Amniotic fluid acetylcholinesterase and prenatal diagnosis

Isoelectric focusing pattern of human amniotic fluid alpha-fetoprotein

Isoelectric focusing (IEF) of amniotic fluid alpha-fetoprotein (AFP) in thin-layer polyacrylamide gels containing 8 M urea followed by immunoblotting reveals at least nine bands, band I lying next to the cathode. Compared with 298 amniotic fluid samples from normal pregnancies, we found that the density of band V was increased in seven cases of fetal death. In 16 amniotic fluid samples from pregnancies with open neural tube defects (ONTD), band V disappeared or was markedly decreased. In seven cases with elevated AFP and positive acetylcholinesterase (AChE) due to contamination with fetal blood, no difference in pattern was observed compared with samples from normal pregnancies. It is suggested that IEF of AFP and subsequent immunoblotting are an apparently diagnostic test for ONTD and intrauterine fetal death (IUFD).

Prolonged elevation of alphafetoprotein and detectable acetylcholinesterase after death of an anomalous twin fetus

Persistence of elevated alphafetoprotein (AFP) levels and the presence of an acetylcholinesterase (AChE) band in amniotic fluid have been reported to occur up to 11 weeks following intrauterine fetal demise (IUFD) of one twin (Bass et al., 1986). We now report a case where such prolongation of these findings was observed in a case of unrecognized monochorionic, monoamniotic twinning, in which case cord entanglement resulted in IUFD at an estimated 10-12 weeks and 25-26 weeks. The fetus suffering early demise (Fetus B) had multiple congenital anomalies, including a neural tube defect. The presence of this defect and/or fetal demise and bleeding into the amniotic sac is entertained as continuing sources of documented elevated AChE and AFP 9-11 weeks after the initial fetal death. We re-emphasize the possibility of unrecognized twinning as a cause of abnormal maternal serum and amniotic fluid study results in the face of one apparently normal fetus.

Quantitative determination of acetylcholinesterase by enzyme antigen immunoassay: methodological aspects and clinical use

We here describe the optimization of an immunochemical measuring method for acetylcholinesterase (AChE) found in different human body fluids. The principle is the binding of a polyclonal antibody to a solid support (microtitre plate), followed by quantitation of the enzymatic active antigen, by its own enzymatic activity. The test is mainly thought as a diagnostic tool for the prenatal detection of neural tube defects (NTD). The assay is optimized with respect to antibodies and a number of physical parameters. The test is accurate and reliable, and it yields quantitative results. Further we show it to give neither false positive nor false negative values in the prediction of NTD. The assay also performs well on other sample-materials. We suggest that the test will be routinely used alongside amniotic alpha-fetoprotein (AFP) determinations to ensure the correct prenatal diagnosis of NTD.

A prospective study of amniotic fluid cholinesterases: comparison of quantitative and qualitative methods for the detection of open neural tube defects

The value of quantitative and qualitative methods of cholinesterase (ChE) analysis in the detection of open neural tube defect (NTD) has been assessed in a prospective survey of 1495 mid-trimester amniotic fluids. Using a quantitative method the mean ChE values were much lower in fluids from pregnancies of normal outcome but it was not possible to discriminate these fluids completely from those associated with NTD pregnancies, particularly when the specimens were contaminated with blood. Similarly, measurement of acetylcholinesterase (AChE) activity alone by three different methods also failed to eliminate the overlap between the two groups. In contrast, polyacrylamide gel electrophoresis revealed only a single band of ChE activity in 1408 out of 1410 fluids from pregnancies with a normal outcome whilst amniotic fluids from all 60 cases of open NTD, 6 out of 7 cases of exomphalos and 3 out of 4 cases of intra-uterine death gave the characteristic second faster-running AChE band. A qualitative gel method which requires the same amount of ChE activity to be loaded from each amniotic fluid is an effective method for pre-natal diagnosis of NTDs.

Identification of acetylcholinesterase and cholinesterase in amniotic fluid by immune absorption technique

A method for immunological detection of acetylcholinesterase (AChE) and cholinesterase (ChE) in amniotic fluid is described. By addition of a small amount of antihuman-erythrocyte membrane antibody or anti-pseudocholinesterase antibody to the sample before electrophoresis the two esterase bands on polyacrylamide gel (PAG) can be absorbed away. Similar staining results can also be obtained by specific inhibition of the two esterases with either BW 284C51 (AChE inhibitor) or Lysivane (ChE inhibitor). In cases with a faint AChE band and in cases with blood contamination the immune absorption technique makes interpretation easier. Nearly identical staining results have been obtained by the immune absorption technique and the inhibition technique in the following samples with an AChE band: 34 samples from pregnancies with severe fetal malformation or intrauterine death (2 cases), 4 fetal serum samples, 4 samples of cerebrospinal fluid, 4 samples of fetal erythrolysate and 4 samples of adult erythrolysate. It can be concluded that an antibody prepared against erythrocyte AChE cross-reacts with AChE in cerebrospinal fluid, and that this antibody can be used for demonstration of AChE in amniotic fluid.

