Amyloid  (A) immunotherapy is emerging as a promising disease-modifying therapy for Alzheimer's disease, although the precise mechanisms whereby anti-A antibodies act against amyloid deposition and cognitive deficits remain elusive. To test the "peripheral sink" theory, whichpostulatesthattheeffectsofanti-AantibodiesinthesystemiccirculationaretopromotetheAeffluxfrombraintoblood,westudiedthe clearance of 125 I-A 1-40 microinjected into mouse brains after intraperitoneal administration of an anti-A monoclonal antibody 266.
125I-A 1-40 was rapidly eliminated from brains with a half-life of ϳ30 min in control mice, whereas 266 significantly retarded the elimination of A, presumably due to formation of A-antibody complex in brains. Administration of 266 to APP transgenic mice increased the levels of monomer A species in an antibody-bound form, without affecting that of total A. We propose a novel mechanism of A immunotherapy by the class of anti-A antibodies that preferentially bind soluble A, i.e., intracerebral, rather than peripheral, sequestration of soluble, monomer form of A, thereby preventing the accumulation of multimeric toxic A species in brains.