Plasma and serum G4 isoenzyme of acetylcholinesterase in patients with Alzheimer-type dementia and vascular dementia

Evaluation of salivary acetylcholinesterase and pseudocholinesterase in patients with Alzheimer's disease: A case-control study

AIM

The aim of this study was to evaluate acetylcholinesterase (AChE) and pseudocholinesterase (PChE) in whole saliva in patients with Alzheimer's disease (AD) and in healthy subjects. Saliva has a high potential for keeping track of general health and diseases. AD is a type of dementia with reduction in brain cholinergic markers that causes memory, thinking, and behavior problems. Up to 90% decrease in AChE activity has been observed in AD.

METHODS AND RESULTS

Thirty healthy subjects and 30 patients with AD participated in this study. Saliva samples were collected from 8 to 10 am. AChE and PChE of saliva were assessed by the Ellman method. Statistical comparison was performed using SPSS 16 for t-test. The activity of AChE and PChE significantly increased in the group with AD compared to the healthy subjects. Sex had no effect on the activities of these enzymes. No correlation existed between the duration of illness and enzymatic activity. The enzyme levels reduced with age.

CONCLUSION

AChE and PChE levels were increased in saliva samples of patients with AD. Therefore, saliva has the potential for being used for the purpose of biomarker evaluation to replace cerebrospinal fluid in patients with AD.

Low Plasma Cholinesterase Activities are Associated with Deficits in Spatial Orientation, Reduced Ability to Perform Basic Activities of Daily Living, and Low Body Mass Index in Patients with Progressed Alzheimer's Disease

Alzheimer's disease (AD) is a progressive and irreversible neurodegenerative disorder characterized by a central cholinergic deficit. Non-neuronal cholinergic changes are, however, described as well. Here we focused on possible changes in the activity of the plasma cholinesterases, acetylcholinesterase (AChE) and butyrylcholinesterase (BChE), in hospitalized AD patients. We analyzed plasma AChE and BChE activities with regards to age, gender, body mass index (BMI), cognitive functions, and ability to perform activities of daily living in AD patients in comparison to healthy subjects. We observed lower AChE activity and trend toward lower BChE activity in AD patients, which both correlated with low BMI. AD patients unable to perform basic activities of daily living (feeding, bathing, dressing, and grooming) showed reduced plasma AChE activities, while worse spatial orientation was linked to lower BChE activities. Three out of four AD patients with the lowest BChE activities died within one year. In conclusion, progressed AD was accompanied by lower plasma AChE activity and trend toward lower BChE activity, which correlated with BMI and deficits in different components of the AD.

Altered levels of acetylcholinesterase in Alzheimer plasma

BACKGROUND

Many studies have been conducted in an extensive effort to identify alterations in blood cholinesterase levels as a consequence of disease, including the analysis of acetylcholinesterase (AChE) in plasma. Conventional assays using selective cholinesterase inhibitors have not been particularly successful as excess amounts of butyrylcholinesterase (BuChE) pose a major problem.

PRINCIPAL FINDINGS

Here we have estimated the levels of AChE activity in human plasma by first immunoprecipitating BuChE and measuring AChE activity in the immunodepleted plasma. Human plasma AChE activity levels were approximately 20 nmol/min/mL, about 160 times lower than BuChE. The majority of AChE species are the light G(1)+G(2) forms and not G(4) tetramers. The levels and pattern of the molecular forms are similar to that observed in individuals with silent BuChE. We have also compared plasma AChE with the enzyme pattern obtained from human liver, red blood cells, cerebrospinal fluid (CSF) and brain, by sedimentation analysis, Western blotting and lectin-binding analysis. Finally, a selective increase of AChE activity was detected in plasma from Alzheimer's disease (AD) patients compared to age and gender-matched controls. This increase correlates with an increase in the G(1)+G(2) forms, the subset of AChE species which are increased in Alzheimer's brain. Western blot analysis demonstrated that a 78 kDa immunoreactive AChE protein band was also increased in Alzheimer's plasma, attributed in part to AChE-T subunits common in brain and CSF.

CONCLUSION

Plasma AChE might have potential as an indicator of disease progress and prognosis in AD and warrants further investigation.

