The effect of community-acquired pneumonia on plasma esterases in older people.

INTRODUCTION: Pneumonia is a major cause of morbidity and mortality in older people. The poor outcome of older pneumonia patients despite treatment is still not understood. OBJECTIVE: The aim of this study was to examine the effect of community-acquired pneumonia on enzymes of drug metabolism in older people. METHODS: Fifteen patients (median age 67 years) with a clinical and radiological diagnosis of community-acquired pneumonia and 14 healthy volunteers matched for age and gender (median age 75 years) were recruited. Plasma activities of benzoylcholinesterase, butyrylcholinesterase, acetylcholinesterase and aspirin esterase were determined spectrophotometrically at three time points in pneumonia patients--within 24 h of admission to hospital, 2 days later and 10 days later. Monocyte aryl hydrocarbon hydroxylase (AHH) activity was determined spectrofluorimetrically at the same time points. Enzyme activities were measured at one time point in healthy controls. RESULTS: Mean plasma benzoylcholinesterase activity was significantly lower in pneumonia patients on admission to hospital (mean +/- SEM 848 +/- 100) and after 10 days of treatment (mean +/- SEM 925 +/- 114) than in healthy controls (mean +/- SEM 1333 +/- 84, P < 0.05). Similarly, plasma acetylcholinesterase activity was significantly lower in pneumonia patients on admission (P = 0.007) and after 10 days of treatment (P = 0.01) than in controls. Butyrylcholinesterase activity was lower in pneumonia patients on admission (P = 0.029) than in healthy controls, but improved slightly after treatment so there was no longer a significant difference at 10 days compared with controls (P = 0.077). In contrast there were no significant differences in plasma aspirin esterase activity or induced monocyte AHH activity between pneumonia patients and healthy controls. The activities of benzoylcholinesterase (r = -0.536, P = 0.04), butyrylcholinesterase (r = -0.638, P = 0.01), acetylcholinesterase (r = -0.583, P = 0.022) and aspirin esterase (r = -0.624, P = 0.013) correlated inversely with the British Thoracic Society pneumonia poor prognostic index. CONCLUSION: The activities of several esterases are reduced in older pneumonia patients. Other enzymes including aspirin esterase and induced monocyte AHH activity are unaltered in pneumonia. There was a significant inverse relationship between the activities of all esterases studied and the British Thoracic Society pneumonia poor prognostic index.

Relationship between age and plasma esterases.

INTRODUCTION: the older population is the most medicated. Despite high drug usage, older people are generally excluded from the research underpinning new drug development. This means that drugs are prescribed to older people with very little understanding of how they are likely to metabolize them. More research is needed to investigate the possible effects of ageing on the biotransformation of drugs. We therefore undertook a cross-sectional study examining the effect of age on the activities of benzoylcholinesterase, butyrylcholinesterase, acetylcholinesterase and aspirin esterase. METHODS: we measured the activities of benzoylcholinesterase and butyrylcholinesterase in 70 healthy volunteers aged 18-85 years. We measured the activities of acetylcholinesterase and aspirin esterase in 43 healthy volunteers aged 18-85 years. We determined plasma activities of benzoylcholinesterase, butyrylcholinesterase, acetylcholinesterase and aspirin esterase spectrophotometrically. RESULTS: we found no correlation between the activities of any of the enzymes measured and advancing age. CONCLUSION: age per se is not associated with reductions in the activities of esterase enzymes.

Plasma esterase activities in young and old patients undergoing open inguinal hernia repair.

Previous research has shown substantial decrements in enzymes of drug metabolism (esterases) in older patients following fracture neck of femur and hip replacement surgery. The main aim of this study was to examine the effect of open inguinal hernia repair on the activities of four plasma esterases in old and young patients. Seventeen older patients (mean age+/-S.E.M. was 67.6+/-1.8) and 12 young patients (mean age+/-S.E.M. was 38+/-3.3) undergoing open hernia repair for clinical reasons were recruited. The activities of plasma benzoylcholinesterase, butyrylcholinesterase, acetylcholinesterase, and aspirin esterase were determined spectrophotometrically, before the operation, 1 day post operatively and 1 week later. There was no significant effect of hernia repair surgery on any of the four enzymes measured in young or old patients. Neither was there any significant difference in enzyme activity between young and old at any of the three time points. Hernia repair surgery is not associated with decrements in enzymes of drug metabolism in man. This contrasts with the previous findings in hip replacement surgery.

Plasma esterases in cystic fibrosis: the impact of a respiratory exacerbation and its treatment.

OBJECTIVES: To determine the effect of an exacerbation of respiratory symptoms in cystic fibrosis (CF) on the activities of plasma benzoylcholinesterase and butyrylcholinesterase. METHODS: Twenty-nine patients with CF in a respiratory exacerbation and 27 healthy volunteers matched for age and sex were recruited. Blood was obtained from the patients when commencing antibiotic treatment and 14 days later on completion of treatment. One blood sample was taken from the healthy volunteers. The activities of benzoylcholinesterase and butyrylcholinesterase were determined by spectrophotometric assay. The circulating inflammatory markers, C-reactive protein and neutrophil elastase-alpha1antiproteinase complex were also measured. RESULTS: Benzoylcholinesterase activity was significantly (P = 0.001) lower in patients at the start of a respiratory exacerbation, compared with healthy controls [mean (SD): 917 (274) versus 1191(298) nmol x ml(-1) x min(-1)]. Benzoylcholinesterase activity increased significantly in patients to 1013 (237) nmol x ml(-1) x min(-1), following a course of antibiotic treatment (P = 0.006). Butyrylcholinesterase activity was also lower (P = 0.001) in patients at the start of a respiratory exacerbation, compared with healthy controls [5.54 (1.64) versus 7.01 (1.79) micromol x ml(-1) x min(-1)], and increased significantly in the patients to 6.31 (1.58) micromol x ml(-1) x min(-1) following treatment (P = 0.006). CONCLUSION: We demonstrated significant suppression of plasma esterase activities during an exacerbation of respiratory symptoms in CF, which was only partially reversed after antibiotic treatment. Further studies are needed to examine other pathways of drug metabolism in this group of chronically infected patients.