Detection of cholinesterase inhibition. The significance of cholinesterase measurements.

Human cholinesterase exists in two forms--acetylcholinesterase located in tissue microsomes and red blood cells and serum cholinesterase found in serum or plasma. The two enzymes display marked differences in structure, substrate specificity, biological function, and origin. Contemporary methods employ acylthiocholine as substrate for serum cholinesterase and a second coupled reaction of thiocholine and chromogenic disulfide agents. Clinical applications are primarily centered on subnormal levels of enzyme activity. The decreased activity levels can be caused by inhibitors, reduced biosynthesis, or dysfunctional genetic variants. Changes in enzyme activity should be related to baseline levels because there is wide individual variation as well as methodological variation. Once baseline levels have been established, cholinesterase activity becomes a sensitive indicator of pesticide intoxication and hepatic biosynthetic capacity. A more sophisticated assay, performed in the presence of an inhibitor, is required to detect the atypical genetic variants of serum or plasma cholinesterase.