Brain cholinesterases: III. Future perspectives of AD research and clinical practice

Alzheimer's disease (AD) is initially and primarily associated with the degeneration and alteration in the metabolism of cholinesterases (ChEs). The use of ChEs inhibitors to treat Alzheimer's condition, on the basis of the cholinergic hypothesis of the disease, is, therefore, without grounds. Most disturbing is the fact that the currently available anti-ChEs are designed to inhibit normal ChEs in the brain and throughout the body, but not the abnormal ones. Based on the acetylcholinesterase (AChE) deficiency theory, treatment should be designed to protect the cranial ChEs system from alteration and/or to help that system fight against degeneration through restoring its homeostatic action for brain structure and function instead. The overlap in the clinical, biochemical, molecular-cellular, and pathological alterations seen in patients with AD and individuals with many other brain disorders, which has bewildered many investigators, may now be explained by the shared underlying mismetabolism of brain ChEs. The abnormal metabolism of ChEs existing in asymptomatic subjects may indicate that the system is "at risk" and deserves serious attention. Future perspectives of ChEs research in vivo and in vitro in connection with AD and clinical diagnosis, prevention and treatment are proposed. Several potentially useful therapeutic and preventive means and pharmacological agents in this regard are identified and discussed, such as physical and intellectual stimulation, and a class of drugs including vitamin E, R-(-)-deprenyl (deprenyl, selegiline), acetyl L-carnitine, cytidine diphosphocholine (CDP-choline), centrophenoxine, L-phenylalanine, naloxone, galactose, and lithium, that have been proven to be able to stimulate AChE activity. Their working mechanisms may be through directly changing the configuration of AChE molecules and/or correcting micro- and overall environmental biological conditions for ChEs.

Association of a salivary acetylcholinesterase with Alzheimer's disease and response to cholinesterase inhibitors

OBJECTIVES

A decrease in cholinergic activity is a key event in the biochemistry of Alzheimer's disease (AD). The aim of the study was to investigate the expression levels of markers of cholinergic function in saliva, which is a readily accessible body fluid that can be obtained from subjects with minimal distress.

DESIGN AND METHODS

Salivary samples were obtained from people with NINCDS-ARDRA "probable" Alzheimer's disease and age- and sex-matched controls. Salivary acetylcholinesterase enzyme (AChE) activity was determined colorometrically.

RESULTS

Robust AChE catalytic activity was detected in the saliva samples that was stable for up to 6 h at room temperature following the provision of the salivary sample. The activity of the enzyme was significantly lower in people with AD than in age-matched controls. In addition, there were significant differences in activity between those who responded to acetylcholinesterase inhibitor (AChE-I) therapy and those who did not.

CONCLUSIONS

Salivary enzyme activity may therefore prove to be a useful marker of central cholinergic activity.

Effect of long-term aluminum feeding on kinetics attributes of tissue cholinesterases

Aluminum (Al) is considered a potential etiological factor in Alzheimer's disease (AD). Neurotoxicity from excess brain exposure to Al is documented from both clinical observations and animal experiments. A key role of the acetylcholine system in memory disturbances that characterize AD has been reported. On this basis, we studied the effect of long-term Al feeding on kinetic properties of cholinesterases employing the rat as experimental model. Animals were given prolonged treatment with soluble salts of Al (100mg AlCl(3)/kg body weight mixed with food for 100-115 days), and the kinetic properties of cholinesterases (acetylcholinesterase, AChE, and butyrylcholinesterase, BChE) were determined in different tissues. Prolonged treatment with Al had no effect on the K(m) values of the soluble and membrane-bound forms of AChE in the brain, but V(max) was instead decreased in all the components of soluble and membrane-bound forms of AChE in the brain. In addition, the Al treatment resulted in complete loss of the component II of erythrocyte membrane AChE. Surprisingly, after prolonged treatment with Al, higher V(max) was observed in all the components of soluble and membrane-bound forms of BChE in the heart and liver. Variable effects of Al exposure were observed on temperature kinetic properties of cholinesterases. Altogether these findings indicate that long-term Al feeding results in inhibition of AChE, while an opposite effect is observed on BChE. Decreased V(max) of the brain AChE could represent the mode of action through which Al may contribute to pathological processes in Al-induced neurotoxicity.

