Ethnic differences in the frequency distribution of serum cholinesterase activity

We studied the activity of the enzyme pseudocholinesterase (serum cholinesterase) and its sensitivity to inhibition by dibucaine and fluoride in 400 (200 Iranian and 200 Irish) healthy subjects. The results show Irish subjects have significantly higher serum cholinesterase activity than Iranian subjects (7.82 +/- 0.14 vs 5.22 +/- 0.09 u/ml, mean +/- SEM, p < 0.01). Furthermore, the percent of inhibition of enzyme activity by dibucaine (82.19 +/- 0.68 vs 69.29 +/- 0.68) and fluoride (79.90 +/- 70.13 +/- 0.62) was also significantly higher (p < 0.001) in Irish than in Iranian subjects. One subject (Iranian) with very low pseudocholinesterase activity and a dibucaine number below 20 (atypical) had a history of apnoea following succinylcholine (suxamethonium). These data indicate that the frequency of atypical and heterozygote genes for cholinesterase activity leading to prolonged apnoea is much higher in Iranian than Irish populations. This study emphasises the importance of ethnic pharmacology.