In another study, Aβ peptide activates sphingomyelinase-2 in primary astrocytes culture, which increases the release of pro-apoptotic exosomes enriched in ceramide and prostate apoptosis response-4 protein (PAR-4), suggesting these exosomes might contribute to glial apoptosis and neurodegeneration seen in AD (Wang et al., 2012). Here, PAWR is linked to Alzheimer disease.