Specific dosage of thyme has limited scientific evidence support. It is not clear that  how the efficacy and safety is balanced in optimal doses of natural products. It is not clear that what are the active components of the product, standardization may not possible, clinical effects of different brands due to preparation of the products may vary from manufacturer to manufacturer. Volatile oil is about 0.4% to 3.4% in common thyme but after standardization of extract contain 0.6% to 1.2%. These standardization of thyme found in commercial products such as topical cosmetic formulations or mouthwash(Manou et.al, 1998). In treatment of actinomycosis, onycholysis (Seperation or loosening of fingernail or toenail) and paronychia ( inflammatory tissue surrounding fingarnails) experts having recommended use of thymol. In little amount of thyme present in food is safe to consume but in orally it’s not exceed10g because 10g dried leaf contain 0.03% phenol and non diluted form of thyme oil is unsafe to use.

Oral recommended dosage:

General dosage for an adult (Above 18 year): one to two grams of thyme extract taken daily

Oil: Thyme oil is consider to be highly toxic, two to three drops of thyme oil on the sugar cube 2-3 times daily has been used.

Liquid extract: 20-40 drops liquid extract (1:1 weight/volume fresh leaf or 1:4 dried leaf) three times daily in juice; or 40 drops tincture (1:10 in 70% ethanol) up to three times daily for upper respiratory tract infection. Safety and efficacy have not been proven.

Tea: it has been recommended to steep 1-2 grams of dried herb in 150 mL boiling water for 10 minutes, strain, and drink several times daily for upper respiratory tract infection/bronchitis symptoms.

Mouthwash: Thymol is a constituent in some combination mouthwash products such as Listerine (demonstrated to be efficacious in the reduction of oral bacteria). For periodontal prophylaxis, it has been recommended to steep 5 grams dried leaf per 100 mL boiling water for 10 minutes and strain (5% infusion).

 

Topical

 

 oil/ointment: For alopecia areata, 2-3 drops of an essential oil combination (thyme, lavender, rosemary, and cedarwood added to grapeseed and jojoba oil) massaged into the scalp every night for seven months has been studied (Hay IC, et.al.1998). For paronychia, 1 drop of 1-2% thymol in chloroform to the affected area three times daily, or 1 drop of 4% thymol in chloroform to a chronically affected area three times daily has been used (Wilson JW et.al, 1965)

 

For childrens doctors not prescribed use of thyme medicines. Avoid hypersensitivity patients from thyme medicines. Symptoms of allergy may include nausea, vomiting, runny nose, severe itching, swelling under the skin, difficulty swallowing, altered voice, low blood pressure, contact dermatitis, inflammation of lung cells, and progressive respiratory difficulty. Occupational asthma has been reported in hypersensitivity patients.

 

 

 

 

 

 

TOXICOLOGY

            Thyme oil contain high amount of thymol and carvacrol that can be highly toxic to the childrens. If it uses in high dosage it shows allergic reactions. It can be neurotoxic. It has been suggested not to exceed oral doses of 10 grams of dried leaf with 0.03% phenol (calculated as thymol) per day to prevent toxicity. Signs of toxicity include nausea, and based on animal studies may include tachypnea and hypotension. Oil extraction of thyme oil is considered to be highly toxic (Kagramanov KM et.al, 1997)

 

Precautions:

Allergy:

Avoid use of thyme medicines  to members of the Allergic patients. Thyme is belonging to the lamiacea (mint) family cause nausea, emesis, pruritis, angioedema, dysphagia, dysphonia, hypotension, and progressive respiratory difficulty.

Adverse Effects:

General: Thyme oil should not be taken orally and should be diluted for topical administration due to potential toxic effects.

Neurologic/CNS: Headache and dizziness have been associated with oral ingestion of thyme and thyme oil. Oral ingestion of thyme oil may cause seizure and coma.

Ocular/Otic: Conjunctivitis has been reported in a farmer exposed to thyme dust.

Dermatologic:Dermatitis caused by thyme dust in farmers exposed to dried thyme. Allergic contact dermatitis was reported in a 70-year-old woman six weeks after initiation of 4% thymol once daily to a chronic paronychia. Topical application of Listerine antiseptic solution to a chronic parenchyma of the toe by a 43-year-old man resulted in contact dermatitis. As an ingredient in toothpaste, cases of inflamed lips and tongue have anecdotally been attributed to thyme oil.

Pulmonary/Respiratory:.High doses of thyme or thyme oil have elicited tachypnea in animals. Oral ingestion of thyme oil may lead to respiratory arrest (anecdotal). Cardiovascular: Hypotension after ingestion of thyme seasoning was seen in a 45-year-old man, possibly related to an allergic response. Animal studies have reported both hypotension and increased cardiac contractility. Anecdotal reports suggest that bradycardia may be associated with ingestion of thyme, and cardiac arrest may occur with oral intake of thyme oil.

