Cu(II) ions are implicated in the pathogenesis of Alzheimer disease by influencing the aggregation of the amyloid- (A)peptide. Elucidating the underlying Cu(II)-induced A aggregation is paramount for understanding the role of Cu(II) in the pathology of Alzheimer disease. The aim of this study was to characterize the qualitative and quantitative influence of Cu(II) on the extracellular aggregation mechanism and aggregate morphology of A 1-40 using spectroscopic, microelectrophoretic, mass spectrometric, and ultrastructural techniques. We found that the Cu(II):A ratio in solution has a major influence on (i) the aggregation kinetics/mechanism of A, because three different kinetic scenarios were observed depending on the Cu(II):A ratio, (ii) the metal:peptide stoichiometry in the aggregates, which increased to 1.4 at supra-equimolar Cu(II):A ratio; and (iii) the morphology of the aggregates, which shifted from fibrillar to non-fibrillar at increasing Cu(II):A ratios. We observed dynamic morphological changes of the aggregates, and that the formation of spherical aggregates appeared to be a common morphological end point independent on the Cu(II) concentration. Experiments with A 1-42 were compatible with the conclusions for A 1-40 even though the low solubility of A 1-42 precluded examination under the same conditions as for the A 1-40 . Experiments with A 1-16 and A 1-28 showed that other parts than the Cu(II)-binding His residues were important for Cu(II)-induced A aggregation. Based on this study we propose three mechanistic models for the Cu(II)-induced aggregation of A 1-40 depending on the Cu(II):A ratio, and identify key reaction steps that may be feasible targets for preventing Cu(II)-associated aggregation or toxicity in Alzheimer disease.Extracellular cerebral plaques composed mainly of amyloid -peptide (A) 1-40 and 1-42 fibrils are a histopathological hallmark of Alzheimer disease (AD) 3 (1, 2). These plaques contain elevated levels of metals, in particular zinc and copper (3). Also, it has been shown that these metal ions can promote the aggregation of A in vitro (4, 5). This implies a key role of the metal ions in the A-mediated pathology of AD (6), although the subject is still under much debate (7,8), and a role of amyloid-independent pathways in AD neurodegeneration have recently been reviewed (9).Specifically regarding the role of metal ions in the amyloidmediated pathology of AD, it is believed that Zn(II) acts as a neuroprotector (10, 11), whereas Cu(II) is considered to mediate neurotoxicity (12)(13)(14). The latter effect is thought to occur through early stage soluble A and A-Cu oligomeric intermediates (15-18) that may be involved in the formation of reactive oxygen species (6). It was discovered that Cu(II) may be released postsynaptically at glutamatergic synapses in hippocampus (19,20), the site for initial A deposition in AD. This provides an explanation for how Cu(II) can interact with A. Seemingly in contrast to the support for the neurotoxic effects of Cu(II),...