Invited review: Anticholinesterases: dramatic aspects of their use and misuse

Protective Effects of Pelargonium graveolens Essential Oil on Methomyl-Induced Oxidative Stress and Spatial Working Memory Impairment in Association with Histopathological Changes in the Hippocampus of Male Wistar Rats

INTRODUCTION

Methomyl (MET) is a carbamate insecticide, used in agriculture and public health to eliminate harmful insects. Besides its advantages in agriculture, it causes neurotoxic effects. The aim of this study was to evaluate the effect of MET on Spatial Working Memory (SWM), oxidative stress parameters, and histopathological changes in the hippocampus, as well as the possible protective role of Pelargonium graveolens Essential Oil (EO).

METHODS

Male Wistar rats were randomized into four groups of six animals: group I as the control that received the vehicle; group II received EO (75 mg/kg b.w), group III received MET (2 mg/kg b.w); and group IV received both MET and EO. The rats were administered the respective doses orally by gavage for 28 days. SWM was assessed using Y-maze on the day before the first treatment and day 28 after the last dose. They were sacrificed by decapitation and their brains were taken for assessing oxidative stress parameters and histopathological analysis.

RESULTS

MET treatment caused SWM deficits. Furthermore, drastic changes were observed in aspartate transaminase, alanine aminotransferase, and alkaline phosphatase activities. The level of malondialdehyde significantly increased, whereas antioxidant (glutathioneS-transferase and catalase) enzyme activities significantly decreased. The CA1 region of the hippocampus of rats exposed to MET revealed severe histological alterations. However, supplementation with EO improved SWM and partially restored the activities of antioxidant systems and prevented neuronal cell damage.

CONCLUSION

P. graveolens EO has the potential in mitigating most of the adverse effects in the hippocampus and prevents SWM impairment induced by MET toxicity.

Characterization of brain acetylcholinesterase of bentonic fish Hoplosternum littorale: Perspectives of application in pesticides and metal ions biomonitoring

Acetylcholinesterase (AChE; EC 3.1.1.7) is a serine hydrolase, whose main function is to modulate neurotransmission at cholinergic synapses. It is, therefore, the primary target of some pesticides and heavy metals. Its inhibition in aquatic organisms has been used as an indicator of the presence of these pollutants in water bodies. The present study aimed to characterize physicochemical and kinetic parameters of brain AChE in the benthic fish Hoplosternum littorale and to analyze the in vitro effects of pesticides (dichlorvos, diazinon, chlorpyrifos, parathion-methyl, temephos, carbaryl, carbofuran, aldicarb, diflubenzuron, novaluron and pyriproxyfen) and metal ions (As³⁺, Cd²⁺, Cu²⁺, Fe²⁺, Mn²⁺, Mg²⁺, K⁺, Pb²⁺, Hg²⁺, Zn²⁺) investigating the potential of this enzyme as environmental biomarker based on current regulations. Specific substrates and inhibitors have indicated AChE to be the predominant cholinesterase (ChE) in the brain of H. littorale. Peak activity was observed at pH 8.0 and 30 °C. The enzymatic activity is otherwise moderately thermostable (≈ 50% activity at 45 °C). The enzyme can reduce the activation energy of acetylthiocholine hydrolysis reaction to 8.34 kcal mol^-1 while reaching a rate enhancement of 10⁶. Among the pesticides under study, dichlorvos presented an IC₅₀ value below the maximum concentrations allowed by legislation. This study presents the first report on the inhibition of brain AChE activity from Siluriformes by the pesticides novaluron and pyriproxyfen. Mercury ion also exerted a strong inhibitory effect on its enzymatic activity. The H. littorale enzyme thus has the potential to function as an in vitro biomarker for the presence of the pesticide dichlorvos as well as mercury in areas of mining and industrial discharge.

Serum β-glucuronidase activity as a biomarker for acute cholinesterase inhibitor pesticide poisoning

β-glucuronidase (BG) activity is a promising biomarker for diagnosis and prognosis after exposure to organophosphorous (OP) pesticides. The aim of this study was to evaluate the changes in serum BG activity in patients with acute OP poisoning and to determine whether these changes correlate with the severity of poisoning. Thirty patients with anticholinesterase pesticide poisoning were included, besides 10 healthy volunteers as a control group. Serum activities of butyrylcholinesterase (BuChE) and BG were measured for each subject on admission, then after 12 and 24 h. Serum levels of BuChE and BG in poisoned patients were significantly different from the control subjects; these differences persisted in repeated measurements. Moreover, the serum levels showed significant differences within each group of the three time points. A significant negative correlation was found between the serum activities of BuChE and BG in all groups at the three time points. In conclusion, serum BG activity seems a reliable marker for OP poisoning even when measured at 24 h after poisoning.

