Amyloid- (A) fibrils exhibit self-propagating, molecular-level polymorphisms that may underlie variations in clinical and pathological characteristics of Alzheimer's disease. We report the molecular structure of a specific brain-derived polymorph that has been identified as the most prevalent polymorph of 40-residue A fibrils in cortical tissue of Alzheimer's disease patients. This structure, developed from cryo-electron microscopy and supported by solid state NMR data, differs qualitatively from all previously described A fibril structures, both in its molecular conformation and its organization of cross- subunits. Knowledge of this brain-derived fibril structure may contribute to the development of structure-specific amyloid imaging agents and aggregation inhibitors with greater diagnostic and therapeutic utility.To derive a three-dimensional (3D) density map from the cryoEM images, we used RELION software for helical reconstruction (30,31), modified to include correlations of particle orientations about the fibril growth direction for particles from the same fibril segment (see Supporting Text). Calculations were performed without additional symmetry, with two-fold rotational symmetry in the repeat unit, and with 21 screw symmetry. The density map with the highest final resolution (2.77 Å) was obtained with near 21 symmetry, generated by a rise of 2.45 Å and twist of -180.34 between repeats ( Fig. 2A). A density map without additional symmetry and Fourier-shell correlation plots are shown in Fig. S2.The density in Fig. 2A consists of four cross- layers. Amino acid sidechains in the two inner layers are well resolved, allowing a unique fitting of residues 13-40 into the density (27). Residues 13-22 form an N-terminal extended segment with one continuous -strand. Residues 30-40 form a C-terminal extended segment comprised of -strands in residues 30-32, 34-36, and 38-39, defined by their intermolecular hydrogen bonding patterns. Glycine residues at positions 33 and 37 adopt non--strand conformations, disrupting these patterns. All -strand segments in the inner layers participate in in-register parallel -sheets. The N-terminal and C-terminal extended segments are separated by an irregular conformation in central residues 23-29, apparently stabilized in part by electrostatic interactions involving oppositely charged sidechains of D23 and K28 (Fig. 2B). Residues 1-12 are not sufficiently ordered to contribute to the density.Conformations within N-terminal, central, and C-terminal segments in Fig. 2A resemble conformations of the same segments in previously described A fibril structures (6,14,25), but the overall structural arrangement is qualitatively different. In previous structures, non--strand conformations at certain residues allow each A molecule to fold onto itself, resulting in roughly U-shaped (6, 7, 11, 25), S-shaped (12, 13, 15-17), or C-shaped (14, 26) conformations that are stabilized by interactions among hydrophobic sidechains within a single cross- subunit. In contrast, each A40 mol...