Integrierte Forschungs- und Behandlungszentren

The aim of the present study was to show the development of the revised and shortened German version (6 items) of the "Systems of Belief Inventory" (SBI-6R-D) as well as to examine its psychometric properties. In a representative German sample the questionnaire has been given to 2513 subjects. A confirmatory factor analysis has been made to prove the original American factor structure. Measurement invariance was tested using multigroup analysis. Correlations were used to determine convergent and discriminant validity towards other items. The SBI-6R-D showed good item and scale characteristics as well as good model fit. In difference to the work of Albani et al. (SBI-15R-D), the 2 factorial structure of the original American questionnaire could be replicated. Scalar invariance could be shown for gender and age, metric invariance for denomination and federal state. Due to the good psychometric properties of the questionnaire it should be further analyzed in future research with other validated religious instruments. The new German short version, the SBI-6R-D, is an economic, reliable and valid questionnaire to measure spiritual and religious attitudes.

B lymphocytes are key players in humoral immunity, expressing diverse surface immunoglobulin receptors directed against specific antigenic epitopes. The development and profile of distinct subpopulations have gained awareness in the setting of primary immunodeficiency disorders, primary or secondary autoimmunity and as therapeutic targets of specific antibodies in various diseases. The major B cell subpopulations in peripheral blood include naïve (CD19+ or CD20+IgD+CD27−), non-switched memory (CD19+ or CD20+IgD+CD27+) and switched memory B cells (CD19+ or CD20+IgD−CD27+). Furthermore, less common B cell subpopulations have also been described as having a role in the suppressive capacity of B cells to maintain self-tolerance. Data on reference values for B cell subpopulations are limited and only available for older age groups, neglecting the continuous process of human B cell development in children and adolescents. This study was designed to establish an exponential regression model to produce continuous reference values for main B cell subpopulations to reflect the dynamic maturation of the human immune system in healthy children.

Background: Post-transplant lymphoproliferative disease (PTLD) is a severe complication of immunosuppressive therapy after solid organ transplantation. In children, most PTLD cases are Epstein-Barr virus-(EBV) associated. Lack of EBV infection prior to transplantation and insufficient EBV-specific immunity are risk factors for PTLD development. Here we present data on EBV-specific T cells in patients treated with Rituximab ± chemotherapy on the Ped-PTLD Pilot 2005 protocol. Patients and methods: Patients with CD20+ PTLD were treated by Rituximab monotherapy (3 weekly infusions). Response was assessed on day 21. If at least a partial remission was achieved patients received 3 more Rituximab infusions every 3 weeks. In patients with no response to antibody treatment a moderate chemotherapy (cytoxan, vincristine, low dose methotrexate and prednisone) was initiated. Peripheral blood mononuclear cells (PBMCs) were isolated from 15 pediatric patients with PTLD and 18 healthy controls. PBMC were stimulated with autologous EBV-transformed LCL, stained with extracellular antibodies for CD3, CD4, and CD8, followed by intracellular staining of interferon-g and detection by flow cytometry. EBV load was analyzed by quantitative PCR of whole blood. Myeloid and plamacytoid dendritic cells were enumerated in peripheral blood by flow cytometry. Laboratory results were correlated with clinical data from the Ped-PTLD registry. Results: At diagnosis, PTLD patients had similar numbers of EBV-specific CD4+ (mean 0.17%) and CD8+ (0.51%) T cells compared to healthy EBV-positive controls (0.18% and 0.49%). Numbers were lower in early (< 1 year after transplantation) compared to late PTLD. No difference in peripheral blood dendritic cell numbers as the pivotal initiator of T cell responses was noted between PTLD patients and healthy controls. In 11/12 evaluable patients, a modest increase in CD4+ and/or CD8+ EBV-specific T cells was noticed during treatment with Rituximab, possibly reflecting increased immunocompetence after reduction of immunosuppressive therapy and antigenic stimulation after liberation of EBV antigen from destroyed B cells. However, this increase did not predict response to Rituximab or chemotherapy. EBV load and circulating B cells decreased to zero in most patients during Rituximab treatment. After completion of treatment recurrence of B cells was accompanied by re-detection of EBV in peripheral blood, which was controlled by strong T cell responses in 12/14 cases. Conclusions: In pediatric PTLD patients numbers of EBV-specific T cells are in the range of healthy EBV seropositive controls. They increase moderately upon reduction of immunosuppression and treatment with Rituximab, but do not predict response to treatment in our cohort. In contrast, recurrence of EBV during complete remission is paralleled by strong T cell responses. EBV-specific T cell therapy may augment endogenous T cell responses to secure successful control of PTLD.

The reversible potassium channel blocker 4-aminopyridine is effective in the treatment of numerous cerebellar dysfunctions, such as episodic ataxia type 2 and downbeat nystagmus syndrome. In 2011, its sustained release form, dalfampridine, was admitted in Europe for the treatment of walking difficulties in patients with multiple sclerosis (MS). Here we report the case of a 44-year old patient with a progressive MS whose upper limb tremor was markedly reduced under treatment with 4-aminopyridine, as documented in a Tremor Activities of Daily Living questionnaire and in the 9-Hole Peg test. Hand accelerations decreased in the left hand from 10.9 m/sec2 to 2.2 m/sec2 and in the right hand from 4.2 m/sec2 to 0.9 m/sec2. This case report indicates for the first time that 4-aminopyridine might be effective in the symptomatic treatment of tremor entities in patients with MS. The finding calls for further prospective studies to determine the usefulness of 4-aminopyridine or its sustained-release form dalfampridine in treating patients with tremor and MS.