Cholinesterase-inhibiting and genotoxic effects of acute carbofuran intoxication in man: a case report

Carbofuran belongs to the group of N-methylcarbamate insecticides used for the control of soil-dwelling and foliar-feeding insects in various crops; its consumption totals approximately 20,000 tonnes per year. Although the neurological effects on human beings have been well documented, little is known on its impact on the genome. A 38-year-old, healthy male worker employed in a carbofuran production facility accidentally inhaled the dust of the active ingredient carbofuran. Thirty minutes later, he experienced weakness, fatigue, perspiration, breathing difficulties, cephalalgia, disorientation, abdominal pain and vomiting. Blood samples were taken to measure cholinesterase activity, and to perform the alkaline comet assay and micronucleus assay combined with pancentromeric probes. Analyses were repeated 72 hr after intoxication and compared with the results obtained from regular monitoring conducted 10 days prior to the accident. Cholinesterase activity showed the highest correlation with the number of apoptotic cells, comet assay tail length, and number of long-tailed nuclei, suggesting that these are the genomic end-points primarily affected by carbofuran intake. Only a weak correlation was detected for the total number of micronuclei, centromere-containing micronuclei and nuclear buds. Since those end-points increased significantly 72 hr after the accident, they could be considered as late biomarkers of the effects of carbofuran intoxication. The results of this report suggest that, in the interests of higher standards in risk assessment and health hazard protection, periodical medical examination of carbamate-exposed populations should include genotoxicity testing in addition to the assessment of cholinesterase activity.

Learning Ability as a Function of Practice: Does It Apply to Farmworkers?

OBJECTIVE

Farmworkers experience significant work-related health risks including pesticide-associated cognitive impairment. Practice effect is a surrogate for learning ability. This study examined differences in cognitive function and learning capacity in Latino farmworkers and nonfarmworkers.

METHODS

Tasks of learning and short-term memory, executive function and working memory, perceptual coding, and psychomotor function were assessed at baseline and 3-month follow-up in 136 farmworkers and 116 nonfarmworkers.

RESULTS

Farmworkers had better performance on visuospatial learning and short-term memory at baseline (P < 0.05). Nevertheless, nonfarmworkers showed more practice effects, or improvement on cognitive performance, at 3-month follow-up relative to farmworkers. Furthermore, the amount of improvement on visuospatial learning ability, short-term visuospatial memory, and perceptual coding ability was significantly higher in nonfarmworkers than in farmworkers.

CONCLUSIONS

Practice effects may serve as an additional cognitive readout to differentiate healthy individuals from those with cognitive impairment.

Cholinesterase inhibitors from botanicals

Alzheimer's disease (AD) is a progressive neurodegenerative disease, wherein a progressive loss of cholinergic synapses occurs in hippocampus and neocortex. Decreased concentration of the neurotransmitter, acetylcholine (ACh), appears to be critical element in the development of dementia, and the most appropriate therapeutic approach to treat AD and other form of dementia is to restore acetylcholine levels by inhibiting both major form of cholinesterase: Acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). Consequently, researches have focused their attention towards finding cholinesterase inhibitors from natural products. A large number of such inhibitors have been isolated from medicinal plants. This review presents a comprehensive account of the advances in field of cholinesterase inhibitor phytoconstituents. The structures of some important phytoconstituents (collected through www.Chemspider.com) are also presented and the scope for future research is discussed.

Environmental and dietary risk factors in Alzheimer’s disease

Alzheimer's disease (AD) is a progressive neurodegenerative disease that affects millions in the aging population worldwide and will affect millions more in the next 20 years. Over 90% of all cases are sporadic, with genetics playing a minor role in the etiology of AD. Therefore, it is crucial to investigate the environment and diet as primary risk factors in AD pathology. This review considers epidemiologic case control studies, and in vitro and in vivo research to investigate the potential of environmental exposure to metals, air pollution and pesticides as well as diet as risk factors for AD. In some cases, the role of genetic mutations and environmental risk is discussed. The evidence examined in this review provides a brief overview of the current literature on selected, significant risk factors in promoting amyloid-beta accumulation and aggregation, thus contributing to neurodegeneration.

Pharmacological effects of Catharanthus roseus root alkaloids in acetylcholinesterase inhibition and cholinergic neurotransmission

