- BuChE is downregulated in fibrotic patients and mice, mainly hepatocyte expressed, and correlates negatively with fibrosis stage and alpha smooth muscle actin.
- Hepatocyte BuChE loss or inhibition increases acetylcholine, activating hepatic stellate cells and promoting fibrosis; BuChE overexpression is protective.
- Unmetabolised acetylcholine activates HSCs via ChRM3 NF-kappaB signalling; Chrm3 deletion attenuates fibrosis, identifying a druggable cholinergic circuit.
Gut. 2026 Sep 23:gutjnl-2026-338932. doi: 10.1136/gutjnl-2026-338932. Online ahead of print.
ABSTRACT
BACKGROUND: Butyrylcholinesterase (BuChE) is a metabolic enzyme implicated in Alzheimer’s disease, detoxification and depression. Although reduced BuChE expression is recognised in cirrhosis, its functional role in fibrogenesis remains undefined.
OBJECTIVE: We investigated whether BuChE regulates fibrosis by modulating acetylcholine (ACh) bioavailability and identified downstream cholinergic signalling.
DESIGN: BuChE expression was assessed via qPCR and immunostaining in patient biopsies. Its contribution was studied using Buche ΔHep, Buche KI/KI-Hep mice, pharmacological inhibition, mutant BuChE conditioned medium and recombinant protein. ACh release and muscarinic ACh receptor (ChRM) function were measured using patch-clamp and calcium mobilisation assay; ChRM3 role was tested via Chrm3 ΔHSC mice and AAV6-mediated overexpression.
RESULTS: BUCHE mRNA and serum activity are significantly downregulated in fibrotic patients and mice, correlating negatively with F stage and alpha-smooth muscle actin expression. BuChE is predominantly expressed in hepatocytes in the liver, which can be reduced by transforming growth factor beta or platelet-derived growth factor treatment, and its anti-fibrotic function requires enzymatic activity. Hepatocyte BuChE deletion or inhibition increases hepatic stellate cell (HSC) activation and fibrosis across multiple models, whereas overexpression is protective, establishing causality. Loss of BuChE leads to accumulation of unmetabolised ACh, which activates HSCs as a damage associated molecular pattern signal via ChRM3-NF-κB signalling. Chrm3 ΔHSC mice exhibit attenuated HSC activation and fibrosis, whereas Chrm3 overexpression promotes fibrogenesis.
CONCLUSION: Hepatocyte injury disrupts BuChE activity, causing local ACh accumulation and subsequent HSC activation via ChRM3 signalling. This newly identified cholinergic circuit drives fibrosis and represents a druggable target for therapeutic intervention.
PMID:42778344 | DOI:10.1136/gutjnl-2026-338932
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