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The Convergence of RNA Metabolism and Proteostasis: A Comprehensive Analysis of XBP1/tRNA-Linked Disorders

1. Introduction: The Evolution of Cellular Stress Response Paradigms

The physiological integrity of eukaryotic cells depends on the precise coordination of two fundamental biological processes: the accurate synthesis of proteins via transfer RNA (tRNA) adaptors and the stringent quality control of protein folding within the endoplasmic reticulum (ER). Historically, these domains were conceptualized as distinct operational theaters—RNA metabolism occurring within the nucleus and cytoplasm involving transcriptional and post-transcriptional modifications, and proteostasis governed by ER-resident chaperones and signaling pathways. However, the last two decades of molecular biology have dismantled this compartmentalized view, revealing a profound and mechanistic convergence centered on a shared enzymatic apparatus. This report provides an exhaustive analysis of the intersection between the Unfolded Protein Response (UPR) and tRNA splicing, delineating the specific molecular machinery involved, the evolutionary divergence from yeast to mammals, and the spectrum of human pathologies that arise when this critical axis is disrupted.

The central discovery bridging these fields was the elucidation of the non-canonical splicing mechanism of XBP1 (X-box binding protein 1) mRNA. Unlike the vast majority of eukaryotic mRNAs, which are processed by the spliceosome—a massive ribonucleoprotein complex that removes introns via two transesterification reactions—XBP1 mRNA retains a specific intron that is excised in the cytoplasm only under conditions of ER stress.1 This excision is catalyzed by the transmembrane sensor IRE1 (Inositol-Requiring Enzyme 1). The subsequent ligation of the XBP1 exons to form the active transcription factor XBP1s was, for years, a subject of intense speculation. In Saccharomyces cerevisiae, the ligation of the homologous HAC1 mRNA is performed by Trl1, a multi-functional enzyme that also ligates tRNAs.1 However, mammals lack a Trl1 homolog. The identification of RTCB (HSPC117) as the long-sought mammalian ligase for both XBP1 and intron-containing tRNAs established the "XBP1/tRNA axis" as a discrete biological entity.1

This shared reliance on RTCB and its associated complex creates a unique vulnerability in human physiology. A single genetic defect in the components of this machinery—whether in the ligase itself, its cofactors like Archease (ZBTB8OS), or the upstream endonucleases like the TSEN complex—can simultaneously compromise global protein synthesis (via tRNA depletion) and the adaptive stress response (via UPR failure). The resulting clinical phenotypes are complex, often severe, and predominantly affect the nervous system, manifesting as Pontocerebellar Hypoplasia (PCH), motor neuron diseases, and specific forms of Parkinsonism. This report synthesizes the structural biology, enzymology, and clinical genetics of these disorders to provide a unified model of pathogenesis rooted in the failure of RNA-mediated proteostasis.

2. Molecular Architecture of the Splicing Machinery

To understand the etiology of XBP1/tRNA-linked disorders, one must first dissect the atomic-level architecture and catalytic mechanisms of the enzymes involved. The system operates through a "cut-and-paste" logic, distinct from spliceosomal splicing, requiring specific endonucleases to generate RNA fragments and a specialized ligase to seal them.

2.1 The tRNA Ligase Complex (tRNA-LC)

The mammalian tRNA Ligase Complex (tRNA-LC) is the functional hub of this pathway. It is a pentameric assembly that has evolved to handle the specific chemical requirements of sealing 2',3'-cyclic phosphate (2',3'>P) and 5'-hydroxyl (5'-OH) termini—the precise ends generated by both tRNA and XBP1 cleavage.1

2.1.1 RTCB: The Catalytic Core

RTCB (RNA 2',3'-cyclic phosphate and 5'-OH ligase), encoded by the RTCB gene (formerly C22orf28 or HSPC117), represents the catalytic subunit. Structural studies of human RTCB and its archaeal homologs (e.g., from Pyrococcus horikoshii) reveal a fold distinct from classical ATP-dependent DNA and RNA ligases.4

