Edited by Paul FraserMore than 30 years ago, two unexpected findings were discovered that challenged conventional thinking in biology. The first was the identification of a misfolded protein with transmissible properties associated with a group of neurodegenerative diseases known as transmissible spongiform encephalopathies. The second was the discovery of a new pathway used for the extracellular release of biomolecules, including extracellular vesicles called exosomes. Two decades later, the convergence of these pathways was shown when exosomes were found to play a significant role in both the transmission and propagation of protein aggregates in disease. Recent research has now revealed that the majority of proteins involved in neurodegenerative diseases are transported in exosomes, and that external stresses due to age-related impairment of protein quality control mechanisms can promote the transcellular flux of these proteins in exosomes. Significantly, exosomes provide an environment that can induce the conformational conversion of native proteins into aggregates that can be transmitted to otherwise aggregate-free cells in the brain. Here we review the current roles of exosomes in the pathology of neurodegenerative diseases.Exosomes are released into the extracellular environment by the majority of cell types in the body. Originally identified to be involved in the non-degradative removal of the transferrin receptor during the maturation process of reticulocytes (1, 2), exosomes have now also been recognized as an important communication and signaling pathway in the body in both normal and disease settings. Exosomes differ from other extracellular vesicles (EVs) 3 based on the secretion pathway used and the size of the vesicle released. Unlike other EVs that can bud from the plasma membrane, such as microvesicles (3), exosomes are created from intraluminal vesicles that form within multivesicular bodies (MVBs, or multivesicular endosomes). The subsequent fusion of the MVB at the plasma membrane releases these vesicles into the extracellular milieu where they are known as exosomes (Fig. 1). This secretion process results in a large number of exosomes being released in the body, with estimates of 3 ϫ 10 6 exosomes per microliter of blood serum. Recent evidence has highlighted the importance of exosomes both for cellular communication and in the delivery of biomolecules.The function of exosomes differs depending on the cell type from which they originate. Initial in vivo studies identified that exosomes derived from dendritic cells could express MHC class II molecules to promote an immune response (4). Since then, exosomes have been found to function in angiogenesis, inflammation, morphogen transportation, and programmed cell death (5). The richest area of exosome research, however, has come from disease studies, in particular the cancer field. Recent evidence has highlighted a role for exosomes to promote metastasis and regulate tumor immune response (6). Of particular interest is the ability of tumors to rel...