Background: Immunoglobulin free light chains (FLC) form the substrate for synthesis of amyloid fibrils in patients with AL amyloidosis. Development of FLC assay (Freelite) has allowed us to better assess the clonal cell burden in patients with AL amyloid. The relationship of the light chain types and their levels in serum to the clinical feature at presentation and the eventual outcome has not been systematically studied.. Methods: We identified 730 patients with biopsy proven AL amyloidosis, who were seen at Mayo Clinic between January 1980 and July 2006, who were seen within 90 days of their diagnosis and in whom FLC levels were performed or had stored serum available for analysis. Cardiac biomarkers (cTnT, NT ProBNP) were also performed on stored serum for some of the patients as part of previous studies. Clinical data and follow up status are prospectively collected into the Dysproteinemia database, which was used for the study.. Results: The median age of the study population was 63 years ...
Immunoglobulin light chain amyloidosis (AL) is characterized by a limited clonal expansion of plasma cells and amyloid formation. Here, we report restriction in the diversity of VL gene usage with a d
... (SFLC, kappa and lambda) are proteins produce by immune cells that are not part of whole (intact) antibodies. Lab tests measure free light chains in the blood and a kappa/lambda ratio to help diagnose multiple myeloma and related diseases.
TY - JOUR. T1 - Long-Term Outcome of Renal Transplantation in Light-Chain Deposition Disease. AU - Leung, Nelson. AU - Lager, Donna J.. AU - Gertz, Morie. AU - Wilson, Kirk. AU - Kanakiriya, Sharan. AU - Fervenza, Fernando Custodio. PY - 2004/1. Y1 - 2004/1. N2 - Background: Light-chain deposition disease (LCDD) is a monoclonal gammopathy characterized by nonamyloid deposition of light chain in various organs. A small number of kidney transplantations have been performed on LCDD patients in whom end-stage renal disease (ESRD) developed. Methods: The authors retrospectively reviewed the clinical and histologic findings and outcome of 7 patients with LCDD who underwent kidney transplantation at our institution. Results: Renal insufficiency, hypertension, and proteinuria were present in all 7 patients. Proteinuria level was greater than 3.5 g/24 h in 3 patients. Three patients had microscopic hematuria. Monoclonal protein was detected in the serum in 3 patients, urine in 5, and was undetectable in ...
Light-chain deposition disease (LCDD) is the deposition of monoclonal light chains in multiple organs. It is a rare disease characterized by deposition of nonamyloid immunoglobulin light chains, and they do not stain with Congo red and do not exhibit a fibrillar structure when examined ultrastructurally.
Immunoglobulin light chain gene translocations in non-Hodgkins lymphoma as assessed by fluorescence in situ hybridisation.: In non-Hodgkins lymphoma (NHL), th
Garver, F.A.; Chang, L.; Mendicino, J.; Isobe, T.; Osserman, E.F., 1975: Primary structure of a deleted human lambda type immunoglobulin light chain containing carbohydrate: protein Sm lambda
FRI0479 Serum Free Light Chains of Immunoglobulins Are Associated with Disease Activity in Systemic Sclerosis: A Prospective and Controlled Study ...
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This test has been cleared or approved by the U.S. Food and Drug Administration and is used per manufacturers instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements ...
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Immunoglobulin secretion by plasma cells infiltrating synovial membranes is a prominent feature of RA. Previous analyses of a cDNA library generated from synovium of RA patient BC revealed immunoglobulin κ light chain transcripts with extensive somatic mutation, frequent N region addition, and unexpected variation in the lengths of CDR3 regions which form the center of the antigen binding site. To determine if these characteristics are present in other individuals, we performed reverse transcription-polymerase chain reaction amplification and sequenced ≥10 Vκ-containing amplicons from nine tissue samples: synovia of three individuals with long-standing RA (including patient BC), PBLs of two of these individuals, and PBLs or splenocytes of four normal individuals. Increased levels of somatic mutation in PBLs appeared to correlate with increased age, which may reflect accumulation of circulating memory cells and/or decreased bone marrow production of naive B lymphocytes. Two of three RA ...
