Targeting Proteasomes and the MHC Class I Antigen Presentation Machinery to Treat Cancer, Infections and Age-Related Diseases

Simple Summary Proteasomes are highly complex, macromolecular, protein-degrading machines that execute the controlled elimination of intracellular proteins. Proteasome-dependent protein degradation governs numerous essential cellular processes that regulate cell and circadian cycles, transcription, growth, and development, and execute the efficient removal of abnormal, denatured, and misfolded polypeptides and proteins. Immunoproteasomes represent a highly specialized proteasomal variant that degrades proteins in cells exposed to oxidative stress and proinflammatory stimuli. Immunoproteasomes are significantly elevated in immune cell types and generate oligopeptides that are exhibited on the tumor complexed with MHC class I molecules to facilitate surveillance mechanisms that eradicate cancer cells. Immunoproteasomes represent actionable therapeutic targets that can be pharmacologically manipulated to treat cancer and infectious diseases, as well as proteinopathies characterized by the pathologic accumulation of toxic, proteinaceous aggregates.Abstract The majority of T-cell responses involve proteasome-dependent protein degradation and the downstream presentation of oligopeptide products complexed with major histocompatibility complex (MHC) class I (MHC-I) molecules to peptide-restricted CD8+ T-cells. However, evasion of host immunity is a cancer hallmark that is achieved by disruption of host antigen processing and presentation machinery (APM). Consequently, mechanisms of immune evasion promote cancer growth and survival as well as de novo and acquired resistance to immunotherapy. A multitude of cell signaling pathways modulate the APM and MHC-I-dependent antigen presentation. Pharmacologics that specifically target and modulate proteasome structure and activity represent a novel emerging strategy to improve the treatment of cancers and other diseases characterized by aberrant protein accumulation. FDA-approved pharmacologics that selectively activate proteasomes and/or immunoproteasomes can be repositioned to overcome the current bottlenecks that hinder drug development to enhance antigen presentation, modulate the immunopeptidome, and enhance the cytotoxic activity of endogenous or engineered T-cells. Strategies to enhance antigen presentation may also improve the antitumor activity of T-cell immunotherapies, checkpoint inhibitors, and cancer vaccines. Proteasomes represent actionable therapeutic targets to treat difficult-to-treat infectious processes and neurodegenerative diseases that are characterized by the unwanted accrual of insoluble, deleterious, and potentially toxic proteins. Taken together, we highlight the breadth and magnitude of the proteasome and the immense potential to amplify and unmask the immunopeptidomic landscape to improve the treatment of a spectrum of human diseases.