Much evidence indicates that women have a higher risk of developing Alzheimer's disease (AD) than do men. The reason for this gender difference is unclear. We hypothesize that estrogen deficiency in the brains of women with AD may be a key risk factor. In rapidly acquired postmortem brains from women with AD, we found greatly reduced estrogen levels compared with those from age-and gender-matched normal control subjects; AD and control subjects had comparably low levels of serum estrogen. We examined the onset and severity of AD pathology associated with estrogen depletion by using a gene-based approach, by crossing the estrogen-synthesizing enzyme aromatase gene knockout mice with APP23 transgenic mice, a mouse model of AD, to produce estrogen-deficient APP23 mice. Compared with APP23 transgenic control mice, estrogen-deficient APP23 mice exhibited greatly reduced brain estrogen and early-onset and increased  amyloid peptide (A) deposition. These mice also exhibited increased A production, and microglia cultures prepared from the brains of these mice were impaired in A clearance͞degradation. In contrast, ovariectomized APP23 mice exhibited plaque pathology similar to that observed in the APP23 transgenic control mice. Our results indicate that estrogen depletion in the brain may be a significant risk factor for developing AD neuropathology.amyloid deposition ͉ aromatase ͉ transgenic animal N europathological hallmarks of Alzheimer's disease (AD) include significant deposition of extracellular  amyloid peptide (A) and presence of neurofibrillary tangles in the brain (1). A is derived from the two-step enzymatic processing of amyloid precursor protein (APP) in which -secretase (BACE) cleaves the -site of APP to release the N terminus of A, and the ␥-secretase protein complex cleaves the ␥-site of APP to release the C terminus of A (2, 3). Overproduction and progressive deposition of A are known to underlie, in part, A plaque formation, a key pathologic feature of AD. The initial cleavage of APP by BACE is critical for A associated with AD neuropathology (4). Recent studies have shown that BACE activity increases with age and is elevated in AD brains (5, 6).Impaired A clearance and͞or degradation may also contribute to A plaque formation. Our previous findings support this hypothesis: Microglia isolated from AD brains have impaired phagocytic activity, leading to reduced A clearance (7). Other groups have found that cytoplasmic A granules in the plaque-associated glia and microglia participate in the clearance of A in A-immunized AD patients and APP transgenic mice (8, 9).Two enzymes are involved in A degradation and clearance: insulin-degrading enzyme (IDE) and neprilysin (NEP). IDE is expressed in high concentrations in the brain. Besides degrading insulin and several regulatory peptides, IDE also degrades the intracellular domain of APP and is responsible for degrading and clearing A from the brain (10, 11). Indeed, genetic linkage studies have shown that late-onset AD loci on chromosome 1...