Acylcholines are comprised of an
acyl chain esterified to a choline
moiety; acetylcholine is the best-characterized member of this class,
functioning as a neurotransmitter in the central and peripheral nervous
systems as well as an inhibitor of cytokine production by macrophages
and other innate immune cells. Acylcholines are metabolized by a class
of cholinesterases, including acetylcholinesterase (a specific regulator
of acetylcholine levels) and butyrylcholinesterase (BChE, an enigmatic
enzyme whose function has not been resolved by genetic knockout models).
BChE provides reserve capacity to hydrolyze acetylcholine, but its
importance is arguable given acetylcholinesterase is the most catalytically
efficient enzyme characterized to date. While known to be substrates
of BChE in vitro, endogenous production of long-chain acylcholines
is a recent discovery enabled by untargeted metabolomics. Compared
to acetylcholine, long-chain acylcholines show greater stability in
circulation with homeostatic levels–dictated by synthesis and
clearance–suggested to impact cholinergic receptor sensitivity
of acetylcholine with varying levels of antagonism. Acylcholines then
provide a link between BChE and non-neuronal acetylcholine signaling,
filling a gap in understanding around how imbalances between acylcholines
and BChE could modulate inflammatory disease, such as the “cytokine
storm” identified in severe COVID-19. Areas for further research,
development, and clinical testing are outlined.