Cholinesterase (CHE, pseudocholinesterase)

Cholinesterase in the blood – more precisely butyrylcholinesterase, also called pseudocholinesterase or CHE – is an enzyme that the liver produces and releases into the blood. It is not the same as acetylcholinesterase, which breaks down the messenger acetylcholine at the nerve endings. Cholinesterase is one of the values that describe the liver's production capacity. It is measured in serum together with the other liver values; the blood sample is taken in a practice.

What cholinesterase does in the body

Cholinesterase in the blood splits so-called choline esters. These include certain drugs such as the muscle relaxant succinylcholine used in anaesthesia and ester-type local anaesthetics, but also substances from food and the environment. It thus acts as a kind of buffer that intercepts such substances before they act at the nerve endings. Because the liver continuously produces the enzyme anew, its activity in the blood reflects how much protein the liver can make – similar to albumin. Unlike GOT and GPT, it therefore shows not cell damage but the synthetic capacity of the liver.

Low cholinesterase – what happens in the body?

Low activity shows that the liver is producing less protein. This occurs with long-standing liver diseases involving remodelling of the tissue (cirrhosis of the liver), but also with malnutrition and with severe inflammation and infections, during which the liver shifts its protein production. Organophosphates, active ingredients of some insecticides, also inhibit the enzyme. Less often, an inherited variant in the BCHE gene is the cause: succinylcholine is then broken down only slowly during anaesthesia, and the muscle relaxation, including paralysis of breathing, lasts much longer than usual. During pregnancy the activity is naturally somewhat lower.

Raised cholinesterase – what happens in the body?

Raised values arise when the liver produces more protein. Studies have observed this with fatty liver, overweight, type 2 diabetes and raised blood fats; cholinesterase rises with the amount of fat stored in the liver. In nephrotic syndrome, in which a lot of protein is lost via the kidneys, the liver steps up its protein production and cholinesterase rises as well. Whether the enzyme itself is involved in fat metabolism or is merely an accompanying feature is being discussed in research.

The interpretation is given in your report.