The amyloid- (A) peptide, a major pathological hallmark of Alzheimer's disease (AD), undergoes a cascade of interactions resulting in the formation of soluble aggregates and their conversion in the brain to insoluble deposits and mature senile plaques. Furthermore, the apoE4 isoform of apolipoprotein E (apoE), which is the major genetic risk factor of AD, is associated with increased A deposition. It is not known how the different A aggregates in the amyloid cascade are formed, contribute to the pathogenesis of AD, or are affected by apoE4. To investigate the initial aggregation stages underlying the amyloid cascade in vivo and how apoE affects them, we examined the effects of prolonged inhibition and subsequent reactivation of the A-degrading protease neprilysin on deposition, disaggregation, and fibrillization of A in apoEtransgenic and control mice. In control mice, intracerebroventricular infusion of thiorphan, which inhibits neprilysin, induced A42 and A40 deposition and fibrillization. On termination of thiorphan treatment, the number of A deposits decreased, whereas the fibrillar A deposits were unaffected. Similar treatments in apoE-deficient mice and mice transgenic for human apoE4 or apoE3 revealed that apoE4 enhances specifically the nucleation and aggregation of immunopositive A deposits and that reversible disaggregation of these deposits and their irreversible conversion to fibrillar deposits are stimulated similarly by the different apoE isoforms. Deposition of A and its enhancement by apoE4 were accompanied by increased astrogliosis both far from and near the A deposits, suggesting that astrogliosis might be triggered by both insoluble and soluble A aggregates.C onverging genetic and histopathological observations led to the formulation of the amyloid hypothesis, which proposes that accumulation of amyloid- (A) peptide, a major constituent of the brain plaques characteristic of Alzheimer's disease (AD), is the primary event in AD pathogenesis (1, 2). Recent findings suggest that brains of individuals with AD also contain soluble and neurotoxic A oligomers, which seem to be an intermediate state in the A-aggregation cascade, whose downstream product is the senile plaque (3-10). There is poor correlation between the severity of dementia and the density of amyloid plaques in AD (11-13); furthermore, in mice transgenic for the human A precursor protein (APP), synaptic degeneration and cognitive decline are observed even before amyloid is deposited (14-16). This finding suggests that the pathological effects of A in AD are mediated by A aggregates that precede the formation of the senile plaque. The relative contributions of the different soluble and insoluble A aggregates to the pathology of AD and the mechanisms underlying their formation in vivo are not yet known.Apolipoprotein E (apoE), the major brain lipid-binding protein, is expressed in humans as three isoforms (apoE2, apoE3, and apoE4), which differ in one or two amino acids (17). The apoE4 genotype is the major genetic ...