Aggregation and fibril formation of amyloid- (A) peptides A40 and A42 are central events in the pathogenesis of Alzheimer disease. Previous studies have established the ratio of A40 to A42 as an important factor in determining the fibrillogenesis, toxicity, and pathological distribution of A. To better understand the molecular basis underlying the pathologic consequences associated with alterations in the ratio of A40 to A42, we probed the concentration-and ratio-dependent interactions between well defined states of the two peptides at different stages of aggregation along the amyloid formation pathway. We report that monomeric A40 alters the kinetic stability, solubility, and morphological properties of A42 aggregates and prevents their conversion into mature fibrils. A40, at approximately equimolar ratios (A40/A42 ϳ 0.5-1), inhibits (>50%) fibril formation by monomeric A42, whereas inhibition of protofibrillar A42 fibrillogenesis is achieved at lower, substoichiometric ratios (A40/A42 ϳ 0.1). The inhibitory effect of A40 on A42 fibrillogenesis is reversed by the introduction of excess A42 monomer. Additionally, monomeric A42 and A40 are constantly recycled and compete for binding to the ends of protofibrillar and fibrillar A aggregates. Whereas the fibrillogenesis of both monomeric species can be seeded by fibrils composed of either peptide, A42 protofibrils selectively seed the fibrillogenesis of monomeric A42 but not monomeric A40. Finally, we also show that the amyloidogenic propensities of different individual and mixed A species correlates with their relative neuronal toxicities. These findings, which highlight specific points in the amyloid peptide equilibrium that are highly sensitive to the ratio of A40 to A42, carry important implications for the pathogenesis and current therapeutic strategies of Alzheimer disease.Alzheimer disease is a progressive neurodegenerative disorder characterized by age-related accumulation of amyloid- (A) 2 proteins in the form of diffuse and neuritic plaques in regions of the brain that are affected by the disease (1-4). The discovery of A fibrils as principal constituents of amyloid plaques led to the emergence of the amyloid hypothesis, which implicates the aggregation of A as the primary trigger for a cascade of pathogenic events culminating in neurodegeneration and development of AD (1, 5-7). A proteins are produced in neuronal and non-neuronal cells as a result of sequential proteolytic cleavage of the type I transmembrane amyloid precursor protein (APP) by -and ␥-secretases (8 -12). Depending on the site of APP cleavage by ␥-secretase, A proteins of various chain lengths are generated (13-16). The predominant A species in human plasma and CSF, as well as in conditioned media of APP-expressing cells, is A40 (ϳ90%) followed by A42 (ϳ10%). Despite the preponderance of A40, in vivo studies reveal that A42 is a major constituent of amyloid plaques and suggest that A42 aggregation plays a critical role in the initiation of plaque f...