The leaves of Catharanthus roseus constitute the only source of the well known indolomonoterpenic alkaloids vincristine and vinblastine. In this work we studied the biological potential of the roots, which are used in several countries as decocts or hot water extracts for the treatment of a number of conditions. The aqueous extract strongly inhibited acetylcholinesterase (AchE) in an in vitro microassay, an effect ascribable mainly to serpentine (IC(50) = 0.775 microM vs physostigmine IC(50) = 6.45 microM) as assessed with the pure compound. Pure alkaloids were tested for muscarinic and nicotinic antagonism using rat ex-vivo preparations, namely, ileum and diaphragm/phrenic-nerve, respectively. Serpentine competitively blocked muscarinic receptors with a pA(2) of 5.2, whereas the precursor ajmalicine up to 80 microM was undistinguishable from control, and catharanthine exhibited an unsurmountable muscarinic antagonism at greater than 10 microM concentrations. Nicotinic receptor mediated diaphragm contractions were fully inhibited by catharanthine (IC(50) = 59.6 microM) and ajmalicine (IC(50) = 72.3 microM), in a reversible but non-competitive manner, unlike the more potent nicotinic antagonist tubocurarine (IC(50) = 0.35 microM) whose competitive blockade was overcome by a physostigmine-induced increase in acetylcholine. Serpentine up to 100 microM did not change diaphragm contractions suggesting reduced affinity for neuromuscular nicotinic receptors. Despite strong in vitro AchE inhibition, serpentine failed to restore diaphragm contractions upon submaximal tubocurarine blockade, suggesting that poor tissue penetration may prevent serpentine from inhibiting AchE in deep neuromuscular synapses in the ex-vivo preparation. To our knowledge, the present study is the first to assess the effect of C. roseus root extracts, as well as of serpentine, ajmalicine and catharanthine on AchE. The results described herein suggest that the currently overlooked C. roseus roots may constitute a promising source of compounds with pharmaceutical interest. Moreover, given serpentine's potent in vitro AchE inhibitory activity and low cholinergic receptor affinity, it is conceivable that minor structural modifications may yield a potent and selective AchE inhibitor, potentially useful for the pharmacological management of conditions such as Alzheimer's disease and/or myasthenia gravis.

Cholinesterase activity among spray workers in Iran

In this study whole blood cholinesterase activities of the agriculture and hygiene spray workers exposed to organophosphorus and carbamate compounds from different parts of Tehran Province in Iran were determined. Lovi Bond method was used in three stages including prepare the questionnaires about spray worker body health conditions, taking their blood samples before and after working and their insight to insecticides and prepare the required solutions. Results showed that no any changes were observed in the 50% of the spray worker blood cholinesterase activity after working. In the 32.4% of them, cholinesterase activity has decreased up to extensive poisoning and in the 17.6% of them cholinesterase activity was much decreased at the end of an acute or severe poisoning, whereas in testifier workers less than 5.9% of them cholinesterase activity was decreased and in the 94.1% of testifier workers cholinesterase activity was normal. Analysis of the data demonstrated that no significant relationship between spray worker blood cholinesterase activity, age groups, history of working, knowledge, cigarette smoking, history of toxicity and their responsibilities were observed. The measurement of pre-exposure cholinesterase values is essential for comparison of the values after pesticide application.

Acetylcholinesterase/butyrylcholinesterase inhibition activity of some new carbacylamidophosphate derivatives

Eight newly synthesized carbacylamidophosphates with the general formula RC(O)NHP(O)Cl2 with R = pCl-C6H4 1a, pBr-C6H4 2a, C6H5 3a, and pMe-C6H4 4a and RC(O)NHP(O)(NC4H8O)2 R = pCl-C6H4 1b, pBr-C6H4 2b, C6H5 3b, pMe-C6H4 4b, were selected to compare the inhibition kinetic parameters, IC50, Ki, kp and KD, on human erythrocyte acetylcholinesterase (hAChE) and bovine serum butyrylcholinesterase (BuChE), Also, the in vivo inhibition potency of compound 2a, 2b and 3a, were studied. The data demonstrates that compound 2a and compound 2b are the potent sensitive as AChE and BuChE inhibitors respectively, and the inhibition of hAChE is about 10-fold greater than that of BuChE.

In vitro biological activity screening of Lycopodium complanatum L. ssp. chamaecyparissus (A. Br.) Doll

This article reports the results of selected biological activities, including anticholinesterase, antioxidant, antibacterial, antifungal and antiviral properties, of the petroleum ether, chloroform and methanol extracts as well as the alkaloid fraction of Lycopodium complanatum L. ssp. chamaecyparissus (A. Br.) Doll (LCC, Lycopodiaceae) growing in Turkey. Anticholinesterase effect of the extracts was tested against both acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) at concentrations of 0.2 and 1 mg mL(-1) using microplate-reader assay based on Ellman method. Antioxidant activity of the LCC extracts was evaluated by 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical-scavenging method at 0.2 mg mL(-1) using microplate-reader assay. Both DNA virus Herpes simplex (HSV) and RNA virus Parainfluenza (PI-3) were employed for antiviral assessment of LCC exracts using Madin-Darby Bovine Kidney and Vero cell lines. Antibacterial and antifungal activities of the extracts were screened against the bacteria: Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Acinobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, Bacillus subtilis as well as the fungi: Candida albicans and C. parapsilosis. Only the petroleum ether extract of LCC possessed remarkable activity against both AChE and BChE at 1 mg mL(-1) (76.5 and 69.6%, respectively), whereas LCC extracts showed low free radical-scavenging activity. All of the extracts were found to be more effective against the ATCC strains than isolated ones, particularly S. aureus, while the extracts had moderate antifungal activity. On the other hand, we found that only the petroleum ether extract was active against HSV. In addition, we also analysed the content of the alkaloid fraction of the plant by capillary gas chromatography-mass spectrometry (GC-MS) and identified lycopodine as the major alkaloid (60.8%).