Because of the less-than-robust response to therapy and impact on choice of optimal chemotherapy and prognosis, chronic kidney disease has drawn attention in the treatment of multiple myeloma, a malignant hematologic disorder that can produce significant amounts of monoclonal immunoglobulin free light chains (FLCs). These low-molecular-weight proteins are relatively freely filtered through the glomerulus and are reabsorbed by the proximal tubule. The present study demonstrated that during the process of metabolism of immunoglobulin FLCs, ROS activated the STAT1 pathway in proximal tubule epithelium. STAT1 activation served as the seminal signaling molecule that produced the proinflammatory molecule IL-1β, as well as the profibrotic agent TGF-β by this portion of the nephron. These effects occurred in vivo and were produced specifically by the generation of hydrogen peroxide by the VL domain of the light chain. To the extent that the experiments reflect the human condition, these studies offer ...
This is an interesting study as it doesnt treat the underlying disease which is MM but is attempting to treat in an animal model a consequence of the disease. Cast nephropathy which leads to intra tubular obstruction can quickly lead to dialysis in many cases. This is a study that shows by using the CDR3 inhibitor, we prevent this bad light chain and THP combo and prevent the precipitation in the tubules. We also know that the free light chains behave differently in each MM case. In some cases, we get cast nephrpathy and in some cases we get light chain deposition disease and some amyloidosis. It appears to be characteristics of the specific light chains produced. While this method might be optimal for cast nephrpathy cases, dont know if this will prevent all MM associated renal diseases. Regardless, this study might lead to growing MM related cast nephropathy studies with this inhibitor; hopefully. ...
The comparison of UPEP and iFLC results at the time of diagnosis (baseline) showed that iFLC was a more sensitive measure of disease, with 100% of patients positive and "measurable" compared with 78% positive and 64% measurable by UPEP. This pattern of results was repeated with the assessments after 1 and 3 cycles of treatment and was also in accord with all other published studies of patients with confirmed diagnoses of LCMM.14,21 UPEP and iFLC were chosen as the measures for comparison as they are the methods approved for monitoring LCMM by the IMWG6 and are quantitative, in contrast to the more sensitive but nonquantitative uIFE or the more sensitive sFLC ratio which may become variable if the noninvolved light chain is highly suppressed.19 Nevertheless, achieving a normal sFLC has been shown to be a clinically relevant measure of treatment efficacy.22,23. The number of missing observations was much higher for the urine assays, particularly after cycle 1, with 60 missing, although urine ...
PubMed Central Canada (PMC Canada) provides free access to a stable and permanent online digital archive of full-text, peer-reviewed health and life sciences research publications. It builds on PubMed Central (PMC), the U.S. National Institutes of Health (NIH) free digital archive of biomedical and life sciences journal literature and is a member of the broader PMC International (PMCI) network of e-repositories.
Note Added in Proof to appear with the article: A Homologue of the Rabbit Kappa Chain Allotype b9 on IgG from a Cottontail Rabbit by Simonetta Landucci Tosi, Rose G. Mage, and Roberto M. Tosi appearing on page 679:. Extensive studies of the phylogeny of rabbit immunoglobulin light chain markers have recently been completed by W. van der Loo, C. Hamers-Casterman and R. Hamers, and reported in a brief communication entitled, "Phylogeny of the rabbit immunoglobulin light chain markers: Distribution of determinants associated with rabbit b-locus in different lagomorph families" published in Arch. Internat. Physiol. Biochim. 89, 54, 1976. A detailed report entitled, "Investigations of the origin of the b-locus polymorphism of the rabbit kappa light chain" is contained in the D. Sc. thesis, Vrije Universiteit Brussels by Dr. W. van der Loo, 1975. Their observations are generally in accord with ours.. ...
About 1 in 5 people with myeloma (20%) do not produce complete immunoglobulins (paraproteins). They only produce part of the immunoglobulin called the light chain (Bence Jones) protein.. The light chain proteins are smaller than complete immunoglobulins and show up in the blood and urine. This can be monitored through the traditional way of urine tests but more commonly now it is monitored in the blood through a test called serum free light chains.. This test can pick up free light chains in the blood and is easier as you dont have to collect 24 hours worth of urine every month. You may have both these tests to help diagnose and monitor this type of myeloma.. ...
