fiorella Kotsias et al.

and peptide trimming by aminopeptidases in the ER lumen (described

Antigen processing and presentation 9

10 Fiorella Kotsias et al.

ER aminopeptidase associated with antigen processing (ERAAP in mice), or

3. Classical MHC class II antigen presentation

Antigen processing and presentation 11

CIITA and the induction of MHC class II expression. Other important

12 Fiorella Kotsias et al.

Antigen processing and presentation 13

restricting HLA-DM activity to more acidic compartments (Denzin et al.,

14 Fiorella Kotsias et al.

via polyubiquitylation. The E3 ubiquitin ligase MARCH1 can ubiquitylate

3.1 Receptor-mediated endocytosis

Antigen processing and presentation 15

the assembly of the clathrin coat, further consisting of other components

16 Fiorella Kotsias et al.

3,4,5-trisphosphate [PtdIns(3,4,5)P3] at the plasma membrane. The nega-

Antigen processing and presentation 17

polymerization. After receptor-mediated antigen recognition, different sig-

18 Fiorella Kotsias et al.

drastic acidification of the phagosomal lumen. In macrophages, phagosomes

Antigen processing and presentation 19

Autophagosomes can then fuse with endosomes to generate a new organelle

20 Fiorella Kotsias et al.

Antigen processing and presentation 21

antigen presentation properties, could explain the heterogeneity in the abil-

4.1 Endo/phagosomal antigen processing for

22 Fiorella Kotsias et al.

mechanisms: phagocytosis, receptor-mediated endocytosis or mac-

Antigen processing and presentation 23

24 Fiorella Kotsias et al.

Fig. 4 Phagosomal processing of antigens during cytosolic cross-presentation. (1) Inter-

Antigen processing and presentation 25

26 Fiorella Kotsias et al.

was shown to participate in the recruitment of cytochrome b558/NOX2 to

Antigen processing and presentation 27

degradation and thus seems to oppose cross-presentation. How is antigen

28 Fiorella Kotsias et al.

(Streng-Ouwehand et al., 2016). Coadministration of the inert particulate

Antigen processing and presentation 29

export of antigens to the cytosol (Delamarre et al., 2003; Gil-Torregrosa

30 Fiorella Kotsias et al.

4.2 Translocation of mildly degraded antigens to the cytosol,

Antigen processing and presentation 31

32 Fiorella Kotsias et al.

Although different mechanisms of antigen translocation to the cytosol