The Alzheimer's disease amyloid peptide A has a heterogeneous COOH terminus, as variants 40 and 42 residues long are found in neuritic plaques and are secreted constitutively by cultured cells. The proteolytic activity that liberates the A COOH terminus from the -amyloid precursor protein is called ␥-secretase. It could be one protease with dual specificity or two distinct enzymes. By using enzyme-linked immunosorbent assays selective for A40 or A42, we have measured A secretion by a HeLa cell line, and we have examined the dose responses for a panel of five structurally diverse ␥-secretase inhibitors. The inhibitors lowered A and p3 secretion and increased levels of the COOH-terminal 99-residue -amyloid precursor protein derivative that is the precursor for A but did not alter secretion of -amyloid precursor protein derivatives generated by other secretases, indicating that the inhibitors blocked the ␥-secretase processing step. The dose-dependent inhibition of A42 was unusual, as the compounds elevated A42 secretion at sub-inhibitory doses and then inhibited secretion at higher doses. A compound was identified that elevated A42 secretion at a low concentration without inhibiting A42 or A40 at high concentrations, demonstrating that these phenomena are separable pharmacologically. Using either of two methods, IC 50 values for inhibition of A42 and A40 were found to have the same rank-order and fall on a trend line with near-unit slope. These results favor the hypothesis that A variants ending at residue 40 or 42 are generated by a single ␥-secretase.A hallmark feature of the neuropathology of Alzheimer's disease is the abundant deposition of amyloid into neuritic and diffuse plaques in the brain parenchyma. The predominant core constituent of amyloid plaques is a 40-to 42-residue amyloid peptide, A.1 A is generated from the -amyloid precursor protein (APP) by two sequential proteolytic cleavages. First, -secretase activity liberates the NH 2 terminus of A, generating a 99-residue COOH-terminal APP fragment (C99). Second, ␥-secretase activity cleaves C99 to liberate the A COOH terminus. APP is also processed in a nonamyloidogenic manner, being cleaved within the A domain by an activity termed ␣-secretase. The terms ␣-, -, and ␥-secretase are conceptual terms for proteases that are not yet definitively identified (reviewed in Refs. 1-3).The A peptide is a constitutive secretory product of a variety of neuronal and non-neuronal cells, in which multiple NH 2 -and COOH-terminal cleavages generate several A species. The most prevalent secreted forms of A appear identical to neuritic plaque core amyloid A and terminate either at residue 40 or 42 (4, 5). Although A40 variants are the predominant component of soluble A extracted from brain and secreted by cultured cells, A42 forms are the predominant constituents of neuritic plaques (6 -9). In vitro, forms of A that terminate at residue 42 form fibril faster than forms of A that terminate at residue 40, by orders of magnitude (10). Mut...