Multi-subunit proteins which function in IMMUNITY. They are produced by B LYMPHOCYTES from the IMMUNOGLOBULIN GENES. They are comprised of two heavy (IMMUNOGLOBULIN HEAVY CHAINS) and two light chains (IMMUNOGLOBULIN LIGHT CHAINS) with additional ancillary polypeptide chains depending on their isoforms. The variety of isoforms include monomeric or polymeric forms, and transmembrane forms (B-CELL ANTIGEN RECEPTORS) or secreted forms (ANTIBODIES). They are divided by the amino acid sequence of their heavy chains into five classes (IMMUNOGLOBULIN A; IMMUNOGLOBULIN D; IMMUNOGLOBULIN E; IMMUNOGLOBULIN G; IMMUNOGLOBULIN M) and various subclasses.. ...
A patient is presented in whom the amyloid component of an intracerebral amyloidoma has been purified and characterized by amino acid sequence analysis. The material originated from an autopsy of a 76-year-old man who 15 years earlier had been operated for an intracerebral amyloid tumour. The tu …
AA (Inflammatory) AmyloidosisDiabetic NephropathyFamilial Renal AmyloidosisIgA NephropathyImmunoglobulin-Related AmyloidosisLight Chain-Associated Renal DisordersMultiple MyelomaNephrotic Syndrome
Addresses: Pilstrom L, Uppsala Univ, BMC, Immunol Programme, Dept Cell & Mol Biol, POB 596, S-75124 Uppsala, Sweden. Uppsala Univ, BMC, Immunol Programme, Dept Cell & Mol Biol, S-75124 Uppsala, Sweden.Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2011-01-14 ...
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Disease response was evaluated according to the IMWG-URC using a validated computer algorithm. Overall response rate was defined as the percentage of participants with a best overall response of stringent complete response (sCR), complete response (CR), very good partial response (VGPR), or partial response (PR).. sCR: As for CR, normal serum free light chain (SFLC) ratio and no clonal cells in bone marrow (BM).. CR: No immunofixation on serum and urine, disappearance of any soft tissue plasmacytomas and , 5% plasma cells in BM biopsy; VGPR: Serum and urine M-protein detectable by immunofixation but not electrophoresis or ≥ 90% reduction in serum M-protein with urine M-protein ,100 mg/24 hours. A ≥ 50% reduction in the size of soft tissue plasmacytomas if present at baseline.. PR: ≥ 50% reduction of serum M-protein and reduction in urine M-protein by ≥ 90% or to , 200 mg/24 hours. A ≥ 50% reduction in the size of soft tissue plasmacytomas if present at baseline.. ...
Disease response was evaluated according to the IMWG-URC using a validated computer algorithm. Overall response rate was defined as the percentage of participants with a best overall response of stringent complete response (sCR), complete response (CR), very good partial response (VGPR), or partial response (PR). sCR: As for CR, normal serum free light chain (SFLC) ratio and no clonal cells in bone marrow (BM). CR: No immunofixation on serum and urine, disappearance of any soft tissue plasmacytomas and , 5% plasma cells in BM biopsy; VGPR: Serum and urine M-protein detectable by immunofixation but not electrophoresis or ≥ 90% reduction in serum M-protein with urine M-protein ,100 mg/24 hours. A ≥ 50% reduction in the size of soft tissue plasmacytomas if present at baseline. PR: ≥ 50% reduction of serum M-protein and reduction in urine M-protein by ≥ 90% or to , 200 mg/24 hours. A ≥ 50% reduction in the size of soft tissue plasmacytomas if present at baseline ...
Sakato, N; Semma, M; Eisen, H N.; and Azuma, T, "A small hypervariable segment in the variable domain of an immunoglobulin light chain stimulates formation of anti-idiotypic suppressor t cells." (1982). Subject Strain Bibliography 1982. 3493 ...
