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Official websites use. Share sensitive information only on official, secure websites. Acetylcholinesterase and butyrylcholinesterase are two closely related enzymes important in the metabolism of acetylcholine and anaesthetic drugs, including succinylcholine, mivacurium, and cocaine. The solanaceous glycoalkaloids SGAs are naturally occurring steroids in potatoes and related plants that inhibit both acetylcholinesterase and butyrylcholinesterase. There are many clinical examples of direct SGA toxicity due to cholinesterase inhibition. The aim of this study was to review the hypotheses that 1 SGAs may be the evolutionary driving force for atypical butyrylcholinesterase alleles and that 2 SGAs may adversely influence the actions of anaesthetic drugs that metabolized by acetylcholinesterase and butyrylcholinesterase. The information was obtained by Medline search and consultation with experts in the study of SGAs and cholinesterases. The SGAs inhibit both acetylcholinesterase and butyrylcholinesterase in numerous in vitro and in vivo experiments. Although accurate assays of SGA levels are difficult, published data indicate human serum SGA concentrations at least ten-fold lower than required to inhibit acetylcholinesterase and butyrylcholinesterase in vitro. However, we review evidence that suggests the dietary ingestion of SGAs can initiate a cholinergic syndrome in humans. This syndrome occurs at SGA levels lower than those which interfere with anaesthetic drug catabolism. The world distribution of solanaceous plants parallels the distribution of atypical alleles of butyrylcholinesterase and may explain the genetic diversity of the butyrylcholinesterase gene. Correlative evidence suggests that dietary SGAs may be the driving force for atypical butyrylcholinesterase alleles. In addition, SGAs may influence the metabolism of anaesthetic drugs and this hypothesis warrants experimental investigation. Acetylcholinesterase AChE; E. Acetylcholinesterase is vital to mammalian life, playing a crucial role in the neuromuscular junction by terminating cholinergic transmission. It is also a target for numerous inhibitors, such as neostigmine, which are important in medical therapy and toxicology. Butyrylcholinesterase also hydrolyzes other compounds such as cocaine 2 and heroin. The growing awareness of the role of BuChE in drug metabolism has led to interest in factors that alter its activity. A non-genetic factor that may influence BuChE activity is liver failure since BuChE is synthesized in the liver; in severe cases of hepatic dysfunction, response to succinylcholine can be prolonged. Anesthesiology ; —6 by kind permission of the authors and Lippincott-Raven Publishers. Depression in BuChE activity also appears to mediate adverse drug reactions to drugs other than the neuromuscular antagonists. For example, cocaine users who are suffering life-threatening adverse reactions have lower plasma BuChE concentrations than cocaine users presenting with less severe toxicity. There is also the suggestion that BuChE limits the adverse effects of maternal cocaine use on fetal development. The similarities of these genes implies that they arose from a common ancestral cholinesterase gene. The evolution of proteins can also be inferred by comparison of DNA sequences of genes in different species. Since all vertebrates contain two distinct cholinesterases, it is presumed that distinct BuChE and AChE genes and proteins actually evolved before the appearance of the first vertebrates. Genetic variation of the BuChE gene has been extensively explored. Many of the BuChE allelic variants display different sensitivities to these natural inhibitors, and this may confer an evolutionary advantage against toxic dietary exposure. A number of naturally occurring BuChE and AChE inhibitors have been discovered, including solanaceous glycoalkaloids SGAs , organophosphates from cyanobacteria, 23 and the fungal antibiotics puromycin and related analogs. Solanaceous glycoalkaloids have elicited concern about toxicity since among 5,—10, identified plant toxins they alone inhibit both AChE and BuChE. The steroidal backbone without the attached sugar moieties is the compound solanidine. Second, inhibition of esterases is important not only with established drugs, such as succinylcholine and mivacurium, but also with newer drugs, such as remifentanil, that are hydrolyzed by non-specific esterases. The implicit assumption in this strategy is that degradatory capacity is increased by the sensitivity of the drug to these non-specific esterases, and thus the influence of inhibitors of AChE and BuChE is minimized. Although no important interactions of AChE and BuChE inhibitors with remifentanil have yet been reported, and hepatic failure affects catabolism minimally, 28 the action of solanidine on nonspecific esterases has not been investigated. Given the trend to develop drugs with rapid catabolism by esterases, it is increasingly important to recognize and test for genetic and environmental influences that might alter the pharmacokinetic behavior of such drugs. In particular, differential sensitivity to natural inhibitors by BuChE