A hallmark of Alzheimer's disease (AD) is the aggregation of β-amyloid peptides (Aβ) into amyloid plaques in patient brain. Cleavage of amyloid precursor protein (APP) by the intramembrane protease γ-secretase produces Aβ of varying lengths, of which longer peptides such as Aβ42 are thought to be more harmful. Increased ratios of longer Aβs over shorter ones, exemplified by the ratio of Aβ42 over Aβ40, may lead to formation of amyloid plaques and consequent development of AD. In this study, we analyzed 138 reported mutations in human presenilin-1 (PS1) by individually reconstituting the mutant PS1 proteins into anterior-pharynx-defective protein 1 (APH-1)aL-containing γ-secretases and examining their abilities to produce Aβ42 and Aβ40 in vitro. About 90% of these mutations lead to reduced production of Aβ42 and Aβ40. Notably, 10% of these mutations result in decreased Aβ42/Aβ40 ratios. There is no statistically significant correlation between the Aβ42/Aβ40 ratio produced by a γ-secretase variant containing a specific PS1 mutation and the mean age at onset of patients from whom the mutation was isolated.Alzheimer's disease | γ-secretase | Aβ peptides | cleavage activity | amyloid hypothesis T he first case of Alzheimer's disease (AD) was reported more than 100 y ago, and the brain of the deceased patient contained characteristic senile plaques (1). These plaques were found to be amyloid in nature by electron microscopy (2), and analysis of amino acid sequence revealed the amyloid to be derived from amyloid precursor protein (APP) (3). APP is first cleaved by β-secretase to produce a 99-residue transmembrane fragment C99, which then undergoes additional cleavages by γ-secretase to generate a series of amyloidogenic β-amyloid peptides (Aβ) with 39-43 amino acids (4, 5). The slightly longer Aβ peptides, particularly Aβ42 and Aβ43, are thought to be more prone to aggregation than the shorter ones such as Aβ40 (6-8). Indeed, the amyloid plaques contain mostly longer Aβ peptides such as Aβ42 (9).Familial cases of AD were found to be genetically linked to missense mutations in APP (10, 11). These observations, together with prior knowledge on amyloid plaques, prompted proposition of the amyloid hypothesis, which regards the formation of β-amyloid plaques as the cause of AD through apoptosis induction of neuronal cells (12). Consistent with this hypothesis, Aβ42 was found to induce cell death (13,14). Human presenilin-1 (PS1) was cloned and found to be targeted by missense mutations in early-onset familial AD (EOFAD) (15). Remarkably, these EOFAD-linked PS1 mutants led to elevated molar ratios of Aβ42 over Aβ40 both in cell lines and in the brains of transgenic animals (16), and the plasma levels of Aβ42 and Aβ43 in FAD patients with PS1 or APP mutations were significantly increased compared with those of healthy individuals (17). These observations led to refinement of the amyloid hypothesis, which identifies increased ratios of longer Aβ peptides over shorter ones as a key early event in AD development (18). The increa...