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(HealthDay)-Elevated levels of polyclonal serum immunoglobulin combined free light chains (cFLCs) may indicate adverse cardiovascular disease (CVD) outcomes in patients with type 2 diabetes, according to research published ...
tetanospasmin: composed of a heavy chain and a light chain; the L chain is a zinc-dependent endopeptidase; classified as EC 3.4.24.68
TY - JOUR. T1 - Immunoglobulin light chain amyloidosis is diagnosed late in patients with preexisting plasma cell dyscrasias. AU - Kourelis, Taxiarchis. AU - Kumar, Shaji K. AU - Go, Ronald S.. AU - Kapoor, Prashant. AU - Kyle, Robert A.. AU - Buadi, Francis K.. AU - Gertz, Morie. AU - Lacy, Martha. AU - Hayman, Suzanne R.. AU - Leung, Nelson. AU - Dingli, David M. AU - Lust, John A.. AU - Lin, Yi. AU - Zeldenrust, Stephen R.. AU - Rajkumar, S Vincent. AU - Dispenzieri, Angela. PY - 2014/11/1. Y1 - 2014/11/1. N2 - AL amyloidosis (AL) is rare and frequently remains undiagnosed until organ function is compromised, even among patients with known pre-existing untreated plasma cell dyscrasias (PCD). We identified 168 patients with AL amyloidosis who had a prior untreated PCD. The earliest symptom or sign (s/s) was defined as the first symptom reported by the patient that could be attributed to organ dysfunction caused by AL. The interval from the time of development of s/s to the establishment of ...
Immunoglobulin light chain amyloidosis (AL) is a plasma cell dyscrasia characterized by deposition of amyloid fibrils in various organs and tissues, derived from monoclonal light chains, leading to organ dysfunction.1-3 High-dose melphalan with autologous stem cell transplant (HDM/SCT) is an effective treatment with high complete hematologic response rates (CR) and is capable of producing durable remissions and prolonged overall survival.4-6 Only selected patients are eligible to receive HDM/SCT, and treatment-related mortality is in the range of 5-15%. More effective and widely applicable treatment modalities in AL amyloidosis are, therefore, needed.. Clinical trials of alternate treatment options have tested non-transplant melphalan-based strategies and novel therapeutics such as lenalidomide and bortezomib. Oral melphalan and dexamethasone (M-Dex) is a standard regimen for patients not eligible to receive HDM/SCT; reported complete response rates range from 13% to 33% and median overall ...
TY - JOUR. T1 - Kappa light chain-associated Fanconis syndrome. T2 - Molecular analysis of monoclonal immunoglobulin light chains from patients with and without intracellular crystals. AU - Déret, Sophie. AU - Denoroy, Luc. AU - Lamarine, Marc. AU - Vidal, Ruben. AU - Mougenot, Béatrice. AU - Frangione, Blas. AU - Stevens, Fred J.. AU - Ronco, Pierre M.. AU - Aucouturier, Pierre. PY - 1999/5/17. Y1 - 1999/5/17. N2 - Plasma cell dyscrasias may be responsible for Fanconis syndrome, due to the toxicity of a free monoclonal kappa light chain toward kidney proximal tubules. Eight cases of Fanconis syndrome were analyzed. We compared the structures of VκI variability subgroup V domains from five cases of Fanconis syndrome and one myeloma without renal involvement. Among Fanconi cases, four putative structures were obtained after molecular modeling by homology, and the other had previously been refined by X-ray crystallography. The complete sequences of one VκI, one VκIII and N-terminal ...
Abstract. Background: Primary systemic amyloidosis (AL) is an incurable plasma cell disorder. Lenalidomide, especially in conjunction with dexamethasone, has b
Results The direct numeric result from hs-cTnT measurement cannot merely be substituted for a cTnT measurement in the Mayo AL staging system. The performance of the receiver operator curve derived an hs-cTnT cut-point of 54 ng/L which improves on the value of 35 ng/L validated with the prior iteration of the assay. An alternate staging option using hs-cTnT alone-using the two thresholds 14 ng/L and 54 ng/L-performs as well as either the original Mayo AL staging system or other systems incorporating hs-cTnT. On multivariate analysis, an hs-cTnT alone staging system was independent of period of diagnosis, type of therapy, and NT-proBNP value, the last of which dropped out of the model. Alternate models were explored, but none performed better than the original system or the new hs-cTnT system. Thus, hs-cTnT can be used alone for the staging of disease prognosis.. ...
So why do I think all of this is predatory in nature? I receive this bill every 20 days, the same bill, and my husband and I make the required phone calls to the medical facility and the primary insurance company. So far neither institution has been able to resolve this claim. If we failed to make these phone calls every 20 days this bill, in all likelihood, would go to collection and could balloon to twice what it is now with fees and interest. That being said, in this case the medical facility actually owns the collection agency that these bills go to so they not only get to collect the amount of the bill, but the fees and interest as well. That doesnt sound shady at all does it?. What most people dont know or dont care to take advantage of is that if you call the medical facility that has sent you a bill to make payment arrangements or to dispute the charges they, in most circumstances, will not send you to collection; however, you have to call them EVERY TIME you receive the same bill. ...