Gastrointestinal: Oral thyme and thyme oil may elicit heart burn, nausea, vomiting, diarrhea, and gastrointestinal irritation (anecdotal).

Endocrine: An extract of Thymus serpyllum, a related species to Thymus vulgaris, has been shown to exert anti-thyrotropic effects in rats, causing decline in thyroid stimulating hormone and prolactin. Estradiol and progesterone receptor-binding activity has been demonstrated in vivo. Endocrine effects of Thymus vulgaris in humans are unclear.

Genitourinary: Oral thyme has anecdotally been reported to exacerbate inflammation associated with urinary tract infections.

Musculoskeletal: Oral use of thyme or thyme oil has been associated with muscle weakness in anecdotal reports, although details are limited.

 

 

 

 

 

 

 

 

Precautions/Warnings/Contraindications:

·         Avoid contact of allergy/hypersensitivity to members of the Lamiaceae (mint) family or to any component of thyme.

·         Avoid oral ingestion or non-diluted topical application of thyme oil due to potential toxicity.

·         Avoid topical preparations in areas of skin breakdown or injury, or in atopic patients, due to multiple reports of contact dermatitis.

·         Use cautiously in patients with gastrointestinal irritation or peptic ulcer disease due to anecdotal reports of gastrointestinal irritation.

·         Use cautiously in patients with thyroid disorders due to observed anti-thyrotropic effects in animal research of the related species Thymus serpyllum.

Pregnancy and Lactation:

Thyme is not recommended in pregnancy or lactation, due to lack of sufficient data. A 1975 review of plants as possible new anti-fertility agents classified thyme as an emmenagogue and abortifacient.

 

 

 

            The acute toxicity of thyme oil and its active constituent thymol are summarized in Table .

Table

Acute Toxicity of Thyme Oil and Thymol

Study

 

Results

Source

 

 

 

 

Acute oral toxicity

 

LD50 (rat): 2,840 mg/kg,

mouse: 1,250mg/kg,

rabbit: >5000mg/kg

Thymol: LD50: (rat) 980 mg/kg bw, (mouse) 1050-2000 mg/kg bw, (guinea pig) 880 mg/kg bw

(Gwynn 2014; HSDB 2015)

Acute dermal toxicity

 

Thymol: LD50 (rabbit): >5000 mg/kg

(Sigma-Aldrich 2014)

Acute inhalation

 

Not found

 

Acute eye irritation

 

Not found

 

Acute dermal irritation

 

Not found

 

Skin sensitization

 

Thymol: Guinea pig: No sensitization reaction

(HSDB 2015)

 

 

Other than oral toxicity, the acute toxicity of thyme and thyme oil is estimated by thymol.

 

 

 

 

 

Sub-chronic Toxicity

No data was found on the subchronic toxicity of thyme or thyme oil; the subchronic toxicity of thymol is summarized in Table .

Table

Sub-chronic Toxicity of Thymol

Study

 

Results

 

Source

 

 

 

 

 

 

 

Repeated Dose 28-day Oral Toxicity Study in Rodents

 

 

     Not found

 

 

90 day oral toxicity in rodents

 

     Not found

 

 

90 day oral toxicity in non-rodents

 

No effect

 

(Hagan et al. 1967)

 

90 Day dermal toxicity

 

     Not found

 

 

90 Day inhalation toxicity

 

     Not found

 

 

Reproduction/development toxicity screening test

 

     Not found

 

 

Combined repeated dose toxicity with reproduction/de­velopment toxicity screening test

 

 

     Not found

 

 

 

 

 

 

Prenatal developmental   toxicity study

 

Possible teratogen

 

(Verrett et al. 1980)

 

Reproduction and fertility effects

 

Not found

 

 

 

A 19 week subchronic toxicity study performed on Osborne-Mendel rats determined thymol to have a no– observable-effect level of 1,000 mg/kg of body weight (Hagan et al. 1967). Thymol caused developmental abnormalities in chicken embryos, but the effects were not significant enough to classify it as a known teratogen (Verrett et al. 1980). However, thymol exhibited genotoxic and potent mutagenic activity against Drosophila melanogaster fruit flies (Karpouhtsis et al. 1998)

Chronic Toxicity

No studies on the chronic toxicity of thyme or thyme oil were found. The chronic toxicity of thymol is summarized in Table 4.

.

                Study

             Results

         Source

Chronic toxicity

Ames test: Mildly positive to negative.

 

(Stammati et al. 1999; Azizan and Blevins 1995)

Carcinogenicity

Negative

 

(Andersen 2005; Stoner et al. 1973)

 

Combined chronic toxicity & carcinogenicity

Not Found

 

 

Thymol (1.2 and 6.0 g/kg) was negative for promoting lung tumors in mice (Stoner et al. 1973). Anti-tumor effects were observed for thymol (Andersen 2005).

