Macroautophagy, a homeostatic process that shuttles cytoplasmic constituents into endosomal and lysosomal compartments, has recently been shown to deliver antigens for presentation on major histocompatibility complex (MHC) class II molecules. Skeletal muscle fibers show a high level of constitutive macroautophagy and express MHC class II molecules upon immune activation. We found that tumor necrosis factor-␣ (TNF-␣), a monokine overexpressed in inflammatory myopathies, led to a marked up-regulation of macroautophagy in skeletal myocytes. Furthermore, TNF-␣ augmented surface expression of MHC class II molecules in interferon-␥ (IFN-␥)-treated myoblasts. The synergistic effect of TNF-␣ and IFN-␥ on the induction of MHC class II surface expression was not reflected by higher intracellular human leukocyte antigen (HLA)-DR levels and was reversed by macroautophagy inhibition, suggesting that TNF-␣ facilitates antigen processing via macroautophagy for more efficient MHC class II loading. Muscle biopsies from patients with sporadic inclusion body myositis, a well defined myopathy with chronic inflammation, showed that over 20% of fibers that contained autophagosomes costained for MHC class II molecules and that more than 40% of double-positive muscle fibers had contact with CD4 ؉ and CD8 ؉ immune cells. These findings establish a mechanism through which TNF-␣ regulates both macroautophagy and MHC class II expression and suggest that macroautophagy-mediated antigen presentation contributes to the immunological environment of the inflamed human skeletal muscle.Autophagy is a homeostatic process that enables eukaryotic cells to deliver cytoplasmic constituents for lysosomal degradation, for example to recycle nutrients for survival during starvation. In addition to this original function, autophagy has emerged as a key mechanism in orchestrating innate and adaptive immune responses. During macroautophagy, the major route of degradation of cytoplasmic constituents, proteins, and organelles are sequestered inside double-membrane vesicles (autophagosomes) that fuse with lysosomes/late endosomes. In the fusion vesicles, often multivesicular and multilamellar amphisomes, the captured material is degraded, and antigenic fragments are loaded onto major histocompatibility complex (MHC) class II molecules for presentation to CD4 ϩ T cells. In turn, innate and adaptive immune signals are capable of regulating macroautophagy via cytokine secretion and cell contact-dependent mechanisms (1-3).In vivo analysis of macroautophagy in transgenic mice expressing the GFP-coupled specific autophagosome marker light chain 3 (LC3), one mammalian homologue of yeast autophagy-related gene 8 (Atg8), demonstrated that the regulation of macroautophagy is organ-dependent and that some tissues produce LC3-positive autophagosomes even in the absence of nutrient starvation. Such constitutive autophagosomal activity has been observed in metabolically active tissues such as liver, thymus, and skeletal muscle (4).Skeletal myocytes are facultative antigen-p...