Comparative evaluation of acetylcholinesterase status and genome damage in blood cells of industrial workers exposed to carbofuran

Literature data on carbofuran genotoxicity in vitro and in vivo are very scarce. There are few papers indicating that occupational exposure to this AChE inhibiting insecticide might be connected to increased risk of developing non-Hodgkin's lymphoma and lung cancer. Other authors showed its genotoxicity in vitro. We used comet and CBMN micronucleus assay combined with centromere probes to evaluate genome damage in lymphocytes of workers employed in carbofuran production. Also, the level of AChE activity in blood and plasma was measured. Only few workers exhibited AChE activity below 85%. Comet assay parameters were slightly but significantly elevated compared to control subjects, especially the long-tailed nuclei ratio. We found poor correlation between AChE activity and comet assay parameters, but significant effect of smoking and alcohol intake on the latest. In binucleated lymphocytes of workers significantly increased number of micronuclei, nuclear buds, and nucleoplasmic bridges was detected. Proportion of micronuclei with centromere, DAPI signal positive micronuclei was also elevated. Micronucleus assay parameters also appeared to be significantly influenced by duration of exposure to carbofuran. Together with published data on carbofuran's effect on health our results might indicate the need for further evaluations of its genotoxicity using a range of different cytogenetic techniques.

In utero methanesulfonyl fluoride differentially affects learning and maze performance in the absence of long-lasting cholinergic changes in the adult rat

There is increasing evidence that acetylcholinesterase (AChE) may have various specific developmental roles in brain development. Nevertheless, specific effects of AChE inhibition during early brain development have not been adequately described. Therefore, methanesulfonyl fluoride (MSF), an irreversible AChE inhibitor that shows high selectivity for the CNS was used to produce AChE inhibition in utero to study subsequent adult behaviors, sleep, and cholinergic markers. Rats exposed to MSF in utero showed a deficit in spatial learning tasks using appetitive motivation but, surprisingly, they performed equally well or better than controls when aversive motivation was used. One hypothesis was that MSF treatment in utero affected the response to stress. Tests of anxiety however showed no differences in basal levels of anxiety. Studies of sleep behavior, however, indicated a higher level of REM sleep which is only seen during the light phase of male rats exposed to MSF in utero as compared to controls. No differences in cholinergic markers in the brains of adults were found except that females exposed to MSF in utero had a higher level of ChAT activity in the synaptosomal fraction of the hippocampus. Even so, whether cholinergic alterations accompany the in utero MSF exposure remains to be determined. The failure to find widespread changes in cholinergic markers in the adult brains suggests changes in behaviors should be further investigated by testing the participation of postsynaptic mechanisms, measuring of cholinergic markers during earlier development periods and the possible participation of other neurotransmitter systems to clearly reveal the role of the cholinergic system following in utero MSF exposure.

Improved analysis of dialkylphosphates in urine using strong anion exchange disk extraction and in-vial derivatization

Determination of dialkylphosphates (DAPs) in urine is useful for assessing human exposure to organophosphates (OPs). An improved method for the determination of four DAPs based on a strong anion exchange (SAX) disk extraction and in-vial derivatization was presented in this study. The matrix effect of urine components such as chloride ion and phosphate ion by using a SAX disk to extract DAPs in urine analysis was carefully evaluated. It was observed that the chloride ion mainly affected the extraction of diethylphosphate (DEP), dimethylthiophosphate (DMTP), and diethylthiophosphate (DETP) in urine. The addition of silver hydroxide could significantly improve the extraction efficiencies of these three DAPs, but it decreases the extraction efficiencies of dimethyldithiophosphate (DMDTP) and diethyldithiophosphate (DEDTP). The LOD of this method for DMTP, DETP, DMDTP, and DEDTP are 5, 5, 11, and 5 microg/L, respectively. A pretreatment strategy for the determination of DMTP, DMDTP, DETP, and DEDTP in urine was proposed which can provide reliable and prompt determination of routine urine analysis.

Acetylcholinesterase inhibitors from plants

Inhibition of acetylcholinesterase (AChE), the key enzyme in the breakdown of acetylcholine, is considered as a promising strategy for the treatment of neurological disorders such as Alzheimer's disease, senile dementia, ataxia and myasthenia gravis. A potential source of AChE inhibitors is certainly provided by the abundance of plants in nature. This article aims to provide a comprehensive literature survey of plants that have been tested for AChE inhibitory activity. Numerous phytoconstituents and promising plant species as AChE inhibitors are being reported in this communication.