 I. DEFINITION 

Immunoglobulin (Ig)

Immunoglobulins are glycoprotein molecules that are produced by plasma cells in response to an immunogen and which function as antibodies. The immunoglobulins derive their name from the finding that they migrate with globular proteins when antibody-containing serum is placed in an electrical field (Figure 1).

II. GENERAL FUNCTIONS OF IMMUNOGLOBULINS

A. Antigen binding 
Immunoglobulins bind specifically to one or a few closely related antigens. Each immunoglobulin actually binds to a specific antigenic determinant. Antigen binding by antibodies is the primary function of antibodies and can result in protection of the host. The valency of antibody refers to the number of antigenic determinants that an individual antibody molecule can bind. The valency of all antibodies is at least two and in some instances more.

B. Effector Functions 
Frequently the binding of an antibody to an antigen has no direct biological effect. Rather, the significant biological effects are a consequence of secondary "effector functions" of antibodies. The immunoglobulins mediate a variety of these effector functions. Usually the ability to carry out a particular effector function requires that the antibody bind to its antigen. Not every immunoglobulin will mediate all effector functions. Such effector functions include:

1. Fixation of complement - This results in lysis of cells and release of biologically active molecules (see chapter two)

2. Binding to various cell types - Phagocytic cells, lymphocytes, platelets, mast cells, and basophils have receptors that bind immunoglobulins. This binding can activate the cells to perform some function. Some immunoglobulins also bind to receptors on placental trophoblasts, which results in transfer of the immunoglobulin across the placenta. As a result, the transferred maternal antibodies provide immunity to the fetus and newborn
 

III. BASIC STRUCTURE OF IMMUNOGLOBULINS

The basic structure of the immunoglobulins is illustrated in figure 2. Although different immunoglobulins can differ structurally, they all are built from the same basic units.

A. Heavy and Light Chains

All immunoglobulins have a four chain structure as their basic unit. They are composed of two identical light chains (23kD) and two identical heavy chains (50-70kD)

B. Disulfide bonds

1. Inter-chain disulfide bonds - The heavy and light chains and the two heavy chains are held together by inter-chain disulfide bonds and by non-covalent interactions The number of inter-chain disulfide bonds varies among different immunoglobulin molecules.

2. Intra-chain disulfide binds - Within each of the polypeptide chains there are also intra-chain disulfide bonds.

C. Variable (V) and Constant (C) Regions

When the amino acid sequences of many different heavy chains and light chains were compared, it became clear that both the heavy and light chain could be divided into two regions based on variability in the amino acid sequences. These are the:

1. Light Chain - VL (110 amino acids) and CL (110 amino acids)

2. Heavy Chain - VH (110 amino acids) and CH (330-440 amino acids)

D. Hinge Region

This is the region at which the arms of the antibody molecule forms a Y. It is called the hinge region because there is some flexibility in the molecule at this point.

E. Domains

Three dimensional images of the immunoglobulin molecule show that it is not straight as depicted in figure 2A. Rather, it is folded into globular regions each of which contains an intra-chain disulfide bond (figure 2B-D). These regions are called domains.

1. Light Chain Domains - VL and CL

2. Heavy Chain Domains - VH, CH1 - CH3 (or CH4)

F. Oligosaccharides

Carbohydrates are attached to the CH2 domain in most immunoglobulins. However, in some cases carbohydrates may also be attached at other locations.



IV. STRUCTURE OF THE VARIABLE REGION

A. Hypervariable (HVR) or complementarity determining regions (CDR)

Comparisons of the amino acid sequences of the variable regions of immunoglobulins show that most of the variability resides in three regions called the hypervariable regions or the complementarity determining regions as illustrated in figure 3. Antibodies with different specificities (i.e. different combining sites) have different complementarity determining regions while antibodies of the exact same specificity have identical complementarity determining regions (i.e. CDR is the antibody combining site). Complementarity determining regions are found in both the H and the L chains.

B. Framework regions

The regions between the complementarity determining regions in the variable region are called the framework regions (figure 3). Based on similarities and differences in the framework regions the immunoglobulin heavy and light chain variable regions can be divided into groups and subgroups. These represent the products of different variable region genes. 
 

V. IMMUNOGLOBULIN FRAGMENTS: STRUCTURE/FUNCTION RELATIONSHIPS

Immunoglobulin fragments produced by proteolytic digestion have proven very useful in elucidating structure/function relationships in immunoglobulins.

A. Fab

Digestion with papain breaks the immunoglobulin molecule in the hinge region before the H-H inter-chain disulfide bond Figure 4. This results in the formation of two identical fragments that contain the light chain and the VH and CH1 domains of the heavy chain.
Antigen binding - These fragments were called the Fab fragments because they contained the antigen binding sites of the antibody. Each Fab fragment is monovalent whereas the original molecule was divalent. The combining site of the antibody is created by both VH and VL. An antibody is able to bind a particular antigenic determinant because it has a particular combination of VH and VL. Different combinations of a VH and VL result in antibodies that can bind a different antigenic determinants.

