Pseudocholinesterases

Acetylcholinesterase (EC 3.1.1.7) (AChE) Acetylcholine acetylhydrolase True ChE ChE I ChE Acet-ylthiocholinesterase Acetylcholine hydrolase Acetyl (3-methylcholinesterase Erythrocyte ChE Butyrylcholinesterase (EC 3.1.1.8) (BChE or BuChE) ChE Pseudocholinesterase Plasma ChE Acylcholine acylhydrolase Non-specific ChE ChEII Benzoylcholinesterase Propionylcholinesterase... 

There is a second type of cholinesterase called butyrylcholinesterase, pseudocholinesterase, or cholinesterase. This enzyme is present in some nonneural cells in the central and peripheral nervous systems as well as in plasma and serum, the liver, and other organs. Its physiologic function is not known, but is hypothesized to be the hydrolysis of esters ingested from plants (Lefkowitz et al. 1996). Plasma cholinesterases are also inhibited by organophosphate compounds through irreversible binding this binding can act as a detoxification mechanism as it affords some protection to acetylcholinesterase in the nervous system (Parkinson 1996 Taylor 1996). 

KalowW. 1956. Familial incidence of low pseudocholinesterase levels [Letter]. Lancet 2 576-577. 

Sanz P, Rodriguez-Vicente MC, Diaz D, et al. 1991. Red blood cell and total blood acetylcholinesterase and plasma pseudocholinesterase in humans Observed variances. Clin Toxicol 29 81-90. 

Certain enzymes, proenzymes, and their substrates are present at all times in the circulation of normal individuals and perform a physiologic function in the blood. Examples of these functional plasma enzymes include lipoprotein Upase, pseudocholinesterase, and the proenzymes of blood coagulation and blood clot dissolution (Chapters 9 and 51). The majority of these enzymes are synthesized in and secreted by the liver. 

Succinylcholine 1-1.5 mg/kg IV up to 150 mg total dose ° Contraindications may include use in patients with a personal or family history of malignant hyperthermia, extensive/severe burns, myopathies with elevated creatine phosphokinase, penetrating eye injuries, pre-existing hyperkalemia, narrow-angle glaucoma, and disorders of plasma pseudocholinesterase... 

Consistent decreases in plasma cholinesterase may not have been observed in rats and dogs because they were treated with lower doses of diisopropyl methylphosphonate. In general, depression of plasma cholinesterase, also known as pseudocholinesterase or butyrylcholinesterase, is considered a marker of exposure rather than an adverse effect. Depression of cholinesterase activity in red blood cells (acetylcholinesterase) is a neurological effect thought to parallel the inhibition of brain acetylcholinesterase activity. It is considered an adverse effect. Acetylcholinesterase is found mainly in nervous tissue and erythrocytes. Diisopropyl methylphosphonate was not found to inhibit RBC... 

The inhibition of two cholinesterase activities in blood can also be used to confirm exposure to certain organophosphate ester compounds. Red blood cell acetylcholinesterase is the same cholinesterase found in the gray matter of the central nervous system and motor endplates of sympathetic ganglia. Synonyms for this enzyme include specific cholinesterase, true cholinesterase, and E-type cholinesterase. Plasma cholinesterase is a distinct enzyme found in intestinal mucosa, liver, plasma, and white matter of the central nervous system. Synonyms for this enzyme include nonspecific cholinesterase, pseudocholinesterase, butyrylcholinesterase, and S-type cholinesterase (Evans 1986). Nonspecific cholinesterase is thought to be a very poor indicator of neurotoxic effects. 

Peedicayil J, Ernest K, Thomas M, et al. 1991. The effect of organophosphorus compounds on serum pseudocholinesterase levels in a group of industrial workers. Hum Exp Toxicol 10 275-278. 

The classical role of AChEs is to terminate transmission of neuronal impulses by rapid hydrolysis of ACh. The closely related butyrylcholin-esterases (BuChEs) or pseudocholinesterases have a less stringent substrate specificity but their function remains ill-defined. In mammals, BuChE is found at high concentration in the plasma and the gut, where it has been... 

The answer is a. (Hardman, p 338. Katzung, pp 438-439.) Ester-type local anesthetics are mainly hydrolyzed by pseudocholinesterases. Amide-type local anesthetics are hydrolyzed by microsomal enzymes in the liver. Of the listed agents, only lidocaine is an amide and can be influenced by liver dysfunction. 

Suxamethonium sensitivity, due to atypical serum pseudocholinesterase Frequency 1/2000 Caucasians... 

Although hydrolytic enzymes, esterases and amidases, are named after their major substrates, the same enzyme can often hydrolyze esters, thioesters, and amides therefore, the differentiation between esterases and amidases is sometimes artificial. The highest hydrolytic activity is in the liver, but the enzyme pseudocholinesterase is found in the serum. Gut bacteria also contain hydrolytic enzymes. 

Esterases that contribute to human drug metabolism fall into three major classes the cholinesterases (acetylcholinesterase, pseudocholinesterase, butyrylcholinesterase, etc.),... 

The contribution of pseudocholinesterase, also known simply as cholinesterase, to drug metabolism is much greater as it possesses considerably broader substrate selectivity. In addition to acetylcholine, it will hydrolyze other choline esters like the muscle relaxant succinylcholine. It will also hydrolyze non-choline-containing drugs like the local anesthetic procaine and the anti-inflammatory agent aspirin (Fig. 6.5). Cholinesterases, particularly... 