Catalytic Mechanism: The ligation reaction catalyzed by RTCB is unique in biology for its energy economy and chemical pathway. Unlike T4 RNA ligase or yeast Trl1, which consume ATP to adenylate the 5'-phosphate, RTCB utilizes GTP. The reaction proceeds through three distinct steps:

1. Enzyme Activation (Guanylylation): RTCB reacts with GTP in the presence of manganese ions (Mn2+) to form a covalent enzyme-guanylate intermediate (RTCB-GMP). The GMP moiety is linked via a phosphoamide bond to a conserved histidine residue (His404 in P. horikoshii, conserved in humans) within the active site.5
2. Substrate Activation: The activated GMP is transferred to the 3' end of the RNA substrate. Specifically, RTCB hydrolyzes the 2',3'-cyclic phosphate of the upstream exon to a 3'-phosphate, and then caps this 3'-phosphate with GMP, forming an RNA(3')pp(5')G intermediate (an inverted 3'-5' pyrophosphate cap).5
3. Ligation: The 5'-hydroxyl group of the downstream exon acts as a nucleophile, attacking the pyrophosphate bond. This releases GMP and forms the seamless 3'-5' phosphodiester bond connecting the two exons.6

Structural Insights: Crystal structures of human RTCB show that the active site coordinates two Mn2+ ions, which are essential for stabilizing the transition states of the phosphoryl transfer reactions.4 The active site geometry is highly specific for the 2',3'>P terminus, explaining why RTCB is the obligate ligase for IRE1 and TSEN products. Notably, homology modeling and crystal structures indicate that the metal coordination in human RTCB involves tetrahedral geometry, distinct from the octahedral coordination seen in archaeal homologs, suggesting subtle evolutionary refinements in the mammalian enzyme.8

2.1.2 Archease (ZBTB8OS): The Essential Cofactor

While recombinant RTCB possesses intrinsic ligase activity in vitro, its turnover rate is catalytically insufficient for cellular life. It requires a dedicated cofactor, Archease (encoded by ZBTB8OS), to function efficiently.1

Archease acts as a specialized guanyl-transferase chaperone. Its primary function is to accelerate the first step of the RTCB reaction cycle—the guanylylation of the active site histidine.7 Structural analyses suggest that Archease binds to the catalytic domain of RTCB, stabilizing the conformation that is receptive to GTP binding. In the absence of Archease, RTCB effectively stalls in an inactive, un-guanylated state. This dependency is so profound that depletion of Archease in mammalian cells phenocopies the depletion of RTCB itself, leading to the accumulation of unspliced XBP1 and pre-tRNAs.7 The protein contains a "zinc finger and BTB domain" fold, although its function diverges significantly from typical transcriptional repressors of the ZBTB family.

2.1.3 The Structural Scaffold: DDX1, FAM98B, CGI-99, and Ashwin

The human tRNA-LC is not a binary enzyme-cofactor pair but a hetero-pentameric machine.

• DDX1: This DEAD-box RNA helicase is integral to the complex. Its ATPase and helicase activities are thought to be required for resolving the highly structured RNA substrates, particularly the rigid stem-loops of tRNAs and the long-range secondary structures of XBP1 mRNA, to allow RTCB access to the splice junctions.1 DDX1 tethers to the complex via a specific C-terminal helix that integrates into the structural core.8
• FAM98B and CGI-99: These two subunits form a tightly interlocked heterodimer via their N-terminal domains. Cryo-electron microscopy (cryo-EM) reconstructions reveal that this heterodimer acts as a "structural clamp," stabilizing the assembly of RTCB and DDX1.8 Specifically, FAM98B and CGI-99 form a pincer-like structure that grips another subunit, Ashwin (also known as C6orf108 or LOC100506109 in some databases, though recent literature confirms Ashwin as a component).
• Paralogous Diversity: Recent data indicates compositional diversity in tRNA-LCs. The paralogous proteins FAM98A and FAM98C can form distinct complexes with RTCB that lack Ashwin, suggesting that different "flavors" of the ligase complex may exist for specialized functions or in different tissue types.11

2.2 The tRNA Splicing Endonuclease (TSEN) Complex

Before RTCB can ligate, the RNA must be cleaved. For tRNAs, this is the exclusive domain of the TSEN complex.