Excessive hippocampal acetylcholine levels in acetylcholinesterase-deficient mice are moderated by butyrylcholinesterase activity

Central cholinergic systems are involved in a plethora of brain functions and are severely and selectively damaged in neurodegenerative diseases such as Alzheimer's disease and dementia with Lewy bodies. Cholinergic dysfunction is treated with inhibitors of acetylcholinesterase (AChE) while the role of butyrylcholinesterase (BChE) for brain cholinergic function is unclear. We have used in vivo microdialysis to investigate the regulation of hippocampal acetylcholine (ACh) levels in mice that are devoid of AChE (AChE-/- mice). Extracellular ACh levels in the hippocampus were 60-fold elevated in AChE-/- mice compared with wild-type (AChE+/+) animals. In AChE-/- mice, calcium-free conditions reduced hippocampal ACh levels by 50%, and infusion of tetrodotoxin by more than 90%, indicating continuous ACh release. Infusion of a selective AChE inhibitor (BW284c51) caused a dose-dependent, up to 16-fold increase of extracellular ACh levels in AChE+/+ mice but did not change ACh levels in AChE-/- mice. In contrast, infusion of a selective inhibitor of BChE (bambuterol) caused up to fivefold elevation of ACh levels in AChE-/- mice, but was without effect in AChE+/+ animals. These results were corroborated with two other specific inhibitors of AChE and BChE, tolserine and bis-norcymserine, respectively. We conclude that lack of AChE causes dramatically increased levels of extracellular ACh in the brain. Importantly, in the absence of AChE, the levels of extracellular ACh in the brain are controlled by the activity of BChE. These results point to a potential usefulness of BChE inhibitors in the treatment of central cholinergic dysfunction in which brain AChE activity is typically reduced.

Neuropsychological sequelae from acute poisoning and long-term exposure to carbamate and organophosphate pesticides

This research examines the effects of different degrees of pesticide exposure on neuropsychological performance. Exposures varied from acute poisoning coupled with chronic exposure to low or high levels of chronic exposure (defined by years of exposure). A cross-sectional neuropsychological and biochemical study was conducted in greenhouse farmers from southern Spain: data from 24 acutely poisoned workers and 40 non-poisoned but chronically (low or high) exposed sprayers were compared to 26 controls. We examined performance on 21 neuropsychological tests that assessed attention, memory, praxis, gnosis, motor coordination, naming and reasoning and also examined values of plasmatic cholinesterase. Results indicated statistically significant neuropsychological deficits in the acute poisoning and high chronic exposure groups after controlling for confounds, whereas similar performance was seen in the low chronic exposed subjects and controls. Subjects who were acutely poisoned performed worse than the other groups on perceptual, visuomotor, visual memory and mood state domains. Both the acutely poisoned and the chronically high exposed subjects obtained significantly lower scores in the perceptual, verbal memory and visuomotor domains. Levels of butyrylcholinesterase were related to the seasonal sprayer activity except in the case of acutely poisoned subjects.

CONCLUSIONS

Both acutely poisoned long-term workers and chronically high (>10 years) exposed workers exhibited similar disturbances in perception and visuo-motor processing, in the absence of any related acute effect of butyrylcholinesterase inhibition. In the case of acutely poisoned subjects, verbal and perceptive learning and recall and constructive abilities were also impaired. These results point to the need for follow-up studies to assess the possible sequelae of chronic and acute exposure to pesticides and their interactions.

Inhibition of NTPDase, 5'-nucleotidase, Na+/K+-ATPase and acetylcholinesterase activities by subchronic treatment with Casearia sylvestris

The aqueous extract of Casearia sylvestris was tested in cortical membrane preparations. C. sylvestris was obtained commercially from two different sources, designated as Sample A and Sample B. The enzymes studied in this work were NTPDase-like, 5'-Nucleotidase, Na(+)/K(+)-ATPase and acetylcholinesterase (AChE). Adult rats received aqueous extracts from C. sylvestris in a dose of 20mg/kg body wt. daily for a 75-day-period, by oral administration (gavage). Our study showed that this treatment caused an inhibition of NTPDase-like activity with both, ATP (19.41% with Sample A and 25.03% with Sample B) and ADP (41.57% with Sample A and 31.20% with Sample B) as substrates. This treatment also caused an inhibition of 5'-nucleotidase activity (28.34% with Sample A and 31.46% with Sample B) and Na(+)/K(+)-ATPase (25.08% with Sample A and 24.81% with Sample B). The rate of acetylcholine degradation was reduced, as shown by the inhibition of AChE (31.65% and 26.74%, Samples A and B, respectively). These results suggest that extracts of C. sylvestris can cause neurochemical alterations in the purinergic and cholinergic systems of the central nervous system.

