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Changes of plasma cholinesterase activity during orthotopic liver transplantation in man.

Variations of plasma cholinesterase activity were studied in eight patients with end stage liver disease having orthotopic liver transplantation and five other patients with hepatic cirrhosis undergoing surgical procedures. Serum cholinesterase activity was found to be below normal limits in every patient, even more so in those having hepatic homotransplantation, probably because of the greater severity of their disease. Blood transfusions increased pseudocholinesterase activity to normal or nearly normal levels; but only after successful transplantation did these levels remain within normality, thus suggesting that the homografts promptly assume production of the serum enzyme.

Cholinesterases↗

Serum cholinesterase in tetanus.

This paper describes the correlation between serum cholinesterase levels and the severity and course of tetanus in a young patient. The diagnostic and prognostic value and significance of this enzyme as well as the therapeutic value of cholinesterase-restoring agents in tetanus are discussed.

Child↗

Prolonged neuromuscular blockade following trimetaphan infusion. A case report and in vitro study of cholinesterase inhibition.

This is a case report with postoperatively prolonged neuromuscular blockade of 17 hours duration suspected to be caused by trimetaphan. Inhibitory action of trimetaphan to true cholinesterase (human red cell cholinesterase) was estimated in vitro, and it is concluded that this action is too weak to cause neuromuscular disturbances by acetylcholine excess in clinical doses. Trimetaphan is considered to have a neuromuscular blocking action of a non-depolarising type.

Aged↗

Some observations of levels of plasma cholinesterase activity within an obstetric population.

An account of plasma cholinesterase activity in samples of maternal and cord blood is presented. It is confirmed that plasma exchange markedly reduces the level of activity in maternal blood, and that the level is further reduced during the first 3-4 postnatal days. A particularly marked decrease was found in those cases in which spontaneous mid-trimester abortion occurred. The level of activity in maternal blood (excluding mothers subjected to plasma exchange) at the time of delivery, was higher than that in cord blood in 61% of cases. In 23% of cases the level of activity was appreciably (0.05 units) higher in cord blood, and two-thirds of these cord samples contained the E2+ electrophoretic variant of plasma cholinesterase. The mean levels of activity in maternal and cord blood of Rhesus negative patients were significantly lower than those among Rhesus positive patients but there was no such distinction between Rhesus positive and Rhesus negative males and nonpregnant females. We encountered an incidence of 1:228 abnormal phenotypes in a series of 1593 mothers who underwent Caesarean section under a technique of general anaesthesia which included a suxamethonium infusion. However, probably only two of the seven patients would definitely be sensitive when not pregnant.

Anesthesia, General↗

Suxamethonium-induced muscle pains are not related to cholinesterase activity.

We have investigated the possibility of using the pre-operative measurement of cholinesterase activity to predict the postoperative development of myalgia following the administration of suxamethonium. Seventy-seven patients presenting for elective extraction of wisdom teeth were entered in the study. All patients received a standard anaesthetic regimen, including suxamethonium to facilitate tracheal intubation, and standardised postoperative analgesia. Myalgia was assessed postoperatively and no correlation between muscle pains and cholinesterase activity was found.

Adult↗

Cholinesterase. Its significance in anaesthetic practice.

Plasma cholinesterase is an enzyme which has importance to the anaesthetist primarily for its role in the metabolism of suxamethonium, although other anaesthetic related drugs that this enzyme metabolises are also increasingly important. In this article we review current thoughts on the function, profile and chemistry of plasma cholinesterase. Causes of variations in the activity of the enzyme are described and the basis of genetic variations is explained.

Anesthesia↗

Changes in brain cholinesterases in senile dementia of Alzheimer type.

Acetyl- and butyryl-cholinesterase activities have been measured biochemically in normal brain tissue, in senile dementia of Alzheimer type and in mental disorders without Alzheimer-type abnormalities. Acetylcholinesterase was significantly reduced and butyrylcholinesterase significantly increased, compared with the normal, in the hippocampus and temporal cortex of the Alzheimer cases. No significant enzyme changes were seen in the other diseases investigated including multi-infarct dementia, schizophrenia and depression. There was no correlation between age and acetylcholinesterase activity, but a significant positive correlation between the butyrylcholinesterase activities with increasing age (60-90 years) was found in the hippocampus. The possible connection between cholinergic system pathology and these cholinesterase abnormalities in Alzheimer dementia is discussed.

Acetylcholinesterase↗

Serum cholinesterase variants in the Danish population.

A total of 1278 adult patients were screened for serum cholinesterase (E.C. 3.1.1.8) variants. The following were used for phenotyping of variants: dibucaine, fluoride, chloride, and urea. The observed incidence of cholinesterase variants in the Danish population was similar to that found in other European countries.

Cholinesterases↗

The combined effects of pregnancy and repeated plasma exchange on serum cholinesterase activity.

