Edited by Paul E. Fraser Prion-like propagation of protein aggregates is thought to be an essential feature in many neurodegenerative diseases, but the mechanisms underlying transcellular transfer of protein aggregates remain unclear. Stopschinski et al. now demonstrate that the cellular uptake of tau, A, and ␣-synuclein aggregates mediated by heparan sulfate proteoglycans (HSPGs) varies with distinct glycosaminoglycan chain length and sulfation patterns. The results help us to understand how different protein aggregates propagate, leading to distinct neurodegenerative pathologies.Prion diseases are a group of fatal transmissible neurodegenerative diseases characterized by the accumulation of an abnormal form of prion protein (PrP Sc ) in the central nervous system (CNS).2 Prion diseases are transmissible interindividually, crossing even species barriers, and propagate intraindividually. Similar to prion diseases, many neurodegenerative diseases are also characterized by the accumulation of abnormal proteins in the CNS including -amyloid protein (A) and tau in Alzheimer's disease (AD), tau in non-AD tauopathies, ␣-synuclein in Lewy body diseases such as Parkinson's disease and dementia with Lewy bodies, and transactive response DNAbinding protein 43 kDa (TDP-43) in frontotemporal dementia and amyotrophic lateral sclerosis (1-3). Increasing evidence from experimental studies has indicated that misfolded aggregated proteins in these diseases have prion-like properties: They propagate through neuronal networks or other pathways in the CNS of individuals and also cause interindividual transmission of these diseases. In human studies, neurodegeneration seems to progress along the neuronal networks by propagation of protein aggregates in the CNS, although evidence for human-to-human transmission is still limited (4, 5).For intercellular propagation of intracellular protein aggregates, release of aggregates from donor cells and uptake of aggregates by recipient cells are essential steps, followed by intracellular seeding in the recipient cells. In transcellular transfer of protein aggregates, multiple mechanisms have been proposed: 1) extracellular vesicles like exosomes and ectosomes reaching the cytoplasm of recipient cells by fusion, 2) free protein aggregates exocytosed from donor cells taken up by recipient cells with receptor-or nonreceptor-mediated endocytosis/macropinocytosis, and 3) transfer through nanotubes, although it remains unclear which is the main mechanism for transcellular transfer of certain protein aggregates in certain areas of the CNS.Diamond and colleagues (6) have focused on heparan sulfate proteoglycans (HSPGs) on the cell surface as receptors for uptake of protein aggregates such as A, tau, and ␣-synuclein. They previously observed that cellular uptake and consequent intracellular seeding of tau and ␣-synuclein fibrils require HSPGs, similar to results from another study (7). Inhibition of the interaction with HSPGs blocked transcellular aggregate propagation, indicating that the interact...