B. Fc

Digestion with papain also produces a fragment that contains the remainder of the two heavy chains each containing a CH2 and CH3 domain. This fragment was called Fc because it was easily crystallized.
 

Effector functions - The effector functions of immunoglobulins are mediated by this part of the molecule. Different functions are mediated by the different domains in this fragment (figure 5). Normally the ability of an antibody to carry out an effector function requires the prior binding of an antigen; however, there are exceptions to this rule.

C. F(ab')2

Treatment of immunoglobulins with pepsin results in cleavage of the heavy chain after the H-H inter-chain disulfide bonds resulting in a fragment that contains both antigen binding sites (figure 6). This fragment was called F(ab')2 because it is divalent. The Fc region of the molecule is digested into small peptides by pepsin. The F(ab')2 binds antigen but it does not mediate the effector functions of antibodies.

 

VI. HUMAN IMMUNOGLOBULIN CLASSES, SUBCLASSES, TYPES AND SUBTYPES

A. Immunoglobulin classes

The immunoglobulins can be divided into five different classes, based on differences in the amino acid sequences in the constant region of the heavy chains. All immunoglobulins within a given class will have very similar heavy chain constant regions. These differences can be detected by sequence studies or more commonly by serological means (i.e. by the use of antibodies directed to these differences).

1. IgG - Gamma heavy chains
2. IgM - Mu heavy chains
3. IgA - Alpha heavy chains
4. IgD - Delta heavy chains
5. IgE - Epsilon heavy chains

B. Immunoglobulin Subclasses

The classes of immunoglobulins can de divided into subclasses based on small differences in the amino acid sequences in the constant region of the heavy chains. All immunoglobulins within a subclass will have very similar heavy chain constant region amino acid sequences. Again these differences are most commonly detected by serological means.

1. IgG Subclasses

a) IgG1 - Gamma 1 heavy chains
b) IgG2 - Gamma 2 heavy chains
c) IgG3 - Gamma 3 heavy chains
d) IgG4 - Gamma 4 heavy chains

2. IgA Subclasses

a) IgA1 - Alpha 1 heavy chains
b) IgA2 - Alpha 2 heavy chains
 

C. Immunoglobulin Types

Immunoglobulins can also be classified by the type of light chain that they have. Light chain types are based on differences in the amino acid sequence in the constant region of the light chain. These differences are detected by serological means.

1. Kappa light chains 
2. Lambda light chains 

D. Immunoglobulin Subtypes
The light chains can also be divided into subtypes based on differences in the amino acid sequences in the constant region of the light chain.

1. Lambda subtypes

a) Lambda 1 
b) Lambda 2 
c) Lambda 3 
d) Lambda 4 

E. Nomenclature

Immunoglobulins are named based on the class, or subclass of the heavy chain and type or subtype of light chain. Unless it is stated precisely, you should assume that all subclass, types and subtypes are present. IgG means that all subclasses and types are present.

F. Heterogeneity

Immunoglobulins considered as a population of molecules are normally very heterogeneous because they are composed of different classes and subclasses each of which has different types and subtypes of light chains. In addition, different immunoglobulin molecules can have different antigen binding properties because of different VH and VL regions.
 

VII. STRUCTURE AND SOME PROPERTIES OF IG CLASSES AND SUBCLASSES

A. IgG

1. Structure
The structures of the IgG subclasses are presented in figure 7. All IgG's are monomers (7S immunoglobulin). The subclasses differ in the number of disulfide bonds and length of the hinge region.

2. Properties

IgG is the most versatile immunoglobulin because it is capable of carrying out all of the functions of immunoglobulin molecules.

a) IgG is the major Ig in serum - 75% of serum Ig is IgG
b) IgG is the major Ig in extra vascular spaces
c) Placental transfer - IgG is the only class of Ig that crosses the placenta. Transfer is mediated by a receptor on placental cells for the Fc region of IgG. Not all subclasses cross equally well; IgG2 does not cross well.
d) Fixes complement - Not all subclasses fix equally well; IgG4 does not fix complement
e) Binding to cells - Macrophages, monocytes, PMNs and some lymphocytes have Fc receptors for the Fc region of IgG. Not all subclasses bind equally well; IgG2 and IgG4 do not bind to Fc receptors. A consequence of binding to the Fc receptors on PMNs, monocytes and macrophages is that the cell can now internalize the antigen better. The antibody has prepared the antigen for eating by the phagocytic cells. The term opsonin is used to describe substances that enhance phagocytosis. IgG is a good opsonin. Binding of IgG to Fc receptors on other types of cells results in the activation of other functions.
 

B. IgM

1. Structure
The structure of IgM is presented in figure 8. IgM normally exists as a pentamer (19S immunoglobulin) but it can also exist as a monomer. In the pentameric form all heavy chains are identical and all light chains are identical. Thus, the valence is theoretically 10. IgM has an extra domain on the mu chain (CH4) and it has another protein covalently bound via a S-S bond called the J chain. This chain functions in polymerization of the molecule into a pentamer.

