The amyloid -peptide (A) has been suggested to exert its toxicity intracellularly. Mitochondrial functions can be negatively affected by A and accumulation of A has been detected in mitochondria. Because A is not likely to be produced locally in mitochondria, we decided to investigate the mechanisms for mitochondrial A uptake. Our results from rat mitochondria show that A is transported into mitochondria via the translocase of the outer membrane (TOM) machinery. The import was insensitive to valinomycin, indicating that it is independent of the mitochondrial membrane potential. Subfractionation studies following the import experiments revealed A association with the inner membrane fraction, and immunoelectron microscopy after import showed localization of A to mitochondrial cristae. A similar distribution pattern of A in mitochondria was shown by immunoelectron microscopy in human cortical brain biopsies obtained from living subjects with normal pressure hydrocephalus. Thus, we present a unique import mechanism for A in mitochondria and demonstrate both in vitro and in vivo that A is located to the mitochondrial cristae. Importantly, we also show that extracellulary applied A can be internalized by human neuroblastoma cells and can colocalize with mitochondrial markers. Together, these results provide further insight into the mitochondrial uptake of A, a peptide considered to be of major significance in Alzheimer's disease.Alzheimer disease ͉ protein import ͉ human brain biopsies T he amyloid- peptide (A) is produced by regulated intramembrane proteolysis of the A precursor protein (APP) by the sequential cleavage by -and ␥-secretases (1-2). Plaques consisting mainly of aggregated A are detected in the neuropil in aged subjects and in particular in subjects with Alzheimer's disease (AD) (3-5). Recently, it has been argued that it is A oligomers and fibrils that cause toxicity, loss of synapses, and ultimately neuronal death (6-9). The exact mechanisms of how A damages the neurons are still unknown; however, several lines of evidence implicate that A exerts its toxicity intracellularly (10, 11) and point toward a role of mitochondria in this process (12). It has been reported that mitochondrial A accumulation impairs neuronal function and, thus, contributes to cellular dysfunction in a transgenic APP mouse model (13). It is noteworthy that in AD at an early stage there is already a reduction in the number of mitochondria (14), the brain glucose metabolism is decreased (15), and the activities of both tricarboxylic acid cycle enzymes (16) and cytochrome c oxidase (COX) are reduced (17)(18)(19)(20). In vitro studies with isolated mitochondria suggest that A 1-42 inhibits COX activity in a copper-dependent manner (21). Furthermore, mitochondrial A-binding alcohol dehydrogenase (ABAD) has been found to be up-regulated in neurons from AD patients (22), and A has been shown to interact with ABAD, resulting in free radical production and neuronal apoptosis. Recently, we have shown that preseque...