Acetylcholinesterase in neural tube defects: a model using chick embryo amniotic fluid

Acetylcholinesterase was measured in amniotic fluid from normal chick embryos and embryos with neural tube defects. Neural tube defects were induced in the chick embryos by three procedures, removal of albumen, mechanical disruption of the closed neural tube or injection of tetanus toxin. The concentration of acetylcholinesterase in amniotic fluid from untreated normal embryos changed throughout the period examined (5-14 days incubation) but was stable at 0.5 U1(-1) over the time period 6-11 days. Amniotic fluid taken from treated embryos with neural tube defects at 8 days always contained a higher concentration of acetylcholinesterase than fluid from sham operated but otherwise normal embryos, mean 40.9 U1(-1), S.E.M. = 10. U1(-1), versus 1.0 U1(-1), S.E.M. = 0.2 U1(-1). The range of values (6.1-393 U1(-1)) was clearly separated from the normal values, range 0.0-5.5 U1(-1). In 13 cases with developmental abnormalities other than neural tube defects, the concentration of acetylcholinesterase was elevated in only one. Two different forms of acetylcholinesterase, as shown by gel electrophoresis, were present in fluid form both normal and defective embryos. These forms were also present in blood plasma, cerebrospinal fluid and in the high speed supernatant from brain extracts, the latter tissue contained an additional form of greater electrophoretic mobility. After irreversible inhibition, enzyme activity in amniotic fluid recovered slowly; only half the control value was reached by 140 h compared with complete recovery in the tissues of the embryo within 19 h. Histochemical staining for acetylcholinesterase showed that the spinal cord in the region of the lesion contained high concentrations of the enzyme. The possible sources of acetylcholinesterase in amniotic fluid are discussed. This chicken model of neural tube defects provides support for the use of acetylcholinesterase tests in the detection of neural tube defects clinically, and provides a model for experimentation with this system.

Acetylcholinesterase and butyrylcholinesterase measurement in the pre-natal detection of neural tube defects and other fetal malformations

Acetylcholinesterase activity in amniotic fluid was measured at 30 degree C by a reaction rate method employing acetyl-beta-methyl thiocholine as substrate and ethopropazine as a selective inhibitor of butyrylcholinesterase. This assay proved more specific than previously reported methods. Activity was greater in five cases of anencephaly (4.8-9.7 U/l) and nine cases of spinal bifida (5.1-8.6 U/l) than in 50 pregnancies with normal outcome (mean activity 2.0 +/- 0.9 (S.D.) U/l). There was no overlap between results from normal and neural-tube-defect groups, and the results showed no significant correlation with gestational age. Butyrylcholinesterase activity in amniotic fluid was measured using butyrylthiocholine as substrate. In accordance with previous reports, levels were elevated in pregnancies affected by neural tube defects. The ratio butyrylcholinesterase/acetylcholinesterase activity showed similar values for anencephalic, spina bifida and normal pregnancies; however, the two cases of exomphalos investigated could be clearly distinguished from all other groups on this basis.

Particulate acetylcholinesterase in amniotic fluid and its implications for neural tube defect screening

Acetylcholinesterase activity in mid-trimester amniotic fluid has been determined by a quantitative spectrophotometric method and a qualitative electrophoretic technique in a limited (76 samples) retrospective study. Differential centrifugation studies on amniotic fluid from normal pregnancies demonstrated the presence of particle-associated acetylcholinesterase sedimenting only at relatively high centrifugal forces. It is postulated that this particle-associated activity was a contributory factor to an observed false-positive incidence of 6.6% when quantitative acetylcholinesterase measurement was used to discriminate between normal pregnancies and those associated with neural tube defects. Discrimination on the basis of electrophoretic analysis of acetylcholinesterase resulted in no misclassification of pregnancies. Particulate acetylcholinesterase would not be expected to influence the interpretation of the electrophoretic pattern due to its size-related exclusion from gel pores. The implication of these observations in the accurate prenatal diagnosis of neural tube defects is discussed.

Polyacrylamide gel electrophoresis of amniotic fluid cholinesterases: a good prenatal test for neural tube defects

The qualitative assay of the cholinesterases (ChE) in amniotic fluid on polyacrylamide gel gave a single major band (cholinesterase) in all samples from normal pregnancies, and two major bands (cholinesterase and acetylcholinesterase) in all cases from fetuses with open neural tube defects. Five fluids which were true false positive on alpha-fetoprotein (AFP) assay (elevated AFP in a clear fluid but normal fetus) had a single band, and two fluids which were false negative on AFP testing (normal AFP but spina bifida fetus) had two bands. The second 'diagnostic' ChE band sometimes occurred, together with other extra bands, in some fluids which were very severely contaminated by maternal or fetal blood, but in four of six fluids from normal fetuses where fetal blood staining was sufficient to cause the AFP to be elevated, there was only one ChE band. It is suggested that the qualitative assay of ChE should be performed in addition to AFP in the prenatal diagnosis of neural tube defects.