2. Properties

a) IgM is the third most common serum Ig.
b) IgM is the first Ig to be made by the fetus and the first Ig to be made by a virgin B cells when it is stimulated by antigen.
c) As a consequence of its pentameric structure, IgM is a good complement fixing Ig. Thus, IgM antibodies are very efficient in leading to the lysis of microorganisms.
d) As a consequence of its structure, IgM is also a good agglutinating Ig . Thus, IgM antibodies are very good in clumping microorganisms for eventual elimination from the body.
e) IgM binds to some cells via Fc receptors.
f) B cell surface Ig 
Surface IgM exists as a monomer and lacks J chain but it has an extra 20 amino acids at the C-terminus to anchor it into the membrane (figure 9). Cell surface IgM functions as a receptor for antigen on B cells. Surface IgM is noncovalently associated with two additional proteins in the membrane of the B cell called Ig-alpha and Ig-beta as indicated in figure 10. These additional proteins act as signal transducing molecules since the cytoplasmic tail of the Ig molecule itself is too short to transduce a signal. Contact between surface immunoglobulin and an antigen is required before a signal can be transduced by the Ig-alpha and Ig-beta chains. In the case of T-independent antigens, contact between the antigen and surface immunoglobulin is sufficient to activate B cells to differentiate into antibody secreting plasma cells. However, for T-dependent antigens, a second signal provided by helper T cells is required before B cells are activated.
 

C. IgA

1. Structure
Serum IgA is a monomer but IgA found in secretions is a dimer as presented in Figure 11. When IgA exits as a dimer, a J chain is associated with it.
When IgA is found in secretions is also has another protein associated with it called the secretory piece or T piece; sIgA is sometimes referred to as 11S immunoglobulin. Unlike the remainder of the IgA which is made in the plasma cell, the secretory piece is made in epithelial cells and is added to the IgA as it passes into the secretions (Figure 12). The secretory piece helps IgA to be transported across mucosa and also protects it from degradation in the secretions.

2. Properties

a) IgA is the 2nd most common serum Ig.
b) IgA is the major class of Ig in secretions - tears, saliva, colostrum, mucus. Since it is found in secretions secretory IgA is important in local (mucosal) immunity.
c) Normally IgA does not fix complement, unless aggregated.
d) IgA can binding to some cells - PMN's and some lymphocytes.
 

D. IgD

1. Structure
The structure of IgD is presented in the Figure 13. IgD exists only as a monomer.

2. Properties

a) IgD is found in low levels in serum; its role in serum uncertain.
b) IgD is primarily found on B cell surfaces where it functions as a receptor for antigen. IgD on the surface of B cells has extra amino acids at C-terminal end for anchoring to the membrane. It also associates with the Ig-alpha and Ig-beta chains.
c) IgD does not bind complement.
 

E. IgE

1. Structure
The structure of IgE is presented in Figure 14. IgE exists as a monomer and has an extra domain in the constant region.

2. Properties

a) IgE is the least common serum Ig since it binds very tightly to Fc receptors on basophils and mast cells even before interacting with antigen.
b) Involved in allergic reactions - As a consequence of its binding to basophils an mast cells, IgE is involved in allergic reactions. Binding of the allergen to the IgE on the cells results in the release of various pharmacological mediators that result in allergic symptoms.
c) IgE also plays a role in parasitic helminth diseases. Since serum IgE levels rise in parasitic diseases, measuring IgE levels is helpful in diagnosing parasitic infections. Eosinophils have Fc receptors for IgE and binding of eosinophils to IgE-coated helminths results in killing of the parasite.
d) IgE does not fix complement.
 

CLINICAL IMPLICATIONS OF HUMAN IMMUNOGLOBULIN CLASSES

Adapted from:F.T. Fischbach in "A Manual of Laboratory Diagnostic Tests," 2nd Ed., J.B. Lippincott Co., Philadelphia, PA, 1984.


IgG

1. Increases in:

a) Chronic granulomatous infections
b) Infections of all types
c) Hyperimmunization
d) Liver disease
e) Malnutrition (severe)
f) Dysproteinemia
g) Disease associated with hypersensitivity granulomas, dermatologic disorders, and IgG myeloma
h) Rheumatoid arthritis

2. Decreases in:

a) Agammaglobulinemia
b) Lymphoid aplasia
c) Selective IgG, IgA deficiency
d) IgA myeloma
e) Bence Jones proteinemia
f) Chronic lymphoblastic leukemia

IgM

1. Increases (in adults) in:

a) Waldenström's macroglobulinemia
b) Trypanosomiasis
c) Actinomycosis
d) Carrión's disease (bartonellosis)
e) Malaria
f) Infectious mononucleosis
g) Lupus erythematosus
h) Rheumatoid arthritis
I) Dysgammaglobulinemia (certain cases)
Note: In the newborn, a level of IgM above 20 ng./dl is an indication of in utero stimulation of the immune system and stimulation by the rubella virus, the cytomegalovirus, syphilis, or toxoplasmosis.

