CD40LG and hyper-IgM syndrome: For instance, in patients with hyper IgM syndrome, a rare primary immunodeficiency disorder, the blood titers of IgM can be abnormally elevated while the concentrations of IgG, IgA, and IgE are decreased.[91] In patients suffering from chronic liver diseases and autoimmune diseases, the IgM is predominantly monomeric instead of multimeric.[92] To make matters worse, IgM levels and functions undergo dynamic changes during disease progression and medication, especially in cancer patients receiving chemotherapy, severely exacerbating the unpredictability of liposome clinical use.