We have demonstrated that the angiotensin-converting enzyme (ACE) genotype is associated with Alzheimer's disease (AD) in the Japanese population (1). To determine why ACE affects susceptibility to AD, we examined the effect of purified ACE on aggregation of the amyloid -peptide (A) in vitro. Surprisingly, ACE was found to significantly inhibit A aggregation in a dose response manner. The inhibition of aggregation was specifically blocked by preincubation of ACE with an ACE inhibitor, lisinopril. ACE was confirmed to retard A fibril formation with electron microscopy. ACE inhibited A deposits on a synthaloid plate, which was used to monitor A deposition on autopsied brain tissue. ACE also significantly inhibited A cytotoxicity on PC12 h. The most striking fact was that ACE degraded A by cleaving A-(1-40) at the site Asp 7 -Ser 8 . This was proven with reverse-phase HPLC, amino acid sequence analysis, and MALDI-TOF/MS. Compared with A-(1-40), aggregation and cytotoxic effects of the degradation products A-(1-7) and A-(8 -40) peptides were reduced or virtually absent. These findings led to the hypothesis that ACE may affect susceptibility to AD by degrading A and preventing the accumulation of amyloid plaques in vivo.Progressive cerebral dysfunction in Alzheimer's disease (AD) 1 is accompanied by innumerable extracellular amyloid deposits in the form of senile plaque and microvascular amyloid. Amyloid protein is derived from the integral membrane polypeptide, -amyloid precursor protein (APP). The released 39 -43 residue amyloid -peptide (A) may subsequently undergo aggregation to form amyloid fibrils under the influence of various amyloid-associated factors (2). The aggregation and deposition of A has been linked to the toxic effects causing cell damage in AD. Because A is present in both normal and AD subjects, an answer to the question of why A accumulates in AD but not in the normal brain may lead to a possible cure for AD.Angiotensin-converting enzyme (ACE; dipeptidyl carboxypeptidase, EC 3.4.15.1) is a membrane-bound ectoenzyme. It catalyzes the conversion of angiotensin I (AngI) to angiotensin II (AngII), which plays an important role in blood pressure and body fluid and sodium homeostasis (3). The cloning of the ACE gene revealed a 287-bp insertion (I)/deletion (D) polymorphism in intron 16. The serum ACE activity of the ACE DD genotype was twice as high as that of the ACE II genotype (4). The ACE genotype is considered to be associated with hypertension, coronary artery disease, left ventricular hypertrophy, myocardial infarction, and diabetic nephropathy (5-7). In particular, the ACE DD genotype is considered to be a risk factor for vascular diseases.We have compared the distribution of an I/D polymorphism of the gene coding for ACE in 133 Japanese sporadic AD patients and 257 control subjects (1). The association between AD and ACE genotypes or alleles was found to be significant. The frequency of the ACE II genotype was 1.4ϫ higher in AD than in controls, whereas that of ACE DD gen...