Transmissible Spongiform Encephalopathy (TSE) or prion disease is caused by the infectious agent prion or scrapie prion protein (PrPSC). In animals, prion disease includes scrapie in sheep and goat; mink spongiform encephalopathy in mink; chronic wasting disease in elk and deer, and bovine spongiform encephalopathy (BSE), a.k.a. mad cow disease in cattle. Human TSE includes, Kuru; Creutzfeldt-Jakob Disease (CJD); Gerstmann-Straussler-Scheinker Disease (GSS) and more recently, variant CJD, which is thought to be caused by the transmission of BSE to human. The search for the transmissible agent of TSE went through many decades of uncertainty. In contrast to all other known pathogens, the TSE agent was shown to lack nucleic acids and appeared to co-purify with proteins. It was not until the 1980s that the infectious agent of TSE was shown to be a protein. Remarkably, the gene encoding for this protein is present in normal mammals. Subsequently, the word “prion”, an acronym for “proteinases infectious particle” was coined to explain this conundrum. It was postulated that the central event in the pathogenesis of prion diseases is the conversion of the normal cellular prion protein (PrPC) into an intermediate isoform (PrP*) and finally the pathological, protease-resistant and infectious, PrPSC. While the concept of “protein only hypothesis” is firmly established, the processes by which the conversion occurs, and the mechanisms by which PrPSC causes pathogenesis remain incompletely understood. Furthermore, despite exhaustive investigations, the normal physiologic functions of PrPC remain elusive. It is clear, however, that expression of PrPC in the central nervous system (CNS) is required for the neurotoxicity of PrPSC as prnp null mice do not develop neurodegeneration. As a rare neurodegeneration disease, prion disease occurs with 1–3 cases in a million people per year, among which approximately 85% is sporadic without known agents, 10%–15% is genetic due to somatic mutations of the PRNP gene, and less than 1% is infectious. It is likely that the first occurrence of mad cow disease in England was caused by feeding meat and bone meal (MBM) contaminated by prions. How the first prion strain causing scrapie, chronic wasting disease, and transmissible mink encephalopathy remains obscure. For the past years, an international ban on MBM feeding has greatly reduced the occurrence of prion diseases, however, several reasons indicate that prion diseases will not be eradicated. First, somatic mutations of PRNP naturally occur, albeit at a rare frequency. Second, prions can adapt to new hosts, thus increasing their host range and overcoming the transmission barrier. Third, prions remaining in the field are infectious, and in some cases may become more infectious after binding to soil, as evidenced by the spread of chronic wasting disease among otherwise healthy deer populations. Fourth, samples from asymptomatic CJD patients or patients who are misdiagnosed under certain situations can contaminate medical instruments or be transplanted unintentionally, thus causing prion disease. More recently, it is postulated that the prion phenomenon, as defined by “the conversion of a normal protein to become an infectious protein” may also contribute to other neurodegenerative diseases. Hence, studying the pathogenesis of prion disease may provide novel insights into the underlying mechanisms of more common neurodegenerative diseases, such as Alzheimer’s disease and Parkinson’s diseases.