Emerging significance of butyrylcholinesterase

Abstract

Butyrylcholinesterase (BChE; EC 3.1.1.8), an enzyme structurally related to acetylcholinesterase, is widely distributed in the human body. It plays a role in the detoxification of chemicals such as succinylcholine, a muscle relaxant used in anesthetic practice. BChE is well-known due to variant forms of the enzyme with little or no hydrolytic activity which exist in some endogamous communities and result in prolonged apnea following the administration of succinylcholine. Its other functions include the ability to hydrolyze acetylcholine, the cholinergic neurotransmitter in the brain, when its primary hydrolytic enzyme, acetylcholinesterase, is absent. To assess its potential roles, BChE was studied in relation to insulin resistance, type 2 diabetes mellitus, cognition, hepatic disorders, cardiovascular and cerebrovascular diseases, and inflammatory conditions. Individuals who lack the enzyme activity of BChE are otherwise healthy, until they are given drugs hydrolyzed by this enzyme. Therefore, BChE is a candidate for the study of loss-of-function mutations in humans. Studying individuals with variant forms of BChE can provide insights into whether they are protected against metabolic diseases. The potential utility of the enzyme as a biomarker for Alzheimer’s disease and the response to its drug treatment can also be assessed.

Keywords: Esterase; Acetylcholinesterase; Variant; Cholinergic; Metabolic syndrome; Cognition; Knockout model

Core Tip: Butyrylcholinesterase (BChE), a hepatic enzyme, hydrolyzes the muscle relaxant succinylcholine. Individuals with variant forms of the enzyme are healthy until they are administered succinylcholine during anesthesia. The enzyme may have regulatory roles in lipid metabolism, cholinergic response, and Alzheimer’s disease. People with variant forms of the enzyme are natural human knockout models and can be followed up to study the metabolic impact of harboring variant forms of BChE.