Fourteen patients are described in whom repeated plasma exchange was performed as part of their treatment for Rh alloimmunisation during pregnancy. Despite administration of fresh frozen plasma at frequent intervals during therapy, serum cholinesterase activity was shown to be reduced to levels sufficient to put many of them at risk from suxamethonium sensitivity. It is recommended that if short-acting muscle relaxants are intended to be used during the delivery of such patients, a careful investigation of cholinesterase status should be undertaken beforehand.

Anesthesia, Obstetrical↗

Postoperative decline in plasma aspirin-esterase and cholinesterase activity in surgical patients.

We studied preoperative and postoperative plasma hydrolysis of aspirin and plasma cholinesterase activity in surgical patients. Postoperative aspirin esterase and cholinesterase activities fell sharply (119 +/- 32 micrograms ml h-1 and 3746 +/- 1068 U l-1 respectively; P < 0.01) in comparison to basal preoperative values (157 +/- 33 micrograms ml h-1 and 4620 +/- 940 U l-1 respectively, P < 0.01). We suggest that alterations in plasma esterase during the postoperative period may be related to the metabolic response to anesthesia- and surgery-induced stress.

Adult↗

Dose-response relationship for mivacurium in patients with phenotypically abnormal plasma cholinesterase activity.

During thiopentone-fentanyl-nitrous oxide anaesthesia and using a cumulative design, we studied the dose-response relationship of mivacurium in 8 patients: 7 patients phenotypically homozygous for the atypical plasma cholinesterase gene and 1 patient homozygous for the silent gene. The estimated mean ED50 and ED95 were 15 and 20 micrograms.kg.bw-1 in patients homozygous for the atypical gene, and 13 and 16 micrograms.kg.bw-1 in the patient homozygous for the silent gene, respectively. The results indicate that mivacurium is 4-5 times more potent in patients homozygous for the atypical or the silent gene than in patients with normal plasma cholinesterase activity and phenotype.

Adult↗

Regulation of cholinesterase gene expression affects neuronal differentiation as revealed by transfection studies on reaggregating embryonic chicken retinal cells.

In the embryonic chicken neuroepithelium, butyrylcholinesterase (BChE) as a proliferation marker and then acetylcholinesterase (AChE) as a differentiation marker are expressed in a mutually exclusive manner. These and other data indicate a coregulation of cholinesterase expression, and also possible roles of cholinesterases during neurogenesis. Here, both aspects are investigated by two independent transfection protocols of dissociated retina cells of the 6-day-old chick embryo in reaggregation culture, both protocols leading to efficient overexpression of AChE protein. The effect of the overexpressed AChE protein on the re-establishment of retina-like three-dimensional networks (so-called retinospheroids) was studied. In a first approach, we transfected retinospheroids with a pSVK3 expression vector into which a cDNA construct encoding the entire rabbit AChE gene had been inserted in sense orientation. As detected at the mRNA level, rabbit AChE was heterologously overexpressed in chicken retinospheroids. Remarkably, this was accompanied by a strong increase in endogenous chicken AChE protein, while the total AChE activity was only slightly increased. This increase was due to chicken enzyme, as shown by species-specific inhibition studies using fasciculin. Clearly, total AChE activity is regulated post-translationally. As an alternative method of AChE overexpression, transfection of spheroids was performed with an antisense-5'-BChE vector, which not only resulted in the down-regulation of BChE expression, but also strongly increased chicken AChE transcripts, protein and enzyme activity. Histologically, a higher concentration of AChE protein (as a consequence of either AChE overexpression or BChE suppression) was associated with an advanced degree of tissue differentiation, as detected by immunostaining for the cytoskeletal protein vimentin.

Animals↗

Interactions of cholinesterase inhibitors and glucocorticoids with ketamine and pentobarbitone-induced general anaesthesia in the rat: possible effects on central cholinergic activity.

Doses of 100, 150 and 200 micrograms kg-1 of the cholinesterase inhibitor neostigmine reverse the anaesthetic action of ketamine. The antagonistic effect is increased as the dose is increased. The duration of anaesthesia induced by pentobarbitone is reversed by the cholinesterase inhibitor in doses of 150, 200 and 250 micrograms kg-1. Choline, in a dose of 50 mg kg-1, significantly antagonizes the action of the two anaesthetics, whereas hemicholinium-3, an inhibitor of the uptake of choline and the synthesis of acetylcholine, markedly potentiates their action. Dexamethasone induces a significant reduction of the duration of anaesthesia produced by ketamine and pentobarbitone. The potentiation of the anaesthetic effect caused by hemicholinium-3 is also reversed by dexamethasone. The acetylcholine content in rat cerebral cortex is increased after treatment with ketamine and pentobarbitone. Measurements of the course of the plasma level of pentobarbitone do not reveal alterations in the pharmacokinetic profile by either neostigmine or dexamethasone. These results indicate that central cholinergic systems may somehow be involved in the anaesthesia induced by ketamine and pentobarbitone and that the interactions described in this paper may be the result of modification by neostigmine and dexamethasone of the alterations in cholinergic activity caused by the two anaesthetics.