Acetylcholinesterase in Alzheimer's disease

Since the discovery of the cholinergic deficit in Alzheimer disease (AD), acetylcholinesterase (AChE) has been widely investigated in tissues involved in the disease. These studies showed modifications in AChE activity and changes in its polymorphism in brain as well as in cerebro-spinal fluid (CSF) and blood. The co-localization of the enzyme in the senile plaque provided evidence of its anomalous features. It has been also shown that AChE forms a stable complex with senile plaque components through its peripheral anionic site. Moreover, the neurotoxicity of amyloid components is increased by the presence of AChE. The occurrence of an altered glycosylation of some AChE forms in AD is closely related to the presence of amyloid formations. Literature on expression, relationships and modifications in the molecular polymorphism of AChE, in brain, CSF and blood in AD is reviewed.

An efficacy and safety analysis of Exelon in Alzheimer's disease patients with concurrent vascular risk factors

We evaluated the efficacy and safety of the centrally acting cholinesterase inhibitor, rivastigmine tartrate, for patients with mild to moderately severe Alzheimer's disease (AD) with or without concurrent vascular risk factors (VRF). Patients (45-90 years of age) were randomized to placebo (n = 235), low-dose rivastigmine (1-4 mg/day, n = 233), or high-dose rivastigmine (6-12 mg/day, n = 231) for 26 weeks. Efficacy measures included the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog), the Clinician's Interview Based Impression of Change (CIBIC-Plus), the Progressive Deterioration Scale (PDS), the Global Deterioration Scale (GDS), and the Mini-Mental State Examination (MMSE). For efficacy and safety analysis, patients were categorized by baseline Modified Hachinski Ischemic Score (MHIS) for the determination of VRF (MHIS > 0: presence of VRF; MHIS = 0: absence of VRF). As early as 12 weeks, the mean change from the baseline ADAS-Cog score was significantly different for those patients treated with high-dose rivastigmine compared with placebo controls in both MHIS categories. However, the treatment difference between high-dose rivastigmine and placebo at each time-point was larger for patients with MHIS > 0. The proportion of responders was significantly greater in the high-dose rivastigmine group for each level of improvement. No differences were noted between treatment groups regarding safety evaluations. Rivastigmine is effective in both categories of patients, and those with VRF experience greater clinical benefit (cognition, activities of daily living, and disease severity).

Cerebrospinal fluid cholinesterases--markers for loss of cholinergic basal forebrain neurons?

The present study was conducted to test the hypothesis that cholinergic basal forebrain neurons are a major source of cerebrospinal fluid (CSF) cholinesterases. To address this question enzyme activities of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) in both CSF and parietal cortex were assayed following selective lesion of basal forebrain cholinergic neurons by a single intracerebroventricular application of the cholinergic immunotoxin 192IgG-saporin. Cholinergic immunolesions led to a dramatic decrease in total AChE activity in parietal cortex, which was due to the specific loss of the G4 molecular form while the activity of the G1 form was increased as compared to nonlesioned animals. In contrast, the total enzyme activity of BChE and its molecular forms were not affected by cholinergic lesion in both parietal cortex and CSF. The data suggest, that cholinergic basal forebrain neurons are seemingly not a major source of cholinesterases in the CSF, and do not provide any evidence for using CSF cholinesterases as a diagnostic marker of basal forebrain cholinergic cell loss in humans.

Non-classical actions of cholinesterases: role in cellular differentiation, tumorigenesis and Alzheimer's disease

The cholinesterases are members of the serine hydrolase family, which utilize a serine residue at the active site. Acetylcholinesterase (AChE) is distinguished from butyrylcholinesterase (BChE) by its greater specificity for hydrolysing acetylcholine. The function of AChE at cholinergic synapses is to terminate cholinergic neurotransmission. However, AChE is expressed in tissues that are not directly innervated by cholinergic nerves. AChE and BChE are found in several types of haematopoietic cells. Transient expression of AChE in the brain during embryogenesis suggests that AChE may function in the regulation of neurite outgrowth. Overexpression of cholinesterases has also been correlated with tumorigenesis and abnormal megakaryocytopoiesis. Acetylcholine has been shown to influence cell proliferation and neurite outgrowth through nicotinic and muscarinic receptor-mediated mechanisms and thus, that the expression of AChE and BChE at non-synaptic sites may be associated with a cholinergic function. However, structural homologies between cholinesterases and adhesion proteins indicate that cholinesterases could also function as cell-cell or cell-substrate adhesion molecules. Abnormal expression of AChE and BChE has been detected around the amyloid plaques and neurofibrillary tangles in the brains of patients with Alzheimer's disease. The function of the cholinesterases in these regions of the Alzheimer brain is unknown, but this function is probably unrelated to cholinergic neurotransmission. The presence of abnormal cholinesterase expression in the Alzheimer brain has implications for the pathogenesis of Alzheimer's disease and for therapeutic strategies using cholinesterase inhibitors.