variants may provide an evolutionary selective advantage. Solanaceous glycoalkaloid levels vary considerably among different plant species and vary with light exposure, mechanical damage, and the vegetable or fruit part e. In potatoes, green shoots or skin often considerably higher levels of SGAs than other parts of the plant. Higher levels of SGAs generally impart a bitter, unpleasant taste. Solanaceous glycoalkaloids received scrutiny as a result of documented outbreaks of toxicity in humans and livestock after potato consumption. The long history of potato toxicity 31 , 32 includes some fatalities. Many of these symptoms mimic the clinical syndrome of massive cholinergic stimulation. Symptoms last approximately 2—24 hr after ingestion of potatoes. Butyrylcholinesterase concentrations in 10 to 17 children analyzed were abnormally low six days after exposure. In all but one case, levels had returned to normal after four to five weeks. This may then create direct toxic effect or, more insidiously, cause altered metabolism of compounds metabolized by BuChE. Critical Rev. Plant Sciences, in press. Individuals consuming a standard serving of potatoes can ingest as much as 20 to 60 mg SGA. This amount overlaps the potentially toxic range of SGA in small children and heavier consumption of foods containing SGAs would also reach the toxic range in adults. Although severe direct toxicity caused by SGAs is rare, the possibility that SGAs under typical dietary conditions may alter BuChE-mediated metabolism has not been addressed experimentally. Given the wide range of commonly used drugs that appear to depend on BuChE for proper termination of action, the effects of SGA inhibition warrant careful study. For this reason, some investigators suggest that hamsters are the preferred animal model for studying the toxic effects of SGAs Friedman and MacDonald, in press. Since symptoms of potato and SGA toxicity resemble the syndrome of massive cholinergic stimulation, inhibition of AChE at cholinergic synapses probably accounts for most of the direct toxic effects of SGAs described above. Pokrovskii first demonstrated anti-cholinesterase activity in potato extracts, 43 and other investigators subsequently confirmed the finding. Clearly, the reported levels of inhibition vary considerably. GP refers to a mutant with asparate changed to glycine and serine changed to proline. Inhibition of plasma cholinesterase BuChE was determined in vitro on plasma on individuals who were presumed homozygous normal phenotype , heterozygote carrier , or homozygous abnormal atypical. BuChE allele composition was based on dibucaine numbers and other assays. Solanaceous glycoalkaloids and dibucaine inhibit butyrylcholinesterase. The atypical butyrylcholinesterase enzyme is much less sensitive to this inhibition. Butyrylcholinesterase activity is assessed by ability to hydrolyze butyrylthiocholine. Note that all concentrations studied for the three compounds, there is far less inhibition of the atypical enzyme that the normal enzyme. The top panel illustrates the pharmacological basis for the dibucaine number assay see introduction. Solanaceous glycoalkaloids inhibit acetycholinesterase. Reprinted in adapted form from Roddick JG: The acetylcholinterease-inhibitory activity of steroidal glycoalkaloids and their aglycones. The neurological effects of Solanum dimidiatum in mice, PhD Dissertation. Radioimmunoassay methods have detected total potato SGA blood serum concentrations of 3. Larger single doses are more toxic than a series of smaller doses in animals, even when the total amount delivered by smaller dosing is much greater. The key question for clinicians is whether normal dietary consumption of solanaceous plants can result in concentrations of SGAs that produce clinically important effects. Although accurate measurement of SGAs is difficult and different methods often provide conflicting results Friedman and MacDonald , the weight of evidence suggests plasma SGA levels associated with normal animal dietary consumption may be lower than those required to inhibit AChE and BuChE in vitro. The pharmacokinetic studies above demonstrate submicromolar concentrations of SGAs in human plasma. How the SGAs interact with each other is unknown. Some experiments have described synergistic effects in the toxic actions of SGAs. The potential inhibition of cholinesterase activity by extracts of potatoes Table II may indicate synergistic effects. World map showing the frequency of the allele for the atypical butyrylcholinesterase in different regions. The numbers indicate number of atypical genes per thousand. Note the especially high frequency of the atypical allele in South and Central America, Europe, and some areas of the Middle East. Many of the areas with high atypical allele frequency are areas where foods containing high levels of solanaceous glycoalkaloids have been consumed for thousands of years. Reprinted in adapated form from Whittaker M: Monographs in human genetics, Cholinesterase. Beckman L Ed. Basel, Karger, , pp. Karger AG, P. Box CH, Basel, Switzerland. The above hypothesis depends upon vital physiological function for BuChE. Although crucial physiological roles