Very significant efforts have been devoted in the last twenty years to developing compounds that can interfere with the aggregation pathways of proteins related to misfolding disorders, including Alzheimer's and Parkinson's diseases. However, no disease-modifying drug has become available for clinical use to date for these conditions. One of the main reasons for this failure is the incomplete knowledge of the molecular mechanisms underlying the process by which small molecules interact with protein aggregates and interfere with their aggregation pathways. Here, we leverage the single molecule level morphological and chemical sensitivity of infrared nanospectroscopy to provide the first direct measurement of the interaction between single A42 oligomeric and fibrillar species and an aggregation inhibitor, bexarotene, originally an anticancer drug capable recently shown to be able to inhibit A42 aggregation in animal models of Alzheimer's disease.Our results demonstrate that the carbonyl group of this compound interacts with A42 aggregates through a single hydrogen bond. These results establish infrared nanospectroscopy as powerful tool in structure-based drug discovery for protein misfolding diseases.Alzheimer's disease (AD) is characterised by memory loss and cognitive impairment. AD is the primary cause of dementia, which affects currently over 50 million people worldwide, a number expected to exceed 150 million by 2050. 1-3 The self-assembly of the 42-residue isoform of the amyloid- (A) peptide into intractable aggregates is considered to be at the core of the molecular pathways leading to AD. [3][4][5] It is therefore important to understand at the molecular level the aggregation process of A42 in order to develop effective therapeutic strategies that aim at inhibiting its self-assembly.Great efforts have been devoted in the last twenty years to understand the molecular basis of this devastating disorder and to develop small molecules that could interfere with the aggregation pathway of A42. 6-12 Indeed, disease-modifying small molecules represent c.a. one third of the registered trials, in which anti-A therapies dominate. 13 However, despite these efforts, no compound has entered the clinical use to date. 13,14 These repeated failures are in part related to an incomplete understanding of the molecular mechanisms underlying the process by which small molecules interact with protein aggregates and how they interfere with the pathways of aggregation. It is increasingly recognised that inhibiting A aggregation per se could have unexpected consequences on the toxicity, as it could not only decrease it, but also leave it unaffected, or even increase it. 15 This complexity is due to the non-linear nature of the aggregation network, in which neurotoxic small oligomeric intermediates [16][17][18][19][20] , can be formed in a variety of ways, some of which highly sensitive to small perturbation. Therefore, promising effective therapeutic strategies must be aimed at targeting precise species in a controlled inte...