Butyrylcholinesterase nerve-agent-inhibited

Presently available methods to diagnose and biomonitor exposure to anticholinesterases, e.g., nerve agents, rely mostly on measurement of residual enzyme activity of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) in blood. More specific methods involve analysis of the intact poison or its degradation products in blood and/or urine. These approaches have serious drawbacks. Measurement of cholinesterase inhibition in blood does not identify the anticholinesterase and does not provide reliable evidence for exposure at inhibition levels less than 20 %. The intact poison and its degradation products can only be measured shortly after exposure. Moreover, the degradation products of pesticides may enter the body as such upon ingestion of food products containing these products. 

A major drawback of the fluoride reactivation method is that not all nerve agent adducts are amenable to fluoride reactivation, with the aged adduct of soman the best known example. This problem can be solved by looking at the BuChE enzyme itself Fidder et al (2002) published a method based on the LC-MS analysis of a nerve agent phosphylated nonapeptide derived after pepsin digestion of inhibited butyrylcholinesterase. The authors presented a procedure to extract BuChE from plasma using... 

Exposure to a toxic dose of OP results in inhibition of acetylcholinesterase and butyrylcholinesterase activities. The most common method to measure OP exposure is to assay acetylcholinesterase and butyrylcholinesterase activities in blood using a spectrophotometric method (EUman et al, 1961 Wilson et al, 2005 Worek et al, 1999). The drawbacks of activity assays are that they do not identily the OP. They show that the poison is a cholinesterase inhibitor but do not distinguish between nerve agents, OP pesticides, carbamate pesticides, and tightly bound, noncovalent inhibitors like tacrine and other anti-Alzheimer drugs. In addition, low-dose exposure, which inhibits less than 20% of the cholinesterase, carmot be determined by measuring acetylcholinesterase and butyrylcholinesterase activity because individual variability in activity levels is higher than the percent inhibition. 

However, even erythrocyte AChE measurements cannot be expected to be a perfect surrogate for the nervous tissue enzyme this is because pharmacokinetic factors may result in differential access of the inhibitor to the red cell and to neural structures. A further consideration is that, where nerve agents react with the enzyme to produce a phosphonylated structure that does not spontaneously reactivate, red cells of mammals lack the protein synthetic capability to synthesize new AChE. By contrast, in nervous tissue, after inhibition by OPs whose enzyme-inhibitor complex with AChE does not readily reactivate, activity may reappear relatively quickly. Thus, Wehner et al (1985) observed approximately 30% recovery after 24 h in di-isopropylfluorophosphate (DFP)-treated mouse CNS reaggregates, which was clearly due to synthesis de novo of AChE. Another consideration in the interpretation of butyrylcholinesterase activity measurements is that the normal range is relatively wide, rendering interpretation in individual patients difficult unless the results of previous estimations in the patient are available (Swami-nathan and Widdop, 2001). 

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