Tetramer Facility Guide - MHC Class II Request Form

Request form for custom synthesis of MHC Class II tetramers

The request form is used for review of the request.

**One request form per tetramer**

Please note: All DRB1*0101, DRB1*0301, DRB1*0401, DRB1*1501, and DRB5*0101 tetramers will be made via exchange, and the client must provide 1 mg of the appropriate peptide.

All I-A(b), I-A(d), I-A(g7), I-A(s), I-A(u), I-E(d), I-E(k), I-E(u), Patr-DRB1*0701, and Patr-DRB1*1001 tetramers will be made with tethered peptides, and the client is not required to provide a peptide sample.

One order contains 200 ug of class II protein.

Important! Your request will not be considered unless all the fields on this form are filled.

(Click here to find out when the Tetramer Resource Committee meets again to review requests.)

Be sure to register with our reagent program if you are a new client.

(Click here to download the Registration Form)

Contact and Shipping Information

Investigator's Name:
Title:
Institution:
Department:
Street Address:
City, State, ZIP
Telephone Number:
Fax Number:
E-mail: (Please note: our system can only accept one email address here on this form.)
Shipping Company / Account No.
All reagents will be shipped to the above address which cannot be a post office box.

Requested Tetramer Information			Epitope Origin
Class II MHC alleles	Peptide Sequence	Fluorescent Label	Organism Name	Protein Name

Funding and Project Information

FOR NEW AND REFILL REQUESTS: PLEASE COMPLETE ALL FIELDS BELOW (failure to complete all fields will delay review and approval process). NIH funding is not a requisite for requesting tetramers.

Title of Current Research Grant(s) or Contract supported by NIH for which tetramers will be used:

Grant or Contract Number (if any):

Please list the staff that will be using this reagent (include collaborators):

Positive Control to test the requested tetramer(s): Yes No

Please provide a description of your positive control. Results from T cell lines, clones or hybridomas are preferred, but assays using T cell bulk cultures are acceptable for immunodominant responses. The data can be submitted as a journal article citation or assay results from the requestor's lab. Please list the journal citations here or email any figures necessary for Tetramer Resource Committee to evaluate your request to TRC@niaid.nih.gov - please include the name of the PI, as it appears on the on-line Tetramer Request form in this email.

Please provide evidence of MHC Restriction. This can be a journal article citation or data from the requestor's lab. Please email any figures or references necessary for Tetramer Resource Committee to evaluate your request to TRC@niaid.nih.gov - please include the name of the PI, as it appears on the on-line Tetramer Request form in this email.

Please provide evidence of peptide binding. The requestor should provide a peptide dose response curve demonstrating appropriate T cell response in order for the committee to evaluate avidity and likelihood of tetramer staining. (This can be a journal article citation or data from the requestor's lab. For journal article citations, please include: name of first author, article title, journal name, publication date, volume, and page numbers. Please email any figures or references necessary for the Tetramer Resource Committee to evaluate your request to TRC@niaid.nih.gov. Please include the name of the PI, as it appears on the on-line Tetramer Request form, in this email.

Research Abstract: This abstract should include a brief description of the research project, experimental system, how the tetramer reagent will be used to facilitate the research project, and a justification as to why tetramer results are needed instead of or in addition to results obtained from assays such as cytokine ELISPOTS or cytokine capture assays that do not require precise identification of MHC restriction. (limit: 1000 words)

If this is a refill request, please also answer the following questions.

Have you submitted a feedback form on your original order?
If you have not provided feedback to the NIH Tetramer Facility Manager, approval of your order could be delayed.
Please go to our online feedback form and submit a complete report.
Please provide your reason for requesting additional tetramer. (If the tetramer no longer works, please provide a brief description of how the tetramer was stored and explain the experimental conditions in which the tetramer failed to stain, including the positive and negative controls that were used in the study.)

Last updated February 12, 2007 (EVR)