Immunoglobulin M

# Overview
Immunoglobulin M, or IgM for short, is a basic antibody that is present on B cells. It is the primary antibody against A and B antigens on red blood cells. IgM is by far the physically largest antibody in the human circulatory system.

# Structure and function
IgM forms polymers where multiple immunoglobulins are covalently linked together with disulfide bonds, mostly as a pentamer but also as a hexamer. IgM has a molecular mass of approximately 900 kD (in its pentamer form). Because each monomer has two antigen binding sites, a pentameric IgM has 10 binding sites.  Typically, however, IgM cannot bind 10 antigens at the same time because the large size of most antigens hinders binding to nearby sites.
The J chain is found in pentameric IgM but not in the hexameric form, perhaps due to space constraints in the hexameric complex.  Pentameric IgM can also be made in the absence of J chain.  At present, it is still uncertain what fraction of normal pentamer contains J chain, and to this extent it is also uncertain whether a J chain-containing pentamer contains one or more than one J chain.  
Because IgM is a large molecule, it cannot diffuse well, and is found in the interstitium only in very low quantities. IgM is primarily found in serum; however, because of the J chain, it is also important as a secretory immunoglobulin.
Due to its polymeric nature, IgM possesses high avidity, and is particularly effective at complement activation.

# Expression
In germline cells, the gene segment encoding the  constant region of the heavy chain is positioned first among other constant region gene segments. For this reason, IgM is the first immunoglobulin expressed by mature B cells.
It is also the first immunoglobulin expressed in the fetus (around 20 weeks) and also phylogenetically the earliest antibody to develop.

# Clinical significance
IgM antibodies appear early in the course of an infection and usually do not reappear after further exposure. IgM antibodies do not pass across the human placenta.
These two biological properties of IgM make it useful in the diagnosis of infectious diseases. Demonstrating IgM antibodies in a patient's serum indicates recent infection, or in a neonate's serum indicates intrauterine infection (e.g. congenital rubella).

# Other points
IgM in normal serum is often found to bind to specific antigens, even in the absence of prior immunization.  For this reason IgM has sometimes been called a "natural antibody".  This phenomenon is probably due to the high avidity of IgM that allow it to bind detectably even to weakly cross-reacting antigens that are naturally occurring in nature.  For example the IgM antibodies that bind to the red blood cell A and B antigens might be formed in early life as a result of exposure to A- and B-like substances that are present on bacteria or perhaps also on plant materials.
IgM antibodies are mainly responsible for the clumping (agglutination) of red blood cells if the recipient of a blood transfusion receives blood that is not compatible with their blood type.

# Related chapters
- Antibody
- IgA, IgD, IgE, IgG

# Resources
- Immunoglobulin+M at the US National Library of Medicine Medical Subject Headings (MeSH)