of BuChE are not clear, recent research suggests an important role in cellular growth and development. For example, the BuChE gene is intensively expressed in bone marrow cells 58 and fetal tissue. For example, prolonged exposure of a family to organophosphate insecticides was shown to result in an abnormally high number of copies of the BuChE gene in germ cells i. Individuals who are homozygous for such mutant alleles, while rare 0. Although this argues against a critical role for BuChE, compensatory mechanisms may operate in these rare individuals who completely lack catalytically active BuChE. Also, the effect of acute exposure to natural BuChE inhibitors at crucial periods of development may be harmful due to the insufficient activation of protective mechanisms. The inhibition of BuChE may influence its reported role in growth and development. Consequently, it is reasonable to hypothesize that resistance to SGA inhibition has been an evolutionary driving force for the high frequency of atypical alleles in some areas of the world. It is not clear whether the SGAs may influence the pharmacokinetic behaviour of drugs dependent on BuChE for catabolism. There has recently been an increased appreciation that dietary intake can influence pharmacokinetics and drug disposition and metabolism. For instance, grapefruit juice markedly inhibits first-pass metabolism of many drugs, including felodipine and nifedipine. Thus it is reasonable to hypothesize that SGAs may alter the pharmacokinetics of drugs metabolized by BuChE, although conclusive experimental evidence on this is currently lacking. Bushway, PhD for helpful discussions and unpublished observations. As a library, NLM provides access to scientific literature. Can J Anaesth. Published in final edited form as: Can J Anaesth. Find articles by Matthew D Krasowski. Find articles by Daniel S McGehee. Find articles by Jonathan Moss. PMC Copyright notice. The publisher's version of this article is available at Can J Anaesth. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Bushway et al. Sizer et al. Neville et al. Patil et al.

Human erythrocyte but not brain acetylcholinesterase hydrolyses heroin to morphine

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Background: delirium is a frequent neuropsychiatric syndrome affecting medical and surgical elderly patients. Cholinergic dysfunction has been implicated in delirium pathophysiology and plasmatic acetylcholinesterase AChE and butyrylcholinesterase BuChE activities are suppressed in patients with delirium. In this cohort study, we investigated whether these changes emerge during delirium or whether they are present before its onset. In addition to a comprehensive clinical and demographic baseline evaluation, venous blood samples were collected from each subject in the morning of hospital admission's day and in the morning of the first postoperative day. Delirium was screened daily with confusion assessment method confirmed with diagnostic and statistical manual of mental disorders DSM-IV -TR. Results: preoperatively, plasma esterase activity was significantly lower in patients who developed delirium compared with the remaining subjects. Following surgery BuChE activity was lower in the delirium group but this difference disappeared after controlling for preoperative values. Plasma cholinesterase activity correlated positively with calcium and haemoglobin and negatively with total bilirubin and international normalised ratio. Conclusion: plasma cholinesterase activity can be a useful candidate biomarker to identify subjects at greater risk of developing postoperative delirium. Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. If you are a member of an institution with an active account, you may be able to access content in one of the following ways:. Typically, access is provided across an institutional network to a range of IP addresses. This authentication occurs automatically, and it is not possible to sign out of an IP authenticated account. Choose this option to get remote access when outside your institution. Enter your library card number to sign in. 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Low preoperative plasma cholinesterase activity as a risk marker of postoperative delirium in elderly patients Get access. Joaquim Cerejeira , Joaquim Cerejeira. Address correspondence to: J. E-mail: jcerejeira netcabo. Oxford Academic. Google Scholar. Pedro Batista. Vasco Nogueira. Adriano Vaz-Serra. Elizabeta B. Select Format Select format. Permissions Icon Permissions. Abstract Background: delirium is a frequent neuropsychiatric syndrome affecting medical and surgical elderly patients. Issue Section:. You do not currently have access to this article. Download all slides. Comments 0. Add comment Close comment form modal. I agree to the terms and conditions. You must accept the terms and conditions. Add comment Cancel. Submit a comment. Comment title. You have entered an invalid code. Submit Cancel. Thank you for submitting a comment on this article. Your comment will be reviewed and published at the journal's discretion. Please check for further notifications by email. 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