2. Decreases in:

a) Agammaglobulinemia
b) Lymphoproliferative disorders (certain cases)
c) Lymphoid aplasia
d) IgG and IgA myeloma
e) Dysgammaglobulinemia
f) Chronic lymphoblastic leukemia

IgA

1. Increases in:

a) Wiskott-Aldrich syndrome
b) Cirrhosis of the liver (most cases)
c) Certain stages of collagen and other autoimmune disorders such as rheumatoid arthritis and lupus erythematosus
d) Chronic infections not based on immunologic deficiencies
e) IgA myeloma

2. Decreases in:

a) Hereditary ataxia telangiectasia
b) Immunologic deficiency states (e.g., dysgammaglobulinemia, congenital and acquired agammaglobulinemia, and hypogammaglobulinemia)
c) Malabsorption syndromes
d) Lymphoid aplasia
e) IgG myeloma
f) Acute lymphoblastic leukemia
g) Chronic lymphoblastic leukemia

IgD

1. Increases in:

a) Chronic infections
b) IgD myelomas

IgE

1. Increases in:

a) Atopic skin diseases such as eczema
b) Hay fever
c) Asthma
d) Anaphylactic shock
e) IgE-myeloma

2. Decreases in:

a) Congenital agammaglobulinemia
b) Hypogammaglobulinemia due to faulty metabolism or synthesis of immunoglobulins

 GENETICS OF IMMUNOGLOBULINS  
 

I. HISTORY


Amino acid sequencing data revealed that a single C region could be associated with many different V regions. Also, it was shown that a single idiotype could be associated with different C regions (eg. IgM and IgG). To explain these data it was suggested that perhaps the two regions of the immunoglobulin molecule were coded for by separate genes and that the V and C region genes were somehow joined before an immunoglobulin molecule was made (i.e. there were two genes for one polypeptide). This was a revolutionary concept but with the advent of recombinant DNA technology, it has been shown to be the correct. The immunoglobulin heavy and light chains are coded for by three separate gene families each one on a separate chromosome - one for the heavy chain and one for each of the light chain types. Each of these gene families has several V region genes and one or more C region genes. The V and C regions genes are not however immediately adjacent to each other. 
 

II. LIGHT CHAIN GENE FAMILIES

A. Germ line gene organization

The organization of the kappa and lambda light chain genes in the germ line or undifferentiated cells is depicted in Figure 1.

1. Lambda light chains - The lambda gene family is composed of 4 C region genes, one for each subtype of lamda chain, and approximately 30 V region genes. Each of the V region genes is composed of two exons, one (L) that codes for a leader region and the other (V) that codes for most of the variable region. Upstream of each of the C genes there is and additional exon called J (joining). The L, V, J and C exons are separated by introns (intervening non-coding sequences).

2. Kappa light chains - The kappa light chain gene family contains only one C region gene, since there is only one type of kappa light chain. There are many V region genes (approximately 250) each of which has a leader exon and a V exon. In the κ gene family there are several J exons located between the V and C genes. All of the exons are separated by introns.
 

B. Gene rearrangement and Expression

As a cell differentiates into a mature B cell that will make a light chain, there is a rearrangement of the various genes (exons) and the gene begins to be expressed as depicted in Figure 2.

As a cell commits to become a B cell making a light chain, there is a rearrangement of the genes at the DNA level such that one of the V genes is brought next to one of the J regions. This occurs by a recombination event which removes the intron between the V and J regions. The selection of which V gene is used is not totally random; there is some preference for the use of V genes nearest to the J regions. However, with time all V genes can be used so that all combinations of V genes and J regions can be generated.

A consequence of this DNA rearrangement is that the gene becomes transcriptionally active because a promoter (P), which is associated with the V gene, is brought close to an enhancer (E), which is located in the intron between the J and C regions. As transcription initiates from the promoter a pre-mRNA is made which contains sequences from the L, V J and C regions as well as sequences for the introns between L and V and between J and C (See Figure 2). This pre-mRNA is processed (spliced) in the nucleus and the remaining introns are removed. The resulting mRNA has the L, V J and C exons contiguous.
The mRNA is translated in the cytoplasm and the leader is removed as the protein is transported into the lumen of the endoplasmic reticulum. The light chain is assembled with a heavy chain in the endoplasmic reticulum and the immunoglobulin is secreted via the normal route of secretory proteins. The region V region of the mature light chain is coded for by sequences in the V gene and J region and the C region by sequences in the C gene.
 