TY - JOUR. T1 - Hereditary systemic immunoglobulin light-chain amyloidosis. AU - Benson, Merrill. AU - Liepnieks, Juris J.. AU - Kluve-Beckerman, Barbara. PY - 2015. Y1 - 2015. N2 - Several members of a family died from renal failure as a result of systemic amyloidosis. Extensive studies to detect previously documented gene mutations associated with amyloidosis failed to identify a causative factor. In search of the genetic basis for this syndrome, amyloid fibrils were isolated from renal tissue of a member of the kin who died while on renal dialysis. Amino acid sequencing of isolated amyloid protein identified sequences compatible with the constant region of the immunoglobulin κ light-chain. Isolation and characterization of κ light-chain protein from serum of an affected member of the kindred revealed mutation in the constant region of kκlight-chain, with cysteine replacing serine at amino acid residue 131. This mutation (Ser131Cys) was confirmed by DNA analysis, which identified a ...
Light chain deposition disease (LCDD) is a rare clinical disorder. The deposition of light chain immunoglobulins mainly affects the kidneys, which have different characteristics than other tissues. To date, the therapeutic approach for the treatment of LCDD has no evidence-based consensus, and clinical experience of reported cases guides current disease management strategies. The present systematic review investigates and summarizes the pathological mechanisms of renal injury and the subsequent treatments for LCDD.
TY - JOUR. T1 - Cardiac Light Chain Amyloidosis: The Role of Metal Ions in Oxidative Stress and Mitochondrial Damage. AU - Diomede, L.. AU - Romeo, M.. AU - Rognoni, P.. AU - Beeg, M.. AU - Foray, C.. AU - Ghibaudi, E.. AU - Palladini, G.. AU - Cherny, R. A.. AU - Verga, L.. AU - Capello, G. L.. AU - Perfetti, V.. AU - Fiordaliso, F.. AU - Merlini, G.. AU - Salmona, M.. N1 - LR: 20170920; JID: 100888899; OTO: NOTNLM; PMCR: 2018/09/20 00:00; 2018/09/20 00:00 [pmc-release]; 2017/01/31 06:00 [pubmed]; 2017/01/31 06:00 [medline]; 2017/01/31 06:00 [entrez]; ppublish. PY - 2017/9/20. Y1 - 2017/9/20. N2 - AIMS: The knowledge of the mechanism underlying the cardiac damage in immunoglobulin light chain (LC) amyloidosis (AL) is essential to develop novel therapies and improve patients outcome. Although an active role of reactive oxygen species (ROS) in LC-induced cardiotoxicity has already been envisaged, the actual mechanisms behind their generation remain elusive. This study was aimed at further ...
Current criteria for differential diagnosis of multiple myeloma (MM), Monoclonal gammopathy of undetermined significance (MGUS), and smoldering multiple myeloma (SMM) are included in the 2003 guidelines by the International Myeloma Working Group (IMWG). An updated version was then published in 2014, highlighting the importance of serum free light chain (sFLC) detection, as well as the κ/λ ratio as excellent indicators of clonality. At present, two commercial assays for sFLC quantification are available: the Freelite™ assay and the N-Latex assay. The first was developed by The Binding Site based on a mixture of polyclonal antibodies directed against a variety of FLC epitopes. It may be run on a wide range of nephelometers, as well as on turbidimeters. The second method was developed by Siemens and runs exclusively on Siemens instruments. It employs a probe mixture of mouse monoclonal antibodies. The aim of our study was to evaluate sFLC measurement and calculated κ/λ ratio in 85 patients with
OBJECTIVES: This study investigated the prevalence and potential incremental prognostic value of combined free light chains (cFLCs) in patients recently hospitalized with decompensated heart failure (HF). BACKGROUND: Inflammatory pathways are recognized in the pathogenesis and progression of HF. Free light chain (FLC) elevation is conventionally associated with monoclonal gammopathies, including multiple myeloma. Polyclonal increases in both kappa and lambda FLCs occur in autoimmune and other chronic inflammatory conditions. Recently, a novel assay for measuring kappa and lambda immunoglobulin FLCs together, known as combined free light chain (cFLC) has been developed. METHODS: Six hundred twenty-eight patients recently hospitalized with decompensated HF were studied. cFLCs were measured by turbidimetry using an immunoassay. The incremental prognostic value of cFLCs for mortality was evaluated using Cox proportional hazard models including 22 established predictors of outcome in HF. RESULTS: Of 628
Lenti ORF particles, Igk (Myc-DDK-tagged) - Mouse immunoglobulin kappa chain, constant region (cDNA clone MGC:102611 IMAGE:4219669), 200 uL, |10^7 TU/mL, 200 µl.
