Reduced butyrylcholinesterase activity is an early indicator of trauma-induced acute systemic inflammatory response

Abstract

PurposeEarly diagnosis of systemic inflammatory response syndrome is fundamentally important for an effective and a goal-directed therapy. Various inflammation biomarkers have been used in clinical and experimental practice. However, a definitive diagnostic tool for an early detection of systemic inflammation remains to be identified. Acetylcholine (Ach) has been shown to play an important role in the inflammatory response. Serum cholinesterase (butyrylcholinesterase [BChE]) is the major Ach hydrolyzing enzyme in blood. The role of this enzyme during inflammation has not yet been fully understood. This study tests whether a reduction in the BChE activity could indicate the onset of the systemic inflammatory response upon traumatic injury.Patients and methodsThis observational study measured BChE activity in patients with traumatic injury admitted to the emergency room by using point-of-care-test system (POCT). In addition, the levels of routine inflammation biomarkers during the initial treatment period were measured. Injury Severity Score was used to assess the trauma severity.ResultsAltered BChE activity was correlated with trauma severity, resulting in systemic inflammation. Reduction in the BChE activity was detected significantly earlier compared to those of routinely measured inflammatory biomarkers.ConclusionThis study suggests that the BChE activity reduction might serve as an early indicator of acute systemic inflammation. Furthermore, BChE activity, measured using a POCT system, might play an important role in the early diagnosis of the trauma-induced systemic inflammation.

A Sustained Reduction in Serum Cholinesterase Enzyme Activity Predicts Patient Outcome following Sepsis

“…The optimal cutoff value for the 90-day survival compares to the previously described BChE levels, observed upon the onset of the severe systemic inflammation [ 14 ]. Our previous study showed even stronger reduction of the normalized BChE activity upon systemic inflammation than nonnormalised data [ 21 ]; however, we did not observe this effect in the present study. Probable reason could be that the exact time point of the clinical diagnosis of the sepsis (and the time point of the initial BChE measurement) differed from the actual time point of the primary inflammation.…”

“…In accordance with our previous studies, the reduction in BChE activity was observed as early as 1-2 hours following the inflammatory onset [ 21 ]. Moreover, a sustained BChE activity reduction, observed in nonsurviving patients, represents a novel red flag warning indicator in the critical care setting, allowing simple and rapid detection of the high-risk septic patients.…”

“…Our previous work, and that of others, has proposed that the enzymatic activity of the BChE might accurately reflect the nonneuronal cholinergic activity during systemic inflammation [ 14 – 20 ]. By using a point-of-care-testing (POCT) system, we have previously shown a rapid and strong reduction in the BChE activity following an inflammatory challenge [ 21 ]. Here, we tested whether the measured BChE activity, obtained from septic patients at the admission to the ICU, might predict the 90-day survival and therefore be used as an early assay for the septic patient outcome.…”

Cholinesterase alterations in delirium after cardiosurgery: a German monocentric prospective study

“…Further, some samples were refrigerated before analysis, thereby potentially altering the measured enzyme activity. Zivkovic et al , however, have also identified a reduced BChE activity following surgery 34. They suggested a cholinergic modulation of the inflammatory response that is independent of POD.…”

Clinical associations between acetylcholine levels and cholinesterase activity in saliva and gingival crevicular fluid and periodontal diseases

“…Evidence has shown that perturbations in BChE activity are associated with diseases with an inflammatory component (Darvesh et al., ). For example, serum BChE activity levels are reduced in sterile inflammatory responses to surgery and in response to traumatic injury (Zivkovic, Bender, Brenner, Hofer, & Schmidt, ; Zivkovic et al., ). Moreover, genetic variations in BChE have been associated with autoimmune diseases such as arthritis and multiple sclerosis (Reale et al., ; Shahmohamadnejad et al., ).…”