Gulf War Syndrome: A Toxic Exposure? A Systematic Review

Using the strength-of-conclusion scheme enumerated in Box 2, based on two class II studies, there is probably a causal link between deployment to the Persian Gulf theater of operation and the development of the poorly defined multisymptom illness known as GWS (level B). Based on class IV studies, there is insufficient evidence to determine if exposure to toxins encountered during the Persian Gulf war caused GWS (level U). A major limitation of the literature regarding the GWS is the reliance on self-reporting to measure exposure to putative causal toxins. Although objective measures of toxin exposure in GWV generally is unavailable, modeling techniques to estimate exposure levels to low-level nerve agents and smoke from oil well fires have been developed. It would be useful to determine if exposure levels determined by these techniques are associated with GWS. The lack of a clear case definition GWS also hampers research. Some go even further, claiming that the absence of such a definition renders the condition illegitimate. Although an objective marker to GWS would be useful for studies, the absence of such a marker does not make the syndrome any less legitimate. in essence, GWS merely is a convenient descriptive term that describes a phenomenon: GWV reporting suffering from medically unexplained health-related symptoms. In this sense, it shares much with the other medically unexplained syndromes encountered in practice. The real debate surrounding medically unexplained conditions is not whether or not they exist, but defining their cause. In this regard, investigators fall into two camps. One camp insists that the conditions are caused by a yet-to-be-discovered medical problem, rejecting out of hand the possibility of a psychologic origin. The other camp insists the conditions are fundamentally psychogenic rejecting the possibility of an undiscovered medical condition. The evidence shows, however, that the conditions exists, the suffering is real, and the causes are unknown.

Donepezil: a clinical review of current and emerging indications

This article reviews the piperidine derivative, donepezil hydrochloride (E2020, Aricept), a reversible central acetylcholinesterase inhibitor currently approved for treatment of mild-to-moderate Alzheimer's disease. Donepezil is well absorbed orally, unaffected by food or by time of administration; it reaches therapeutic levels in doses of 5-10 mg/day and peak plasma concentrations are obtained 3-4 h after oral administration. A single bedtime dose is recommended due to the long elimination half-life of the drug (70 h). Donepezil does not cause liver toxicity or significant drug interactions and is relatively well-tolerated. Initial side effects include nausea, vomiting, diarrhoea, insomnia, muscle cramps, fatigue, anorexia and syncope. Caution is advised in patients with bradycardia. Long-term use of donepezil in AD has been found to delay nursing-home placement and to result in caregiver respite. Donepezil also slows deterioration of cognition and global function in patients with moderate-to-severe AD, with improvement of abnormal behaviours. In addition to AD, donepezil demonstrates significant improvement in cognition, global function and activities of daily living in comparison with placebo-treated patients with vascular dementia and has potential therapeutic benefit for other neurological conditions.

Metrifonate (Trichlorfon): a review of the pharmacology, pharmacokinetics and clinical experience with a new acetylcholinesterase inhibitor for Alzheimer’s disease

Metrifonate is a cholinesterase inhibitor, effective in the treatment of both the cognitive and behavioural symptoms of Alzheimer's disease (AD). Previously used as an antihelminthic and insecticide, clinical experience with metrifonate in AD patients is large and growing. The parent compound is relatively inactive; it is metabolised non-enzymatically to 2,2-dimethyl dichlorovinyl phosphate (DDVP), which irreversibly inhibits the acetylcholinesterase enzyme. The elimination half-life of DDVP is 2.1 h; cholinesterase inhibition by DDVP is stable and may persist for up to 55 days. Metrifonate can be administered once daily. In vitro and animal data regarding possible carcinogenesis of metrifonate and DDVP are conflicting; experience in the treatment of humans with schistosomiasis or AD support its safety. Animal studies demonstrate its efficacy in enhancing memory in animals with cholinergic deficits. Double-blind, placebo-controlled studies have shown the benefit of metrifonate compared to placebo in improving scores on the Clinical Global Impression of Change, Alzheimer's Disease Assessment Scale-Cognitive Subscale and the Neuropsychiatric Inventory.

Tissue distribution of cholinesterases and anticholinesterases in native and transgenic tomato plants

Acetylcholinesterase, a major component of the central and peripheral nervous systems, is ubiquitous among multicellular animals, where its main function is to terminate synaptic transmission by hydrolyzing the neurotransmitter, acetylcholine. However, previous reports describe cholinesterase activities in several plant species and we present data for its presence in tomato plants. Ectopic expression of a recombinant form of the human enzyme and the expression pattern of the transgene and the accumulation of its product in transgenic tomato plants are described. Levels of acetylcholinesterase activity in different tissues are closely effected by and can be separated from alpha-tomatine, an anticholinesterase steroidal glycoalkaloid. The recombinant enzyme can also be separated from the endogenous cholinesterase activity by its subcellular localization and distinct biochemical properties. Our results provide evidence for the co-existence in tomato plants of both acetylcholinesterase activity and a steroidal glycoalkaloid with anticholinesterase activity and suggest spatial mutual exclusivity of these antagonistic activities. Potential functions, including roles in plant-pathogen interactions are discussed.