Blood markers in Alzheimer disease: subnormal acetylcholinesterase and butyrylcholinesterase in lymphocytes and erythrocytes

In patients with the clinical diagnosis of Alzheimer disease (AD), we searched for systemic changes in components of the blood as a diagnostic tool. The acetylcholine-related enzymes acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) were measured in plasma, erythrocytes, platelets and lymphocytes. Results did not show a general effect; notwithstanding, specific cell types presented alterations either in AChE or BuChE but not in both enzymatic activities. In AD patients, AChE of lymphocytes was reduced by 60% compared with the age-matched controls. However, when patients were divided, the sporadic but not the familial subgroup exhibited a significant reduction. In erythrocytes the BuChE activity was reduced by 45% in sporadic AD. The molecular forms of the lymphocyte AChE were characterized by velocity sedimentation. Both globular forms were subnormal, more so the tetrameric G4 AChE form than the G2 form.

A protease is recovered with a dimeric form of acetylcholinesterase in fetal bovine serum

A protease activity which co-purified with affinity-purified fetal bovine serum acetylcholinesterase (AChE) has been shown to release the amyloid protein precursor (APP) of Alzheimer's disease from cell membranes. The nature of this protease and its relationship to AChE have not been established. In this study, the protease activity was found to be recovered with a minor dimeric form of AChE. This minor form (AChEII) was distinguished from the more abundant tetrameric form (AChEI) by a higher catalytic subunit relative molecular mass (M(r)) of 80,000 (80K), and by a lower affinity for edrophonium-Sepharose. The difference in subunit M(r) was due to differing degrees of glycosylation, as deglycosylation of both AChEI and AChEII gave rise to a similar subunit M(r) of 62K. The protease activity recovered with AChEII was not an intrinsic property of the esterase, as it was separated from the esterase by anion-exchange chromatography, and by immunoprecipitation with anti-AChE antibodies. AChEI possessed a similar subunit M(r) to the tetrameric form of AChE secreted from the bovine adrenal gland, while AChEII possessed a similar subunit molecular weight to the dimeric membrane-bound form of bovine erythrocyte AChE. Thus, it is possible that AChEII may be a solubilised form of a dimeric glycosylphosphatidyl inositol-linked AChE.

Changes in acetylcholinesterase and butyrylcholinesterase in Alzheimer's disease resemble embryonic development--a study of molecular forms

The pattern of molecular forms of acetylcholinesterase (AChE, EC 3.1.1.7) and butyrylcholinesterase (BChE, EC 3.1.1.8) separated by density gradient centrifugation was investigated in the brain and cerebrospinal fluid in Alzheimer's disease (AD), in human embryonic brain and in rat brain after experimental cholinergic deafferentation of the cerebral cortex. While a selective loss of the AChE G4 form was a rather constant finding in AD, a small but significant increase of G1 for both AChE and BChE was found in the most severely affected cases. Both in normal human brain and in AD a significant relationship could be established between the AChE G4/G1 ratio in different brain regions and the activity of choline acetyltransferase (ChAT). A similar decrease of the AChE G4 form as observed in AD can be induced in rat by experimental cholinergic deafferentation of the cerebral cortex. The increase in G1 of both AChE and BChE in different brain regions in AD is quantitatively related to the local density of neuritic plaques which are histochemically reactive for both enzymes. In human embryonic brain, a high abundance of G1 and a low G4/G1 ratio for both AChE and BChE was found resembling the pattern observed in AD. Furthermore, both in embryonic brain and in AD AChE shows no substrate inhibition which is a constant feature of the enzyme in the adult human brain. It is, therefore, concluded that the degeneration of the cholinergic cortical afferentation in AD as reflected by a decrease of AChE G4 is accompanied by the process of a neuritic sprouting response involved in plaque formation which is probably associated with the expression of a developmental form of the enzyme.