Regulatory T cells and immunoglobulin E: A new therapeutic link for autoimmunity?

Autoimmune diseases have a prevalence of approximately 7 to 9% and are classified as either organ-specific diseases, including type I diabetes, multiple sclerosis, inflammatory bowel disease and myasthenia gravis, or systemic diseases, including systemic lupus erythematosus, rheumatoid arthritis and Sjögren's syndrome. While many advancements have been made in understanding of the mechanisms of autoimmune disease, including the nature of self-tolerance and its breakdown, there remain unmet needs in terms of effective and highly targeted treatments. T regulatory cells (Tregs) are key mediators of peripheral tolerance and are implicated in many autoimmune diseases, either as a result of reduced numbers or altered function. Tregs may be broadly divided into those generated in the thymus (tTregs) and those generated in the periphery (pTregs). Tregs target many different immune cell subsets and tissues to suppress excessive inflammation and to support tissue repair and homeostasis: there is a fine balance between Treg cell stability and the plasticity that is required to adjust Tregs' regulatory purposes to particular immune responses. The central role of immunoglobulin E (IgE) in allergic disease is well recognized, and it is becoming increasingly apparent that this immunoglobulin also has a wider role encompassing other diseases including autoimmune disease. Anti-IgE treatment restores the capacity of plasmacytoid dendritic cells (pDCs) impaired by IgE- high-affinity IgE receptor (FcεR1) cross-linking to induce Tregs in vitro in atopic patients. The finding that antiIgE therapy restores Treg cell homeostasis, and that this mechanism is associated with clinical improvement in asthma and chronic spontaneous urticaria suggests that antiIgE therapy may also have a potential role in the treatment of autoimmune diseases in which Tregs are involved

Reconstructed Marine Fisheries Catches at a Remote Island Group:Pitcairn Islands (1950–2014)

The remote Pitcairn Island Group in the South Pacific was designated one of the world's largest marine reserves in 2016, encompassing some of the few remaining near-pristine areas within EEZ boundaries. Pitcairn's domestic fisheries are small-scale, and consist mainly of subsistence (non-commercial) and limited artisanal (commercial) catches. There is no locally-based industrial (large-scale commercial) fishery and the level of foreign industrial activity in recent times has been minimal, due in part to the low biomass of commercially valuable species, along with economic constraints of the EEZ's geographic isolation. Using a catch reconstruction method we estimated the total domestic marine catches for the Pitcairn Islands from 1950 to 2014. We show that overall the Pitcairn Islands' small-scale fisheries catches were almost 2.5 times higher than the data reported by the Food and Agriculture Organization (FAO) of the United Nations on behalf of the Pitcairn Islands, however, this primarily reflects discrepancies prior to the 1980s. Overall, catches for the subsistence and artisanal sectors started with around 12 t·year−1 in 1950, but declined to 4 t·year−1 by 2014. Domestic reconstructed subsistence catch levels were entirely driven by changes in the human population on the island, with reconstructed artisanal catches only occurring in recent years (2000 onwards). Industrial fishing is entirely executed by foreign vessels, this catch is considerably variable throughout the years and ceases entirely in 2006. The implementation of one of the world's largest marine reserves surrounding the offshore waters of Pitcairn Island has been specifically designed not to affect the rates of subsistence and artisanal fishing conducted by the resident population. Although there is no industrial fishing in the Pitcairn EEZ at present, climate change is predicted to influence the routes of migrating commercially-targeted species, potentially altering fishing effort levels and shift target fishing zones. Implementation of MPAs such as the Pitcairn Island Marine Reserve protect large oceanic areas from risk of future industrial exploitation, whilst protecting near-shore reef and deep-water zones, maintaining domestic coastal fisheries vital for local communities

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2