Acetylcholinesterase (ACHE) is a serine hydrolase that rapidly hydrolyzes the neurotransmitter acetylcholine in synaptic clefts, thereby terminating signal transduction at neuromuscular junctions 1. This enzymatic activity is fundamental to proper functioning of both peripheral and central nervous systems 1. Beyond its primary catalytic role, ACHE has been identified as a component of nitric oxide signal transduction pathways, particularly in red blood cell membranes, suggesting broader physiological functions 2. The enzyme serves as a biomarker and prognostic factor for various diseases, with erythrocyte ACHE activity correlating with clinical parameters across multiple pathological conditions 2. ACHE shows significant disease relevance in Alzheimer's disease, where genetic variants such as rs1799806/ACHE demonstrate association with disease pathogenesis and affect gene expression in brain regions through expression quantitative trait loci (eQTL) mechanisms 3. The clinical significance of ACHE extends beyond neurological disorders, as its activity levels in red blood cells provide valuable diagnostic and prognostic information across various disease states, making it a versatile clinical biomarker 2.