Acetylcholine↗

S protein/vitronectin in chronic liver diseases: correlations with serum cholinesterase, coagulation factor X and complement component C3.

S protein/vitronectin plays an important role as a regulatory component in the terminal steps of the complement- and coagulation cascades. In patients suffering from chronic liver diseases, plasma S protein concentration was measured and compared with changes in serum cholinesterase activity, coagulation factor X activity and complement component C3 concentration. Significant decreases of all these proteins were seen in liver cirrhosis. Changes in S protein concentration correlated closely with those of cholinesterase, factor X and complement C3. The data give support for the liver as the main organ of plasma S protein/vitronectin synthesis.

Adult↗

The effect of cholinesterase inhibitors on the secretion of APPS from rat brain cortex.

In this study we examined the question whether cholinesterase inhibitors (ChEI) could alter the release of amyloid precursor protein (APP) from superfused brain cortical slices of the rat following electrical as well as pharmacological stimulation with bethanechol (BETHA). Three ChEI, both reversible and irreversible were tested for their ability to enhance the release of non-amyloidogenic soluble derivatives (APPs). These included physostigmine (PHY), heptyl-physostigmine (HEP) and 2,2-dichlorovinyldimethyl phosphate (DDVP), at the concentrations producing cholinesterase (ChE) inhibition ranging from 5% to 95%. All three ChEI elevated APPs release significantly above control levels. Electrical field stimulation significantly increased the release of APPs within 50 min. Similar increase was observed after muscarinic receptor stimulation with BETHA. Tetrodotoxin (TTX) completely blocked the effect of electrical stimulation. These findings suggest that long-term administration of ChEI to Alzheimer's disease (AD) patients may have a neuroprotective effect by activating normal APP processing and decreasing the formation of amyloidogenic APP products.

Amyloid beta-Protein Precursor↗

Effects of cholinesterase inhibitors on the secretion of beta-amyloid precursor protein in cell cultures.

One of the main characteristics of Alzheimer's disease (AD) is the cerebrovascular deposition of the amyloid beta-peptide (A beta), which is derived from a larger beta-amyloid precursor protein (beta APP). The majority of beta APP is processed by either a secretory of lysosomal/endosomal pathway. Carboxyl-truncated soluble derivatives of beta APP (sAPP) are generated by the proteolytic processing of full-length beta APP by either alpha- or beta-secretase enzyme. Our objective is to determine whether the processing of beta APP can be regulated by cholinesterase inhibitors, some of which were shown to produce a moderate improvement in memory and cognitive functions in patients with Alzheimer's disease. Here we have analyzed the levels of sAPP derivatives in cultured cells treated with different drugs by immunoblotting samples of conditioned media. The immunoreactive protein bands were developed by probing with the monoclonal antibody 22C11. Treating neuroblastoma, pheochromocytoma and fibroblast cells with high dose of either 3,4-diaminopyridine, metrifonate, or physostigmine did not inhibit the secretion of sAPP. Treating glioblastoma with either 3,4-diaminopyridine or metrifonate showed an increase in secretion of sAPP. However, treatment of cells with tacrine reduced release of sAPP in conditioned media of cell lines studied. The difference in action of metrifonate, physostigmine, and tacrine on beta APP is independent of their anticholinesterase activities. Our results suggests that noncatalytic functions of cholinesterase inhibitors can be utilized to alter the metabolism of beta APP, which might in turn affect the process of deposition of A beta, a key component of the cerebrovascular amyloid detected in AD.

4-Aminopyridine↗

The distribution of cholinesterases in the cat carotid body.

1. The distribution of acetyl- and butyrylcholinesterase in the carotid body of the cat has been examined histochemically. Studies were made on normal carotid bodies and on carotid bodies from cats in which certain nerves had been cut some time previously. The nerves sectioned were the sinus nerve, the post-ganglionic sympathetic branch of the superior cervical ganglion or the preganglionic cervical sympathetic trunk.2. It was confirmed that more butyrylcholinesterase than acetylcholinesterase is present. Both enzymes are found in three sites: (i) as strands, (ii) as plexuses, (iii) inside a few cells.3. The distribution is unaffected by cutting the sinus nerve or preganglionic cervical sympathetic nerves. Disorganization and depletion of the cholinesterases in the strands and plexuses occurs when the post-ganglionic branch of the superior cervical ganglion is cut. The cholinesterase in cells is unaffected.4. In carotid bodies in which vessels were filled with red blood cells or in which the vascular bed was injected with carmine-gelatine, it was seen that strands and plexuses are associated with blood vessels, and with blood vessels and cells respectively.5. It is suggested that a cholinergic pathway controlling carotid body blood vessels runs in the post-ganglionic cervical sympathetic.

Acetylcholinesterase↗