RPS19 is a structural component of the small ribosomal subunit (40S) essential for protein synthesis 1. It plays a critical role in pre-rRNA processing and maturation of ribosomal subunits, functioning as part of the small subunit (SSU) processome where it coordinates with ribosome biogenesis factors to enable RNA folding, modification, and cleavage 23. Beyond its canonical ribosomal function, RPS19 participates in intercellular signaling, notably through RPS19-C5AR1 axis interactions that mediate communication between stromal and tumor regions in colorectal cancer microenvironments 45. RPS19 dysfunction is particularly relevant to Diamond-Blackfan anemia (DBA), a rare congenital bone marrow failure disorder characterized by erythroid hypoplasia 6. RPS19 mutations account for approximately 25% of DBA cases and impair erythropoiesis through mechanisms including translational dysfunction and P53 activation 78. Recent therapeutic advances in gene therapy using lentiviral vectors targeting RPS19-deficient DBA have shown promise in restoring normal hematopoiesis 7, offering potential curative approaches for patients who become steroid-resistant or transfusion-dependent.