Homocysteine inhibits butyrylcholinesterase activity in rat serum

In the present work we investigated the in vitro effects of homocysteine (Hcy) and methionine (Met), metabolites accumulated in homocystinuria, on butyrylcholinesterase (BuChE) activity in rat serum. We also studied the kinetics of the inhibition of BuChE activity caused by Hcy. For determination of BuChE we used serum of 60-day-old Wistar rats, which was incubated in the absence (control) or presence of Hcy (0.01-0.5 mM) or Met (0.2-2.0 mM). The kinetics of the interaction of Hcy and BuChE was determined using the Lineweaver-Burk double reciprocal plot. Results showed that serum BuChE activity was not altered by Met, but it was significantly inhibited (37%) by 500 microM Hcy, a concentration similar to those found in blood of homocystinuric patients. The apparent Km values, in the absence and presence of 500 microM of Hcy, were 0.034 and 0.142 mM, respectively, and V(max) of BuChE for acetylcholine (ACh) as substrate was 1.25 micromol ACSCh/h/mg of protein. The Ki value obtained was 120 microM, and the inhibition was of the competitive type, suggesting a common binding site for Hcy and ACh. It is proposed that inhibition of cholinesterase activity may be one of the mechanisms involved in the neurological dysfunction observed in homocystinuria.

Antidepressants inhibit human acetylcholinesterase and butyrylcholinesterase activity

This study examines the effect of the antidepressants fluoxetine, sertraline and amitriptyline on cholinesterase (acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE)) activities in human serum and erythrocyte membrane (ghost). The concentrations used range from 3 to 60 microM for fluoxetine and amitriptyline and 0.3 to 12 microM for sertraline. At the micromolar range concentration, different classes of antidepressants, including fluoxetine and sertraline (selective serotonin reuptake inhibitors (SSRIs)) and amitriptyline (tricyclic antidepressant) inhibited human serum cholinesterase. The order of inhibitory potency was sertraline>amitriptyline>>fluoxetine and the IC(50) values were 4.05, 9.43 and 62 microM, respectively. Analysis of kinetic data indicated that the inhibition caused by all the antidepressants was mixed in nature. At the micromolar range concentration, sertraline (60-120 microM) and amitriptyline (60-180 microM) inhibited human erythrocyte AChE. The order of inhibitory potency was sertraline>amitriptyline and the IC(50) values were 80 and 134 microM, respectively. Analysis of kinetic data indicated that the inhibition caused by all the antidepressants in AChE human erythrocyte membrane (ghost) was mixed in nature. The interaction of sertraline with the cholinesterase is labile since the removal of inhibitor by gel filtration recovered completely the enzyme activity. Our results demonstrate that the usual clinical antidepressants are inhibitors of the cholinesterases on human serum and erythrocyte membrane.

Actions of pyridostigmine and organophosphate agents on chick cells, mice, and chickens

Gulf War veterans were given pyridostigmine bromide (PB) tablets to enhance the therapeutic effect of antidotes to nerve agents in the event of exposure. The goal of this research is to examine whether combined exposure to PB and sarin (agent GB) is more neurotoxic to sensitive surrogate animals, mice and chickens, than if given separately. Scoping trials were performed to establish appropriate dose-response ranges for sarin and control chemicals. IC50 values were determined in chickens and mice for in vitro inhibition of acetylcholinesterase (AChE) and neuropathy target esterase (NTE). The results indicated PB neither inhibits NTE nor does it spare sarin's inhibition of AChE. Chick embryo nerve cells in vitro showed more inhibition of AChE activity and no faster recovery when PB treatment was followed by DFP treatment than the other way around. Experiments on chickens also indicated that PB treatment did not inhibit NTE and that it crossed the blood brain barrier inhibiting brain AChE although to a lesser extent than it inhibited blood cholinesterases. Other experiments determined multiple dose levels in chickens for sarin and DFP that inhibited > 80% of NTE, considered a threshold for triggering organophosphate-induced delayed neuropathy.

