The pathogenic basis of inclusion body myositis (IBM), the leading muscle degenerative disease afflicting the elderly, is unknown, although the histopathological features are remarkably similar to those observed in Alzheimer's disease. One leading hypothesis is that the buildup of amyloid- (A) peptide within selective skeletal muscle fibers contributes to the degenerative phenotype. A is a small peptide derived via endoproteolysis of the amyloid precursor protein (APP). To determine the pathogenic effect of augmenting A42 levels in skeletal muscle, we used a genetic approach to replace the endogenous wildtype presenilin-1 (PS1) allele with the PS1 M146V allele in MCK-APP mice. Although APP transgene expression was unaltered, A levels, particularly A42, were elevated in skeletal muscle of the double transgenic (MCK-APP/PS1) mice compared to the parental MCK-APP line. Elevated phospho-tau accumulation was found in the MCK-APP/PS1 mice, and the greater activation of GSK-3 and cdk5 were observed. Other IBM-like pathological features, such as inclusion bodies and inflammatory infiltrates, were more severe and prominent in the MCK-APP/PS1 mice. Motor coordination and balance were more adversely affected and manifested at an earlier age in the MCK-APP/PS1 mice. The data presented here provide experimental evidence that A42 plays a proximal and critical role in the muscle degenerative process. Inclusion body myositis (IBM), the most prevalent muscle disorder among the elderly, is characterized by proximal and distal skeletal muscle weakness.1-3 The clinical features of this disorder are characterized by muscle weakness and atrophy, with selective involvement of both proximal and distal muscle groups, including the quadriceps, iliopsoas, triceps, and biceps muscles. In sporadic IBM, the majority of patients usually exhibit proximal weakness, and the quadriceps are more severely affected compared to other lower limb muscles.3 In hereditary IBM, however, affected muscles may exhibit a more restricted focus. For example, the quadriceps may be selectively spared in certain autosomal recessive cases. 4,5 Histopathologically, both sporadic and hereditary IBM are characterized by atrophic muscle fibers and fibers containing rimmed vacuoles and abnormal protein aggregates, particularly amyloid- (A), which is derived via endoproteolysis of the amyloid precursor protein (APP), and hyperphosphorylated tau. 2,6 -10 IBM and Alzheimer's disease (AD) share many pathohistological features including the buildup of aggregated proteins such as A and tau. In this regard, IBM can also be considered as a proteinopathy. As in AD, the role of the A peptide is unresolved, although evidence suggests that it plays an early and critical role in the muscle degeneration. IBM remains the only known condition in which A accumulates pathologically outside the central nervous system, except for age-related macular degeneration.11 This distinction implicates a critical role for A in the pathogenesis of IBM. A noteworthy difference between...