Pathogenic generation of the 42-amino acid variant of the amyloid -peptide (A) by -and ␥-secretase cleavage of the -amyloid precursor protein (APP) is believed to be causative for Alzheimer disease (AD). Lowering of A 42 production by ␥-secretase modulators (GSMs) is a hopeful approach toward AD treatment. The mechanism of GSM action is not fully understood. Moreover, whether GSMs target the A domain is controversial. To further our understanding of the mode of action of GSMs and the cleavage mechanism of ␥-secretase, we analyzed mutations located at different positions of the APP transmembrane domain around or within the A domain regarding their response to GSMs. We found that A 42 -increasing familial AD mutations of the ␥-secretase cleavage site domain responded robustly to A 42 -lowering GSMs, especially to the potent compound GSM-1, irrespective of the amount of A 42 produced. We thus expect that familial AD patients carrying mutations at the ␥-secretase cleavage sites of APP should respond to GSM-based therapeutic approaches. Systematic phenylalanine-scanning mutagenesis of this region revealed a high permissiveness to GSM-1 and demonstrated a complex mechanism of GSM action as other A species (A 41 , A 39 ) could also be lowered besides A 42 . Moreover, certain mutations simultaneously increased A 42 and the shorter peptide A 38 , arguing that the proposed precursor-product relationship of these A species is not general. Finally, mutations of residues in the proposed GSM-binding site implicated in A 42 generation (Gly-29, Gly-33) and potentially in GSM-binding (Lys-28) were also responsive to GSMs, a finding that may question APP substrate targeting of GSMs.Alzheimer disease (AD) 3 is the most common neurodegenerative disorder worldwide. The -amyloid precursor protein (APP), a type I membrane protein, plays a central role in the pathogenesis of the disease (1). Sequential cleavage of APP by -and ␥-secretase generates the amyloid- (A) peptide, which deposits as plaques in the brain of affected patients and represents one of the principal pathological hallmarks of the disease (1). ␥-Secretase is an intramembrane-cleaving protease complex, which cleaves the APP transmembrane domain (TMD) in a progressive, stepwise manner via cleavages at the ⑀-, -, and ␥-sites until it is sufficiently shortened to allow the release of A from the membrane (2-4). A peptides generated by ␥-secretase cleavage differ in their C termini. The major product released is A 40 , whereas A 38 and A 42 represent minor species (1). The highly aggregation-prone, neurotoxic A 42 is believed to be causative for AD by initiating a cascade of pathogenic events, which ultimately causes neurodegeneration and dementia (1). Increased production of A 42 underlies the vast majority of mutations associated with familial AD (FAD), which manifests with a very early disease onset. The majority of FAD mutations have been found in PS1, the catalytic subunit of ␥-secretase (5), whereas only a few mutations were found in its h...