Abstract

Diamond-Blackfan Anemia (DBA) is a rare congenital bone marrow failure syndrome primarily characterized by erythroblastopenia and macrocytic anemia. This disorder results from mutations in ribosomal protein (RP) genes, which lead to defective ribosomal RNA maturation, nucleolar stress, and impaired erythropoiesis. Mutations in RP genes have been identified, with RPS19 being the most commonly affected gene, accounting for approximately 25% of all cases. Other frequently mutated genes include RPL5, RPL11, and RPS26. These mutations are mostly heterozygous and cause defective ribosome assembly and biogenesis, which activates the p53 pathway, resulting in cell cycle arrest and apoptosis. In addition, non-RP gene mutations, such as those in GATA1, TSR2, or HEATR3, have been linked to DBA-like phenotypes, further complicating the genetic landscape. Congenital malformations, particularly craniofacial anomalies, thumb abnormalities, and cardiac defects, are common in patients with specific RP gene mutations, such as RPL5 and RPL11. Advances in next-generation sequencing have improved the identification of novel mutations; however, approximately 20–25% of DBA cases remain genetically unexplained. In this review, we explore the genetic landscape of DBA and provide insights into the underlying mutations and their contributions to disease pathophysiology.