Cardiovascular diseases remain a significant cause of morbidity and mortality in developed countries. The amyloidoses are an important group of systemic diseases that cause substantial cardiac impairment. Recently there have been advances in the manner in which these diseases are diagnosed, classified, and treated. Topics to be covered in this session included amyloid subtyping techniques including mass spectrometry, classification of the amyloidoses including new and rare forms of amyloid, the state of the art use of protein folding inhibitors to treat amyloidosis, and the results obtained from an a new international consortium for performing cardiac transplantation coupled with stem cell transplantation to treat immunoglobulin light chain amyloidosis. The session will be capped by Dr. Michael Fishbein, the recipient of the SCVP Distinguished Achievement Award, speaking on arteriosclerosis. In addition, there will be a portion of the session devoted to short presentations by a selected subset ...
Sjögren’s syndrome, sarcoidosis and systemic immunoglobulin light chain amyloidosis all share common features when analyzed through salivary gland ultrasound, according to findings published in Arthritis Care & Research.“Ultrasound is becoming substantially more popular for imaging of salivary glands in the rheumatology community,” Eugene Kissin, MD, of Boston University
A common renal complication of multiple myeloma is "myeloma kidney," a condition also known as cast nephropathy. The renal lesions (casts) are directly related to the production of monoclonal immunoglobulin free light chains (FLCs), which coprecipitate with Tamm-Horsfall glycoprotein (THP) in the lumen of the distal nephron, obstructing tubular fluid flow. Here, we report that analysis of the binding interaction between FLCs and THP demonstrates that the secondary structure and key amino acid residues on the complementarity-determining region 3 (CDR3) of FLCs are critically important determinants of the molecular interaction with THP. The findings permitted development of a cyclized competitor peptide that demonstrated strong inhibitory capability in the binding of FLCs to THP in vitro. When used in a rodent model of cast nephropathy, this cyclized peptide construct served as an effective inhibitor of intraluminal cast formation and prevented the functional manifestations of acute kidney injury ...
HCAK 1, HCAK1, Ig kappa chain C region, IGKC, Immunoglobulin kappa constant, Immunoglobulin kappa constant region, Immunoglobulin kappa light chain, Kappa 1 immunoglobulin light chain, Km, MGC111575, MGC62011, MGC72072, MGC88770, MGC88771, MGC88809.
Rat anti Mouse kappa light chain antibody, clone LO-MK-1 recognises the murine kappa immunoglobulin light chain, and does not cross-react
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Rabbit light chain 3315, prepared from a homogeneous antipneumococcal antibody, was subjected to hydrolysis by pepsin without prior reduction and alkylation of the intrachain disulfide bonds. Gel filtration of the hydrolysate on Sephadex G-10, G-15, and G-25 and ion exchange chromatography on SP-Sephadex yielded several disulfide bridge peptides. These were fully reduced and alkylated and sequenced by Edman degradation. The peptides were located in the light chain sequence determined in independent studies from our laboratory.. The half-cystine residues in this κB rabbit chain are located at positions 23, 80, 88, 134, 171, 194, and 214. The extra disulfide bridge extends between residues 80 and 171, thus joining the variable and constant domains. This is consistent with x-ray diffraction crystallographic studies showing that the corresponding residues in human light chains are separated by a distance compatible with disulfide bond formation.. ...
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Hozumi, N; Wu, G; Murialdo, H; Baumal, R; Mosmann, T; Winberry, L; and Marks, A, "Arrangement of lambda light chain genes in mutant clones of the mopc 315 mouse myeloma cells." (1982). Subject Strain Bibliography 1982. 402 ...