Composition: The eukaryotic TSEN complex is a heterotetramer comprising two catalytic subunits (TSEN2, TSEN34) and two structural subunits (TSEN54, TSEN15).12

• Catalysis: TSEN2 and TSEN34 are evolutionarily related to archaeal endonucleases. TSEN2 is responsible for cleaving the 5' splice site of the tRNA intron, while TSEN34 cleaves the 3' splice site.12
• Architecture: The four subunits assemble into a "box-like" architecture. TSEN54 and TSEN15 provide the structural scaffold that positions the two catalytic subunits at the correct distance to excise the intron. This "molecular ruler" function is critical because tRNA introns vary in sequence but are located in a structurally conserved position within the anticodon loop.14
• Substrate Recognition: The complex recognizes the "mature domain" of the tRNA (the L-shaped body) rather than the intron sequence itself, ensuring it acts only on correctly folded pre-tRNAs.14

2.3 The Enigmatic Role of CLP1

Associated with the TSEN complex is the RNA kinase CLP1. Its role has been a subject of significant debate and is central to understanding PCH10.

• Activity: CLP1 possesses 5'-hydroxyl kinase activity. It uses ATP to phosphorylate the 5'-OH of RNA termini.14
• The Paradox: The termini generated by TSEN cleavage are a 5'-exon (2',3'>P) and a 3'-exon (5'-OH). The 5'-OH of the 3'-exon is the nucleophile required by RTCB for ligation. If CLP1 phosphorylates this 5'-OH to a 5'-phosphate, it blocks RTCB-mediated ligation.9 Thus, CLP1 activity appears to be antagonistic to the canonical splicing pathway.
• Regulatory Switch: Current models suggest CLP1 acts as a gatekeeper. By phosphorylating the 3'-exon or the excised intron, CLP1 may divert these RNAs towards degradation (via the exonuclease Xrn1) or towards alternative processing pathways, such as the circularization of the intron (into tricRNAs), rather than productive ligation.18 In CLP1 kinase-dead models, this regulation is lost, leading to aberrant accumulation of tRNA fragments.20

2.4 IRE1: The ER Stress Sensor

For XBP1 splicing, the cleavage is performed by IRE1 alpha (ERN1).

• Activation: Upon sensing unfolded proteins (via dissociation of BiP or direct binding of peptides), IRE1 oligomerizes in the ER membrane and undergoes trans-autophosphorylation.2
• RNase Activity: The cytosolic domain of IRE1 exerts endoribonuclease activity. It cleaves XBP1 mRNA at two specific non-canonical consensus sites (CUGCAG) that form stem-loop structures.2
• Chemistry: Like TSEN, IRE1 cleavage leaves 2',3'-cyclic phosphate and 5'-OH ends, rendering the fragments compatible with RTCB.1

3. The Functional Intersection: Proteostasis and Translation

The molecular machinery described above services two critical physiological pathways. The intersection of these pathways at the level of the RTCB/Archease complex is the defining feature of the "XBP1/tRNA disorders."

3.1 The Canonical tRNA Splicing Pathway

In the human genome, approximately 6-7% of tRNA genes contain introns.1 While a minority, these include essential isodecoders for Leucine (Leu-CAA), Tyrosine (Tyr-GTA), Isoleucine (Ile-TAT), and Arginine (Arg-TCT).23

• Process: Pre-tRNAs are transcribed, folded, and cleaved by TSEN. The exon halves are held together by base pairing and sealed by tRNA-LC (RTCB).
• Proteostatic Implication: Failure in this pathway leads to the depletion of the mature pool of these specific tRNAs. During translation, when the ribosome encounters a codon requiring one of these tRNAs (e.g., UAU for Tyrosine), it stalls. Ribosome stalling triggers the Ribosome-Associated Quality Control (RQC) pathway and the Integrated Stress Response (ISR) via GCN2 kinase activation.24 If prolonged, this leads to a cessation of global protein synthesis and cell death.