III. HEAVY CHAIN GENE FAMILY

A. Germ line gene organization

The organization of the heavy chain genes is depicted in Figure 3.
In the heavy chain gene family there are many C genes, one for each class and subclass of immunoglobulin. Each of the C genes is actually composed of several exons, one for each domain and another for the hinge region. In the heavy chain gene family there are many V region genes, each composed of a leader and V exon. In addition to several J exons, the heavy chain gene family also contains several additional exons called the D (diversity) exons. All of the exons are separated by introns as depicted in Figure 3.

B. Gene rearrangements and expression
As a cell differentiates into a mature B cell that will make a heavy chain, there is a rearrangement of the various genes segments (exons) and the gene begins to be expressed as depicted in Figures 4 and 5.

As a cell commits to become a B cell making a heavy chain, there are two rearrangements at the DNA level. First, one of the D regions is brought next to one of the J regions and then one of the V genes is brought next to the rearranged DJ region. This occurs by two recombination events which remove the introns between the V, D and J regions. As with the light chains the selection of the heavy chain V gene is not totally random but eventually all of the V genes can be used.

A consequence of these DNA rearrangements is that the gene becomes transcriptionally active because a promoter (P), which is associated with the V gene, is brought close to an enhancer (E), which is located in the intron between the J and Cmu regions. As transcription initiates from the promoter a pre-mRNA is made which contains sequences from the L, V, D, J Cmu and Cdelta regions as well as sequences for the introns between L and V, between J and Cmu, and between Cmu and Cdelta (Figure 4).

The pre-mRNA is processed (spliced) in the nucleus and the remaining introns, including those between the exons in the C genes, are removed (See Figure 5). The pre-mRNA can be processed in two ways, one to bring the VDJ next to the Cmu gene and the other to bring the VDJ next to the Cdelta gene. The resulting mRNAs have the L, V, D, J and Cmu or Cdelta exons contiguous and will code for a mu and a delta chain, respectively.

The mRNAs are translated in the cytoplasm and the leader is removed as the protein is transported into the lumen of the endoplasmic reticulum. The heavy chain is assembled with a light chain in the endoplasmic reticulum and the immunoglobulin is secreted via the normal route of secretory proteins. The region V region of the mature heavy chain is coded for by sequences in the V gene, D region and J region and the C region by sequences in the C gene.
 

IV. MECHANISM OF DNA REARRANGEMENTS

Flanking the V, J and D exons there are unique sequences referred to as recombination signal sequences (RSS), which function in recombination. Each RSS consists of a conserved nonamer and a conserved heptamer that are separated by either 12 or 23 base pairs (bp) as illustrated in Figure 6. The 12bp and 23 bp spaces correspond to one or two turns of the DNA helix.

Recombination only occurs between a 1 turn and a 2 turn signal. In the case of the λ light chains there is a 1 turn signal upstream of the J exon and a 2 turn signal downstream of Vlambda. In the case of the κ light chains there is a 1 turn signal downstream of the Vkappa gene and a 2 turn signal upstream of the J exon.. In the case of the heave chains there are 1 turn signals on each side of the D exon and a 2 turn signal downstream of the V gene and a 2 turn signal upstream of the J exon. Thus, this ensures that the correct recombination events will occur.

The recombination event results in the removal of the introns between V and J in the case of the light chains or between the V, D, and J in the case of the heavy chains. The recombination event is catalyzed by two proteins, Rag-1 and Rag-2. Mutations in the genes for these proteins results in a severe combined immunodeficiency disease (both T and B cells are deficient), since these proteins and the RSS are involved in generating both the B and T cell receptors for antigen.
 

V. ORDER OF GENE EXPRESSION IN IG GENE FAMILIES

An individual B cell only produces one type of light chain and one class of heavy chain. (N.B. The one exception is that a mature B cell can produce both μ and δ heavy chains but the antibody specificity is the same since the same VDJ region is found on the μ and δ chains). Since any B cell has both maternal and paternal chromosomes which code for the immunoglobulin genes there must be some orderly way in which a cell expresses its immunoglobulin genes so as to ensure that only one type of light chain and one class of heavy chain is produced.

The order in which the immunoglobulin genes are expressed in a B cell is depicted in Figure 7 and 8.

Heavy chain (Figure 7) 
A cell first attempts to rearrange one of its heavy chain genes; in some cells the maternal chromosome is selected and in others the paternal chromosome is selected. If the rearrangement is successful so that a heavy chain is made, then no further rearrangements occur in the heavy chain genes. If, on the other hand, the first attempt to rearrange the heavy chain genes is unsuccessful (i.e. no heavy chain is made), then the cell attempts to rearrange the heavy chain genes on its other chromosome. If the cell is unsuccessful in rearranging the heavy chain genes the second time, it is destined to be eliminated.
 

Kappa light chain (Figure 8) 
When a cell successfully rearranges a heavy chain gene, it then begins to rearrange one of its kappa light chain genes. It is a random event whether the maternal or paternal kappa light chain genes are selected. If the rearrangement is unsuccessful (i.e. it does not produce a functional kappa light chain), then it attempts to rearrange the kappa genes on the other chromosome. If a cell successfully rearranges a kappa light chain gene, it will be a B cell that makes an immunoglobulin with a kappa light chain.

