Bence Jones protein explained

Bence Jones protein is a monoclonal globulin protein or immunoglobulin light chain found in the urine, with a molecular weight of 22–24 kDa.^[1] Detection of Bence Jones protein may be suggestive of multiple myeloma,^[2] or Waldenström's macroglobulinemia.

Bence Jones proteins are particularly diagnostic of multiple myeloma in the context of target organ manifestations such as kidney failure, lytic (or "punched out") bone lesions, anemia, or large numbers of plasma cells in the bone marrow. Bence Jones proteins are present in 2/3 of multiple myeloma cases.^[3]

The proteins are immunoglobulin light chains (paraproteins) and are produced by neoplastic plasma cells. They can be kappa (most of the time) or lambda.^[3] The light chains can be immunoglobulin fragments or single homogeneous immunoglobulins. They are found in urine as a result of decreased kidney filtration capabilities due to kidney failure, sometimes induced by hypercalcemia from the calcium released as the bones are destroyed, dehydration due to polyuria, amyloidosis or from the light chains themselves. The light chains were historically detected by heating a urine specimen (which causes the protein to precipitate) and nowadays by electrophoresis of concentrated urine.^[4] More recently, serum free light chain assays have been utilised in a number of published studies which have indicated superiority over the urine tests, particularly for patients producing low levels of monoclonal free light chains, as seen in nonsecretory multiple myeloma^{[5] [6] [7]} and amyloid light chain amyloidosis (AL amyloidosis).^{[7] [8] [9] [10]}

History

The Bence Jones protein was described by the English physician Henry Bence Jones in 1847 and published in 1848.^[11]

Notes and References

1. Bernier, G. M. & Putnam, F. W. (1963). Nature (London), 200, 223±225.
2. Web site: Anderson . Alyssa . What Is a Bence-Jones Protein Test? . WebMD . 27 September 2023 . en.
3. Book: Hoffbrand V, Moss P, Pettit J . Essential Haematology (Essential) . limited . 5th . Blackwell Publishing Professional . 2006 . 978-1-4051-3649-5 . 218.
4. Web site: Bence Jones Protein Test. TheFreeDictionary.com.
5. Drayson M, Tang LX, Drew R, Mead GP, Carr-Smith H, Bradwell AR . Serum free light-chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma . Blood . 97 . 9 . 2900–2 . May 2001 . 11313287 . 10.1182/blood.V97.9.2900. 8779162 . free .
6. Shaw GR . http://www.archivesofpathology.org/doi/10.1043/1543-2165(2006)130[1212:NPCMEM2.0.CO;2 Nonsecretory plasma cell myeloma--becoming even more rare with serum free light-chain assay: a brief review ]. Archives of Pathology & Laboratory Medicine . 130 . 8 . 1212–5 . August 2006 . 16879026 . 10.5858/2006-130-1212-NPCMEM .
7. Katzmann JA, Abraham RS, Dispenzieri A, Lust JA, Kyle RA . Diagnostic performance of quantitative kappa and lambda free light chain assays in clinical practice . Clinical Chemistry . 51 . 5 . 878–81 . May 2005 . 15774572 . 10.1373/clinchem.2004.046870. free .
8. Lachmann HJ, Gallimore R, Gillmore JD . Outcome in systemic AL amyloidosis in relation to changes in concentration of circulating free immunoglobulin light chains following chemotherapy . British Journal of Haematology . 122 . 1 . 78–84 . July 2003 . 12823348 . 10.1046/j.1365-2141.2003.04433.x. 23475887 . etal. free .
9. Abraham RS, Katzmann JA, Clark RJ, Bradwell AR, Kyle RA, Gertz MA . Quantitative analysis of serum free light chains. A new marker for the diagnostic evaluation of primary systemic amyloidosis . American Journal of Clinical Pathology . 119 . 2 . 274–8 . February 2003 . 12579999 . 10.1309/LYWM-47K2-L8XY-FFB3. free .
10. Akar H, Seldin DC, Magnani B . Quantitative serum free light chain assay in the diagnostic evaluation of AL amyloidosis . Amyloid . 12 . 4 . 210–5 . December 2005 . 16399645 . 10.1080/13506120500352339. 7839338 . etal.
11. Jones HB . On a new substance occurring in the urine of a patient with mollities ossium . . 1848 . 138 . 55–62 . 10.1098/rstl.1848.0003. 186208792 .