Sequential processing of the -amyloid precursor protein by -and ␥-secretase generates the amyloid -peptide (A), which is widely believed to play a causative role in Alzheimer disease. Selective lowering of the pathogenic 42-amino acid variant of A by ␥-secretase modulators (GSMs) is a promising therapeutic strategy. Here we report that mutations in presenilin (PS), the catalytic subunit of ␥-secretase, display differential responses to non-steroidal anti-inflammatory drug (NSAID)-type GSMs and more potent second-generation compounds. Although many pathogenic PS mutations resisted lowering of A 42 generation by the NSAID sulindac sulfide, the potent NSAID-like second-generation compound GSM-1 was capable of lowering A 42 for many but not all mutants. We further found that mutations at homologous positions in PS1 and PS2 can elicit differential A 42 responses to GSM-1, suggesting that a positive GSM-1 response depends on the spatial environment in ␥-secretase. The aggressive pathogenic PS1 L166P mutation was one of the few pathogenic mutations that resisted GSM-1, and Leu-166 was identified as a critical residue with respect to the A 42 -lowering response of GSM-1. Finally, we found that GSM-1-responsive and -resistant PS mutants behave very similarly toward other potent second-generation compounds of different structural classes than GSM-1. Taken together, our data show that a positive A 42 response for PS mutants depends both on the particular mutation and the GSM used and that attenuated A 42 responses to low potency GSMs can be overcome for many PS mutants by second generation GSMs.
The amyloid -peptide (A)4 is a 37-43-amino acid secreted peptide and an invariant pathological hallmark of Alzheimer disease (AD). The 42-amino acid variant A 42 has been suggested to be causative for the disease by triggering the amyloid cascade, a sequence of pathogenic events that ultimately leads to neurodegeneration and dementia in affected patients (1). The pathogenic peptide is generated by a sequential cleavage of the -amyloid precursor protein (APP) by -and ␥-secretase (2). After -secretase cleavage, ␥-secretase cleaves the C-terminal fragment of APP that is left in the membrane by an intramembrane cleavage to release the various A species (3-5). Although A 42 is normally a minor species produced by this cleavage besides the major A 40 species, its production is enhanced by familial AD (FAD) mutations in presenilin (PS) 1 and PS2, the catalytic component of ␥-secretase (6), as well as by a subset of FAD mutations in APP. Targeting -and ␥-secretase by specific inhibitors is one of the current approaches toward an effective AD treatment (7). With respect to ␥-secretase, however, ␥-secretase inhibitors also block the cleavage of Notch1, a major physiological ␥-secretase substrate and, thus, the generation of the Notch1 intracellular domain (NICD), which is a crucial signaling molecule controlling cell differentiation (7). Interfering with the cleavage of this substrate accounts for adverse side effects in...