Lambda light chain (Figure 8) - If a cell is unsuccessful in rearranging both of its kappa light chain genes, it then attempts to make a lambda light chain. It is a random event whether the maternal or paternal lambda light chain genes are selected. If the rearrangement is unsuccessful (i.e. it does not produce a functional lambda light chain), then it attempts to rearrange the lambda genes on the other chromosome. If a cell successfully rearranges a lambda light chain gene, it will be a B cell that makes an immunoglobulin with a lambda light chain.

The orderly sequence of rearrangements in the immunoglobulin gene families explains:
1) Why an individual B cell can only produce one kind of immunoglobulin with one kind of heavy and one kind of light chain.
2) Why a individual B cell can only make antibodies of one specificity.
3) Why there is allelic exclusion in immunoglobulin allotypes at the level of an individual immunoglobulin molecule but co-dominant expression of allotypes in the organism as a whole.
 

VI. ORIGIN OF ANTIBODY DIVERSITY

A. Background

Antibody diversity refers to the sum total of all the possible antibody specificities that an organism can make. It is estimated that we can make 107 - 108 different antibody molecules. One of the major questions in immunology has been how can we make so many different antibody molecules.

Theories which have attempted to explain the origin of antibody diversity fall into two major categories.

1. Germ line theory 
This theory states that we have a different V region gene for each possible antibody we can make.
2. Somatic mutation theory 
This theory state that we have only one or a few V region genes and the diversity is generated by somatic mutations which occur in these genes.

B. Current Concepts

Our current thinking is that both the germ line and somatic mutation theories have some merit. It is thought that antibody diversity is generated by the following mechanisms.

1. A large number of V genes
There are:

a) 30 lambda V genes
b) 300 kappa V genes
c) 1000 heavy chain V genes

2. V-J and V-D-J joining
The region where the light chain V gene and J region or the heavy chain V gene and D and J regions come together is in the third hypervariable region. Since it is random which V and which J or D regions come together, there is a lot of diversity that can be generated by V-J and V-D-J joining.

3. Junctional diversity (Inaccuracies in V-J and V-D and D-J recombination) - (Figure 9)

Recombination between V-J and V-D-J is not always perfect and additional diversity can arise by errors that occur in the recombination event that brings the V region next to the J or D regions or the D region next to the J region. It is estimated that these inaccuracies can triple the diversity generated by V-J and V-D-J joining. The diversity generated by this mechanisms is occurring in the third hypervariable region and thus, is directly affecting the combining site of the antibody.

4. N region insertion 
At the junction between D and J segments there is often an insertion of a series of nucleotides which is catalyzed by the enzyme terminal transferase. Terminal transferase catalyzes the random polymerization of nucleotides into DNA without the need for a template. This leads to further diversity in the third hypervariable region.

5. Somatic Mutation 
There is evidence that somatic mutations are occurring in the V gene, particularly in the place that codes for the second hypervariable region. Thus, somatic mutation probably contributes to antibody diversity to some extent.

6. Combinatorial Association 
Any individual B cell has the potential to make any one of the possible heavy chains and any one of the possible light chains. Thus, different combinations of heavy and light chains within an individual B cell adds further diversity.

7. Multispecificity 
Due to cross reactions between antigenic determinants of similar structure an antibody can often react with more than one antigenic determinant. This is termed multispecificity. Multispecificity also contributes to antibody diversity.

An example of how these mechanisms can generate a great deal of diversity is illustrated below:
 

 

 

 

B Cell Receptor (Immunoglobulin)

Heavy

Kappa

V gene segments

1000

300

D gene segments

15

-

J gene segments

4

4

N region insertion

++

-

Junctional diversity

+++

+

Somatic mutation

+

+

Combinatorial association

V x D x J

1000 X 15 X 4

V x J

300 x 4

Total

6 x 104

1.2 x 103

 

 

Combinatorial association

7.2 x 107

These calculations do not take into consideration the contributions of lambda light chains, somatic mutation junctional diversity, N region insertions or multispecificity.

The process of gene rearrangement of the heavy and light chains and the combinatorial association of these chains occurs during B cell development and is independent of antigen. Clones of B cells expressing all of the possible antibody specificities are produced during development and antigen simply selects those clones which have the appropriate receptor. The selected clones are then activated, proliferate and differentiate into antibody secreting plasma cells.

VII. T CELL RECEPTOR FOR ANTIGEN

T cells also have a receptor for antigen on their surfaces. This receptor is not an immunoglobulin molecule but it is composed of two different polypeptide chains which have constant and variable regions analogous to the immunoglobulins. Diversity in the T cell receptor is also generated in the same way as described for antibody diversity (e.g. by VJ and VDJ joining of gene segments and combinatorial association). However, no somatic mutation has been observed in T cells.

 

 

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