3.2 The Non-Canonical XBP1 Splicing Pathway (UPR)

The Unfolded Protein Response is a homeostatic mechanism to adjust ER capacity.

• Process: During ER stress, IRE1 cleaves the 26-nucleotide intron from XBP1 mRNA. RTCB ligates the exons. The product, XBP1s, encodes a potent bZIP transcription factor.1
• Target Genes: XBP1s translocates to the nucleus and drives the transcription of chaperones (BiP/GRP78), ERAD components (EDEM1, HRD1), and lipid synthesis enzymes (to expand the ER membrane).1
• Proteostatic Implication: Without XBP1s, the cell cannot expand its ER capacity to match the protein folding load. This is particularly catastrophic for secretory cells (like plasma cells secreting antibodies) 1 and neurons (secreting neurotransmitters and surface receptors).

3.3 The "UPRosome" Concept

Recent research suggests that RTCB does not float freely but is dynamically recruited to the ER membrane to form a "UPRosome" with IRE1.

• Regulation: The activity of RTCB within this complex is fine-tuned by post-translational modifications.

• c-ABL Kinase: Under chronic stress, c-ABL phosphorylates RTCB at Tyrosine 306 (Y306). This phosphorylation inhibits the interaction between RTCB and IRE1, effectively turning off XBP1 splicing.25 This may represent a "molecular switch" to transition from an adaptive UPR to a terminal (apoptotic) UPR if stress is unresolved.
• PTP1B Phosphatase: The ER-resident phosphatase PTP1B removes the inhibitory phosphate from Y306, reactivating RTCB and sustaining the adaptive UPR.25
• Implication: Disorders affecting these regulators could theoretically mimic RTCB deficiencies.

3.4 RIDD: The Destructive Alternative

IRE1 has a second function: Regulated IRE1-Dependent Decay (RIDD).

• Mechanism: IRE1 cleaves ER-localized mRNAs, miRNAs, and even tRNAs that possess a specific consensus sequence and secondary structure.27
• Outcome: Unlike XBP1, these cleavage products are not ligated. They are degraded by the exosome. RIDD reduces the protein influx into the ER (by destroying mRNAs) but can also be cytotoxic if it degrades essential transcripts (like CD59 or pro-survival miRNAs).2
• tRNA Cleavage: IRE1 can specifically cleave tRNAGly(GCC) in the anticodon loop. This cleavage is distinct from TSEN cleavage and generates tRNA halves (tRHs) that may act as signaling molecules.29

4. Pathophysiology of Pontocerebellar Hypoplasia (PCH)

Pontocerebellar Hypoplasia represents the most clinically prominent group of disorders linked to this axis. The phenotype—severe underdevelopment of the cerebellum and pons—points to a specific vulnerability of these hindbrain structures to defects in RNA processing and translation.

4.1 Overview of PCH

PCH is classified into subtypes (1-10) based on clinical features and genetic etiology. A significant subset of these (Types 2, 4, 5, 6, and 10) are directly caused by mutations in the tRNA/XBP1 machinery.30

4.2 TSEN-Associated PCH (Types 2, 4, 5)

Mutations in the TSEN complex subunits are the classical cause of PCH.

