In protein conformational disorders ranging from Alzheimer to Parkinson disease, proteins of unrelated sequence misfold into a similar array of aggregated conformers ranging from small oligomers to large amyloid fibrils. Substantial evidence suggests that small, prefibrillar oligomers are the most toxic species, yet to what extent they can be selectively targeted and remodeled into non-toxic conformers using small molecules is poorly understood. We have evaluated the conformational specificity and remodeling pathways of a diverse panel of aromatic small molecules against mature soluble oligomers of the A42 peptide associated with Alzheimer disease. We find that small molecule antagonists can be grouped into three classes, which we herein define as Class I, II, and III molecules, based on the distinct pathways they utilize to remodel soluble oligomers into multiple conformers with reduced toxicity. Class I molecules remodel soluble oligomers into large, off-pathway aggregates that are non-toxic. Moreover, Class IA molecules also remodel amyloid fibrils into the same off-pathway structures, whereas Class IB molecules fail to remodel fibrils but accelerate aggregation of freshly disaggregated A. In contrast, a Class II molecule converts soluble A oligomers into fibrils, but is inactive against disaggregated and fibrillar A. Class III molecules disassemble soluble oligomers (as well as fibrils) into low molecular weight species that are non-toxic. Strikingly, A non-toxic oligomers (which are morphologically indistinguishable from toxic soluble oligomers) are significantly more resistant to being remodeled than A soluble oligomers or amyloid fibrils. Our findings reveal that relatively subtle differences in small molecule structure encipher surprisingly large differences in the pathways they employ to remodel A soluble oligomers and related aggregated conformers.A central tenet of protein folding is that a given amino acid sequence encodes a single folded structure (1). By analogy, one would expect that a given protein sequence would encode a single misfolded structure (e.g. a single amyloid fibril conformation). Instead, each protein sequence encodes numerous aggregated isoforms that possess unique secondary and tertiary structures (2-12). Previous work has firmly established that small, prefibrillar conformers (herein referred to as soluble oligomers) of diverse polypeptides are the most toxic aggregates both in vitro and in vivo (11,(13)(14)(15)(16)(17). However, elucidating the structural attributes of such toxic conformers that differentiate them from their non-toxic counterparts has proven difficult (see Refs. 11 and 18 -22 for recent progress).Significant evidence linking protein misfolding to cellular toxicity in numerous aggregation disorders has motivated the search for small molecules that prevent aggregation (see Refs. 23-25, and references therein). A general conclusion of these studies is that many small molecules redirect the aggregation cascade rather than inhibiting it completely (26). In hind...