Amyloid fibrils, large ordered aggregates of amyloid  proteins (A), are clinical hallmarks of Alzheimer's disease (AD). The aggregation properties of amyloid  proteins can be strongly affected by singlepoint mutations at positions 22 and 23. The Dutch mutation involves a substitution at position 22 (E22Q) and leads to increased deposition rates of the AE22Q peptide onto preseeded fibrils. We investigate the effect of the E22Q mutation on two key regions involved in the folding and aggregation of the A peptide through replica exchange molecular dynamics simulations of the 15-28 fragment of the A peptide. The A15-28 peptide encompasses the 22-28 region that constitutes the most structured part of the A peptide (the E22-K28 bend), as well as the central hydrophobic cluster (CHC) (segment 17-21), the primary docking site for A monomers depositing onto fibrils. Our simulations show that the 22-28 bend is preserved in the A(15-28) peptide and that the CHC, which is mostly unstructured, interacts with this bend region. The E22Q mutation does not affect the structure of the bend but weakens the interactions between the CHC and the bend. This leads to an increased population of -structure in the CHC. Our analysis of the fibril elongation reaction reveals that the CHC adopts a -strand conformation in the transition state ensemble, and that the E22Q mutation increases aggregation rates by lowering the barrier for A monomer deposition onto a fibril. Thermodynamic signatures of this enhanced fibrillization process from our simulations are in good agreement with experimental observations. Alzheimer's disease ͉ explicit water ͉ familial type ͉ molecular dynamics simulations ͉ replica exchange T he presence of amyloid fibrils in the brain is a clinical hallmark of Alzheimer's disease (AD). The fibrils consist of large ordered aggregates of amyloid- (A) peptides, proteolytic by-products of the enzymatic cleavage of the Alzheimer amyloid precursor protein (APP). AD can be sporadic (occurring in elderly patients and characterized by a slow progression) or familial (a hereditary form characterized by early onset of the disease and aggravated severity). The majority of familial forms of AD involve single-point mutations in the 22-23 segment of the A peptide. The focus of this work is on the Dutch form of AD, which involves a mutation encoded by a point substitution G to C at codon 693 of the amyloid precursor protein (APP). The result is the production of an A peptide in which residue E22 is mutated to Q (E22Q mutation). Patients who have this mutation are at risk of developing cerebral amyloid angiopathy that typically leads to cerebral hemorrhage and stroke. Many in vitro experiments show that the AE22Q peptide aggregates much more readily than its wild-type (WT) counterpart (1-3). As a free monomer in solution, the WT A peptide is for the most part unstructured with residual structure observed locally in a few regions of the primary sequence (4). The A peptide can populate a variety of oligomeric species, some...