• TSEN54: The homozygous missense mutation A307S (c.919G>T) is the most common cause of PCH Type 2A.14 This founder mutation creates a hypomorphic allele. Null mutations in TSEN54 are lethal in early development (as seen in zebrafish and mice models).32 More severe mutations lead to PCH Type 4, which has a deeper phenotype and early lethality.
• TSEN2, TSEN34, TSEN15: Mutations in these subunits are rarer but result in similar phenotypes (PCH2, PCH4, PCH5).13
• Pathomechanism:

• Complex Instability: Biochemical studies reveal that PCH-associated mutations, including A307S, often do not abolish catalytic activity in vitro. Instead, they cause thermal instability of the TSEN complex.12 At physiological temperatures, or under febrile stress, the mutant complex may dissociate or degrade, reducing the effective concentration of active enzyme.
• Neuronal Specificity: Why does a ubiquitous defect cause specific hindbrain failure? Neurons in the developing cerebellum and pons have exceptionally high protein synthesis rates during specific developmental windows. A reduction in TSEN efficiency leads to a "supply chain" failure of mature tRNAs. The resulting translational stress triggers p53-mediated apoptosis, specifically ablating the proliferating progenitors of the cerebellum.35
• XBP1 Link: While TSEN does not splice XBP1, the proteotoxic stress caused by translational errors (mistranslation due to tRNA imbalance) places a heavy load on the UPR. If the UPR machinery (shared with the tRNA machinery) becomes overwhelmed or sequestered, the cells die.

4.3 CLP1-Associated PCH (Type 10)

PCH Type 10 is caused by the homozygous R140H mutation in CLP1.16

• Phenotype: Patients present with microcephaly, cerebellar hypoplasia, and distinct features like peripheral motor neuronopathy, mimicking Spinal Muscular Atrophy (SMA).20
• Mechanism: The R140H mutation impairs the interaction between CLP1 and the TSEN complex.

• Kinase-Ligase Uncoupling: In the absence of functional CLP1 interaction, the regulation of the 3'-exon terminus is disrupted.
• Toxic Fragments: A critical finding in CLP1 models (human neurons and mice) is the accumulation of linear tRNA introns and "tRNA fragments" (tRFs). Normally, CLP1 might tag these for degradation or circularization. In its absence, these aberrant RNA species accumulate. These fragments are cytotoxic; they can sensitize neurons to oxidative stress and trigger p53-dependent cell death.17 Thus, PCH10 is driven not just by the loss of mature tRNAs, but by the gain-of-toxicity of aberrant RNA processing byproducts.

4.4 Mitochondrial Links: PCH Type 6 (RARS2)

PCH Type 6 is caused by mutations in RARS2, the mitochondrial arginyl-tRNA synthetase.37

• Convergence: While RARS2 is not a splicing enzyme, its failure leads to the same downstream consequence: a lack of functional charged tRNAs (specifically in mitochondria). This halts mitochondrial translation, causing energy failure and secondary stress. The phenotypic overlap (cerebellar hypoplasia) confirms that the cerebellum is uniquely sensitive to tRNA metabolism defects, whether cytoplasmic (TSEN/RTCB) or mitochondrial (RARS2).37

5. Disorders of the Ligase Module (RTCB/Archease)

Defects in the ligation step affect both tRNA maturation and the UPR directly.

5.1 RTCB Deficiency Syndromes

• Genetic Evidence: Homozygous null mutations in RTCB are embryonic lethal in mice and flies, underscoring its essentiality.32 However, rare human patients with hypomorphic variants in RTCB have been identified.
• Phenotype: These patients present with a neurodevelopmental disorder characterized by microcephaly, global developmental delay, hypotonia, and seizures. The phenotype strongly resembles PCH, reinforcing the pathway connection.39
• Mechanism:

• tRNA Defect: Accumulation of 2',3'>P terminated tRNA halves.
• UPR Defect: Complete inability to generate XBP1s. This renders neurons defenseless against misfolded proteins.
• Immune Defect: Evidence from B-cell specific knockouts suggests these patients likely suffer from humoral immunodeficiency. Plasma cells require massive ER expansion to secrete antibodies; without RTCB (and thus XBP1s), they fail to secrete IgA/IgG and undergo apoptosis.1

5.2 Archease (ZBTB8OS) and Parkinsonism

• Genetic Evidence: Variants in ZBTB8OS have been linked to Parkinsonism with Spasticity (X-linked or autosomal) and Congenital Contractural Arachnodactyly.41
• Parkinsonism Pathomechanism: The link to Parkinson's Disease (PD) is mechanistically robust. Dopaminergic neurons (DA neurons) are the primary cell type lost in PD. These cells are under chronic oxidative stress due to dopamine metabolism and are prone to accumulating alpha-synuclein aggregates.

