Insulin-degrading enzyme (IDE) is a zinc metalloprotease that degrades the amyloid -peptide, the key component of Alzheimer disease (AD)-associated senile plaques. We have previously reported evidence for genetic linkage and association of AD on chromosome 10q23-24 in the region harboring the IDE gene. Here we have presented the first functional assessment of IDE in AD families showing the strongest evidence of the genetic linkage. We have examined the catalytic activity and expression of IDE in lymphoblast samples from 12 affected and unaffected members of three chromosome 10-linked AD pedigrees in the National Institute of Mental Health AD Genetics Initiative family sample. We have shown that the catalytic activity of cytosolic IDE to degrade insulin is reduced in affected versus unaffected subjects of these families. Further, we have shown the decrease in activity is not due to reduced IDE expression, suggesting the possible defects in IDE function in these AD families. In attempts to find potential mutations in the IDE gene in these families, we have found no coding region substitutions or alterations in splicing of the canonical exons and exon 15b of IDE. We have also found that total IDE mRNA levels are not significantly different in sporadic AD versus age-matched control brains. Collectively, our data suggest that the genetic linkage of AD in this set of chromosome 10-linked AD families may be the result of systemic defects in IDE activity in the absence of altered IDE expression, further supporting a role for IDE in AD pathogenesis.2 is the primary component of senile plaques, a pathological hallmark in the brains of patients with Alzheimer disease (AD). Elevated levels of cerebral A have also been observed in AD patients (1, 2), implicating excessive accumulation of A as a key pathogenic event in AD. Unlike early onset autosomal dominant AD, the vast majority of AD cases do not show any clear evidence of Mendelian transmission and predominantly present with late onset AD (LOAD) (onset age Ͼ65). However, there is evidence that genetic factors play a significant role in modifying the disease risk/age of onset in the majority of LOAD cases (3, 4). To date, only the ⑀4 allele of the apolipoprotein E gene (APOE) has been firmly established as a LOAD genetic risk factor and has been proposed to be involved in A clearance (5). Cerebral A accumulation has been proposed to greatly influence the age of onset of LOAD and is determined by the amount of A generated versus the amount that is degraded and exported from the brain over one's lifetime (6, 7).Several proteases have been identified to degrade A, including neprilysin, plasmin, endothelin-converting enzyme-1 as well as insulin-degrading enzyme (IDE) (EC 3.4.24.56) (1). IDE, also called insulysin, is a zinc metalloprotease that cleaves small polypeptides, many of which share amyloid fibril-forming ability, including insulin, atrial naturetic peptide, amylin, calcitonin, and A (8, 9). IDE is a major protease to degrade soluble, monomeric A (10, 11) an...