Membrane disruption mediated by the accumulation of amyloid-β
(Aβ) on cell membranes is central to the pathogenesis of Alzheimer’s
disease (AD). Cholesterol, an important component of membranes, is
well-recognized as a risk factor in AD. It can affect the aggregation
and pore formation of Aβ on membranes whereas the specific effects
are rather complex, particularly regarding the non-linear response
to cholesterol concentrations. Yet, the mechanistic understanding
of the role of cholesterol in Aβ–membrane interactions
remains incomplete. Herein, we employed microsecond-scale molecular
dynamics simulations to investigate the effects of cholesterol on
Aβ dimerization in a lipid bilayer containing different molar
ratios of cholesterol (0, 20, and 40 mol %). Cholesterol reduces the
time required for the formation of stable dimers and exerts dual effects
on Aβ–membrane interactions. First, cholesterol promotes
the extraction of the C-terminal region from the membrane to water.
Consequently, at the ratios of 0 and 20 mol %, peptides are anchored
at the membrane–water interface, but they are repelled to water
at a ratio of 40 mol % with high structural flexibility. Second, cholesterol
weakens Aβ–membrane interactions, thereby enhancing inter-peptide
interactions. The former is favorable for dimerization while the latter
is not. The balance between two factors eventually leads to a non-monotonic
effect on the degree of dimerization, whereby the number of inter-peptide
contacts is the largest at a cholesterol ratio of 20 mol %. These
results provide atomistic insights into the regulation mechanism of
Aβ42 aggregation by cholesterol and help to understand the pathological
link between cholesterol and AD.