• The Protective Role: In C. elegans models, overexpression of alpha-synuclein kills DA neurons. This toxicity is prevented by RTCB and Archease, which facilitate the splicing of xbp-1. If Archease or RTCB is depleted, the neuroprotective xbp-1 response is lost, and DA neurons degenerate rapidly.3
• Human Relevance: Patients with ZBTB8OS mutations likely have reduced RTCB efficiency. While sufficient for development, this reduced capacity fails to protect DA neurons from age-related proteostatic stress, leading to early-onset Parkinsonism.

• Congenital Contractural Arachnodactyly: This phenotype (long fingers, contractures) suggests a developmental role. ZBTB8OS mutations have been associated with heart failure and congenital heart defects (e.g., Tetralogy of Fallot) in genetic screens.42 This likely reflects the requirement for high-fidelity protein synthesis and secretion during the formation of cardiac and skeletal connective tissues.

5.3 Cancer Implications

The ZBTB8OS locus is involved in gene fusions in cancer, specifically the ZBTB8OS-AC090627.1 inter-chromosomal fusion found in various malignancies.44 Furthermore, RTCB expression is often elevated in cancers (e.g., Glioblastoma), where it may support the high demand for protein synthesis and help tumor cells survive ER stress (hypoxia/nutrient deprivation) via the UPR.39 Conversely, mutations in the machinery are potential tumor suppressors or drivers depending on the tissue context.46

6. Peripheral Neuropathies and the Protective UPR

The peripheral nervous system (PNS) provides a clear example of how this axis functions in "defense" mode.

6.1 Charcot-Marie-Tooth Type 1B (CMT1B)

CMT1B is a demyelinating neuropathy caused by mutations in the MPZ (Myelin Protein Zero) gene. Many MPZ mutations cause the protein to misfold and be retained in the ER of Schwann cells.47

6.2 The XBP1 Rescue Mechanism

In CMT1B, the UPR is chronically activated.

• Protective Function: Research using Mpz mutant mice shows that the IRE1/XBP1 axis is a crucial coping mechanism. When Xbp1 is genetically deleted in these mice, the neuropathy transitions from moderate to catastrophic. Schwann cells undergo apoptosis, and hypomyelination becomes severe.47
• Implication: This demonstrates that the RTCB/IRE1 machinery is actively suppressing disease in these patients. Any secondary hit to this pathway (e.g., aging, oxidative stress inhibiting RTCB) would precipitate rapid clinical decline.
• Therapeutic Proof-of-Concept: Genetic overexpression of XBP1s in these models ameliorates the neuropathy, suggesting that boosting the ligase/splicing axis is a viable therapeutic strategy.48

7. Animal Models and Experimental Evidence

The characterization of these disorders relies heavily on model organisms, which have dissected the specific contributions of each gene.

8. Therapeutic Implications and Future Directions

The "XBP1/tRNA axis" presents specific opportunities for therapeutic intervention.