Reversible and irreversible acetylcholinesterase inhibitors cause changes in neuronal amyloid precursor protein processing and protein kinase C level in vitro

The alternative routes of cleavage of the amyloid precursor protein (APP) result in the generation and secretion of both soluble APP and beta-amyloid, the latter being the main component of the amyloid deposits in the brains of individuals with Alzheimer's disease (AD). This study examined the question of whether acetylcholinesterase (AChE) inhibitors can alter the processing of APP and the level of protein kinase C (PKC) in primary rat basal forebrain cultures. Western blotting was used to test two AChE inhibitors (reversible and irreversible) for their ability to enhance the release of APP and PKC content. These inhibitors were ambenonium (AMB) and metrifonate (MTF), at different concentrations. A significant increase was found in the cell-associated APP level in a basal forebrain neuronal culture, and there was an elevation of the APP release into the medium. Increases were similarly observed in the PKC levels after AMB or MTF treatment. The results suggest that these AChE inhibitors promote the non-amyloidogenic route of APP processing, which may be due to their stimulatory effects on PKC. The PKC activation may enhance the alpha-secretase activity and consequently the production of the N-terminal APP. Since both a decreased level of APP secretion and a low activity and level of PKC may be involved in the pathogenesis of AD, it is concluded that the administration of AChE inhibitors to AD patients may facilitate the memory processes and exert a neuroprotective effect.

Modulatory role of presynaptic nicotinic receptors in synaptic and non-synaptic chemical communication in the central nervous system

Neuronal nicotinic acetylcholine receptors (nAChRs) belong to a family of ligand-gated channels closely related to but distinct from the muscle nAChRs. Recent progress in neurochemical and pharmacological methods supports the hypothesis of presynaptically located nAChRs on axon terminals and indicates that the major effect of nAChR is the modulation rather than processing of fast synaptic transmission. Strong neurochemical evidence indicate that the most important function of presynaptic nAChRs in either synaptic or non-synaptic localization is to increase transmitter release initiated by axonal firing, or directly induce Na(+) and Ca(2+) influx followed by a depolarization sufficient to activate local voltage-sensitive Ca(2+) channels, as a result transmitter of vesicular origin will be released. Therefore, it is somewhat expected that nicotine-induced transmitter release of different monoamines including norepinephrine (NE), dopamine (DA), serotonin (5-HT) can be tetrodotoxin (TTX)- and [Ca(2+)](o)-sensitive. However, some of the nAChR agonists at higher concentrations (1, 1-dimethyl-4-phenylpiperazinium (DMPP) and lobeline), besides their effects on presynaptic nAChRs, are able to inhibit the uptake of NE and 5-HT into nerve terminals, thereby their transmitter releasing effects are extended in time and space. The effect on the uptake process is different from classical nicotinic actions, not being sensitive to nAChR antagonism, but can be prevented by selective uptake blockers or reduced temperature. Considering neurochemical, pharmacological and electrophysiological evidence it seems likely that presynaptic nAChRs on monoaminergic fibers are composed of alpha3 or alpha4 subunits in combination with the beta2 subunit. This is supported by the observation that nicotinic agonists have no presynaptic effect on transmitter release in knockout mice lacking the beta2 nAChR subunit gene. The essential brain function lies not only in impulse transmission within a hard-wired neuronal circuitry but also within synaptic and non-synaptic communication subjected to presynaptic modulation. Since the varicose noradrenergic, dopaminergic, serotonergic, glutamatergic and cholinergic axon terminals mainly do not make synaptic contact, but their varicosities are equipped with nAChRs and these non-synaptically localized receptors are of high affinity, it is suggested that nicotine inhaled during smoking might exert its behavioral, psychological, neurological and neuroendocrinological effects via these receptors.

Effect of neostigmine on the hippocampal noradrenaline release: role of cholinergic receptors

The effect of the cholinesterase inhibitor neostigmine on hippocampal noradrenaline (NA) release was studied using in vivo microdialysis. Local application of neostigmine significantly increased the release of NA. The effect was potentiated by coperfusion of the nicotinic antagonist mecamylamine but was completely blocked by the muscarinic antagonist atropine. The neostigmine-evoked NA release was not affected by the M2-selective muscarinic antagonist gallamine but was completely blocked by the M1-selective muscarinic antagonist pirenzepine. While muscarinic antagonists had no effect on the resting release of NA, mecamylamine increased it. Our data indicate that acetylcholine can stimulate the hippocampal NA release via M1 muscarinic receptors and that a population of nicotinic receptors mediate inhibitory tone on hippocampal NA release. The fact that neostigmine is able to enhance both cholinergic and noradrenergic neurotransmission may help to understand the beneficial effect of cholinesterase inhibitors in Alzheimer's disease.

Conclusions and comments. Xth International Symposium on Cholinergic Mechanisms

Ancient medicine men of Egypt and Arabia employed, under another name, the cholinergic agents, as did the hunters, warriors and shamans of Africa and South America. An explosion of cholinergic science occurred in the last and the current century, and the ISCMs witnessed and catalyzed this progress. The Xth ISCM emphasized the molecular characteristics of the receptors, cholinesterase and of the system engaged in liberation of Ach.