ADAMTS-18 is a member of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) family of proteases, which are known to play important roles in development, angiogenesis and coagulation; dysregulation and mutation of these enzymes have been implicated in many disease processes, such as inflammation, cancer, arthritis and atherosclerosis. Mutations of ADAMTS-18 have been linked to abnormal early eye development and reduced bone mineral density. In this review, we briefly summarize the structural organization and the expression of ADAMTS-18. We will also focus on the emerging role of ADAMTS-18 in several pathophysiological conditions which include: hematological diseases, tumorgenesis, osteogenesis, eye-related diseases, central nervous system disorders, and last but not least a research perspective of ADAMTS-18 and its potential as a promising diagnostic and therapeutic target.