Pseudocholinesterase is a polymorphic enzyme. Succinylcholine is a paralyzing agent used during surgery to prevent muscle twitching. When succinylcholine is used in patients who are deficient in pseudocholinesterase, they wake up from the anesthetic but remain paralyzed for a prolonged period of time. 

While there are clear differences in substrate selectivity between the drug metabolizing hydrolytic enzymes, there is also significant overlap, i.e., they will often tend to metabolize the same substrates but at different rates. For example, pseudocholinesterase, hCE-1, and hCE-2 catalyze the hydrolysis of heroin and cocaine. 

Reference has repeatedly been made to the powerful anticholinesterase activity of D.F.P. (p. 61). Towards pseudocholinesterase, for example, it is effective in concentration as low as 10 11M. In order to throw light on its mode of action with esterases,3 radioactive D.F.P. containing 32P was prepared.4 An account of its production on what may be conveniently called the one-gram scale , directly from phosphorus, is given below. 

In Chapter in we drew attention to the fact that some nerve fibres are myelinated. It has been suggested that the pseudocholinesterase of the central nervous system may be concerned in myelin metabolism and that inhibition of pseudo-cholinesterase... 

Inhibition of the two principal human cholinesterases, acetylcholinesterase and pseudocholinesterase, may not always result in visible neurological effects (Sundlof et al. 1984). Acetylcholinesterase, also referred to as true cholinesterase, red blood cell cholinesterase, or erythrocyte cholinesterase is found in erythrocytes, lymphocytes, and at nerve synapses (Goldfrank et al. 1990). Inhibition of erythrocyte or lymphocyte acetylcholinesterase is theoretically a reflection of the degree of synaptic cholinesterase inhibition in nervous tissue, and therefore a more accurate indicator than pseudocholinesterase activity of inhibited nervous tissue acetylcholinesterase (Fitzgerald and Costa 1993 Sundlof et al. 1984). Pseudocholinesterase (also referred to as cholinesterase, butyrylcholinesterase, serum cholinesterase, or plasma cholinesterase) is found in the plasma, serum, pancreas, brain, and liver and is an indicator of exposure to a cholinesterase inhibitor. 

Cholinesterase Acylcholine acylhydrolase, butyrylcholinesterase, pseudocholinesterase Choline esters and other esters... 

Fig. 27 RBC (tme) as well as pseudocholinesterase inhibition was measured several times in this study. A surprisingly large reduction in cholinesterase levels can be well tolerated when EA 3443 is present. Small doses (unspecified) of VX were used here, producing shorter periods of antidotal effect, lasting only a few hours following each treatment.

The effect of a standard dose of succinylcholine lasts only about 10 min. It is often given at the start of anesthesia to facilitate intubation of the patient. As expected, choUnesterase inhibitors are unable to counteract the effect of succinylcholine. In the few patients with a genetic deficiency in pseudocholinesterase (= nonspecific cholinesterase), the succinylcholine effect is significantly prolonged. 

This enzyme [EC 3.1.1.8] (also known as cholinesterase, pseudocholinesterase, acylcholine acylhydrolase, nonspecific cholinesterase, and benzoylcholinesterase) catalyzes the hydrolysis of an acylcholine to generate choline and a carboxylic acid anion. A variety of choline esters and a few other compounds can serve as substrates. 

Smith, R. L., Loewenthal, H., Lehmann, H., and Ryan, E., A simple colorimetric method for estimating serum pseudocholinesterase. Clin. Chim. Acta 4, 389-390 (1959). 

Cholinesterase inhibitors are a very important class of compounds related to cholinomimetics. Besides their therapeutic importance, a few of them are used as pesticides in agriculture, and the most toxic are used as chemical poisoning agents. Use of these substances is based on changes that take place after inactivation of cholinesterase or pseudocholinesterase (a less specific enzyme), i.e. effects observed as a result of acetylcholine buildup in neuro-effector compounds. Cholinesterase inhibitors are classified both by their chemical structure as well as by the type of their chemical reaction with the enzyme, which determines their temporary action. 

There are two major types of cholinesterases acetylcholinesterase (AChE) and pseudocholinesterase (pseudo-ChE). AChE (also known as true, specific, or erythrocyte cholinesterase) is found at a number of sites in the body, the most important being the cholinergic neuroeffector junction. Here it is localized to the prejunctional and postjunctional membranes, where it rapidly terminates the action of synaptically released ACh. It is essential to recognize that the action of ACh is ter-... 

Remifentanil, recently approved for use in the United States and Europe, is the first truly ultra-shortacting opioid. Remifentanil s uifique ester linkage allows it to be rapidly degraded to an inactive carboxylic acid metabolite by nonspecific esterases found in tissue and red blood cells. Since it is not a good substrate for plasma pseudocholinesterase, deficiency of the enzyme does not influence its duration of action. Also, hepatic and renal insufficiencies do not influence remifentanil s pharmacokinetics, so it is useful when liver or kidney failure is a factor. Because of its rapid clearance following infusion, remifentanil has gained popularity as an agent for maintenance of anesthesia when an IV technique is practical. 

Pharmacokinetics Systemic absorption of tetracaine is variable. Metabolized by plasma pseudocholinesterase. Excreted in the urine. 

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