Butyrylcholinesterase: A Review of Its Biochemical Role, Clinical Significance, Therapeutic Potential, and Limitations

Introduction:: BChE is an enzyme classified as a nonspecific cholinesterase with a widespread distribution in human plasma, the liver, and the CNS. Historically viewed as a less important enzyme than AChE; however, recent data suggest that BChE has much more importance related to neurodegeneration, detoxification of chemical compounds, and variability in pharmacogenomic responses between individuals. Research has shown that both alterations in the level of BChE enzyme activity and BChE genetic polymorphisms can lead to differences in susceptibility to diseases and responses to drugs. Methods:: A systematic literature search was conducted through PubMed, Scopus, and Web of Science covering studies published between 2000 and 2024. The articles obtained from the above search engine were studied to give an overview of the literature related to the physiological and pathological aspects of BChE. Results:: According to this review, BChE plays a compensatory role in the breakdown of ACh, especially when AChE is not functioning properly. Low or high BChE levels have been linked to several diseases. In addition to the disease-related impacts of abnormal BChE levels, genetic variations such as the K-variant, unusual alleles, and fluoride-resistant forms of BChE affect its enzymatic activity and the metabolism of drugs. Discussion:: Emerging evidence suggests that BChE serves many functions in catalyzing different biocatalytic processes and has developed increased potential for use in medicine/biomedicine. Conclusion:: Research efforts on BChE should include identifying the physiological roles of BChE, developing specific and selective molecules to regulate BChE isoforms or activities, and incorporating genetic information when developing individualized treatment plans.