Costs of Inflammatory markers worldwide and the use of Butyrylcholinesterase (BChE)

Objective: Butyrylcholinesterase (BChE) is an enzyme that shares similarities with acetylcholinesterase (AChE) but has been less studied due to its uncertain physiological role. Initially regarded as an ‘orphan enzyme,’ recent studies suggest that BChE plays a significant role in inflammation, primarily through its involvement in the cholinergic anti-inflammatory pathway. This enzyme, primarily produced by the liver, is found in several tissues and is known to hydrolyze acetylcholine, a neurotransmitter that modulates immune responses. BChE levels are influenced by various diseases, such as diabetes, cardiovascular diseases, and neurological disorders, which are associated with inflammation. This study reviews the costs of inflammatory biomarkers worldwide and investigates the association between BChE and inflammation. Data from multiple countries reveal varying costs for biomarkers like C-reactive protein (CRP), procalcitonin (PCT), and BChE, with BChE being a more cost-effective option in certain regions such as Greece and Armenia. Furthermore, BChE activity correlates inversely with the degree of systemic inflammation, and its levels may serve as a predictive marker for conditions such as surgical infections and anastomotic leaks. The findings underscore the potential of BChE as a useful and affordable biomarker for monitoring inflammation, particularly in settings where other biomarkers are more costly. However, further research is needed to validate its widespread clinical application.