8.1 Pharmacological Modulation

• RTCB Activators: Small molecules that mimic Archease activity or stabilize the RTCB-GTP intermediate could enhance ligase function in patients with hypomorphic mutations in RTCB or ZBTB8OS.
• Kinase Inhibitors: Since c-ABL phosphorylation (Y306) inhibits RTCB, c-ABL inhibitors (e.g., Imatinib, Nilotinib) might enhance XBP1 splicing and provide neuroprotection in Parkinson's or PCH models. This is already being explored in Parkinson's clinical trials.25
• PTP1B Activators: Enhancing PTP1B activity would dephosphorylate and activate RTCB, boosting the adaptive UPR.51

8.2 Gene Therapy

• Bypassing the Block: In disorders where the primary defect is the failure to produce XBP1s (e.g., RTCB deficiency), delivering a gene encoding the pre-spliced XBP1s (active form) could bypass the need for the ligase. This has shown efficacy in CMT1B mice.48
• Enzyme Replacement: For CLP1 or TSEN disorders, re-introducing the wild-type gene via AAV vectors is a logical approach, though the precise stoichiometry of the complex (especially for TSEN) poses a challenge.20

8.3 Diagnostic Challenges

The overlapping phenotypes of these disorders (microcephaly, spasticity, developmental delay) often lead to diagnostic odysseys.

• Recommendation: Clinical Whole Exome Sequencing (WES) for neurodevelopmental disorders should specifically scrutinize the "tRNA-LC module" (RTCB, ZBTB8OS, DDX1, FAM98B, CGI-99) alongside the known PCH genes (TSEN, CLP1, RARS2).
• Biomarkers: The accumulation of specific tRNA halves (tRFs) or the absence of XBP1s in patient-derived fibroblasts or PBMCs could serve as functional biomarkers for these conditions.1

9. Conclusion

The distinction between RNA metabolism and protein homeostasis is biological artifice. The cell utilizes a shared, high-efficiency machinery—centered on the RTCB ligase complex—to manage both the supply of translational adaptors (tRNA splicing) and the capacity of the folding environment (XBP1 splicing).

The human disorders arising from this axis—Pontocerebellar Hypoplasias (types 2, 4, 5, 6, 10), RTCB deficiency syndrome, Archease-linked Parkinsonism, and CMT1B—are fundamentally diseases of inter-system failure. A defect in one component initiates a cascade where translational stalling (due to tRNA defects) generates proteotoxic stress, while the machinery required to resolve that stress (XBP1/UPR) is simultaneously disabled or overwhelmed. This "double hit" mechanism explains the profound neurotoxicity observed in these conditions.

Recognizing these disorders as a unified entity—"XBP1/tRNA-linked Proteostasis Disorders"—provides a powerful framework for understanding their pathogenesis. It shifts the focus from isolated gene defects to system-wide failures, opening new avenues for therapies that target the intersection of RNA processing and cellular stress responses. The future of treating these devastating conditions lies in restoring the delicate balance of this convergent machinery.

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38. Insights into the structure and function of the RNA ligase RtcB – PMC – PubMed Central, 访问时间为 十一月 25, 2025， https://pmc.ncbi.nlm.nih.gov/articles/PMC10630183/
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42. Investigating variant and expression of CVD genes associated phenotypes among high-risk Heart Failure patients – bioRxiv, 访问时间为 十一月 25, 2025， https://www.biorxiv.org/content/10.1101/2023.01.24.525457v1.full.pdf
43. Functional mutation, splice, distribution, and divergence analysis of impactful genes associated with heart failure and other cardiovascular diseases – NIH, 访问时间为 十一月 25, 2025， https://pmc.ncbi.nlm.nih.gov/articles/PMC10556087/
44. Identification of Novel Fusion Transcripts in High Grade Serous Ovarian Cancer – MDPI, 访问时间为 十一月 25, 2025， https://www.mdpi.com/1422-0067/22/9/4791
45. Human LINE-1 retrotransposons: impacts on the genome and regulation by host factors, 访问时间为 十一月 25, 2025， https://www.jstage.jst.go.jp/article/ggs/98/3/98_22-00038/_html/-char/en
46. An Automatized Workflow to Study Mechanistic Indicators for Driver Gene Prediction with Moonlight – bioRxiv, 访问时间为 十一月 25, 2025， https://www.biorxiv.org/content/10.1101/2022.11.18.517066v1.full.pdf
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