The Convergence of Bone Marrow Failure Syndromes Such as del (5q) MDS and DBA, Ribosomal Protein (RP) Haploinsufficiency, and Induction of p53. In this model, reduced RP gene dosage triggers stabilization/activation of the p53 pathway in the erythroid department, resulting in increased apoptosis and ineffective erythropoiesis/anemia. Figure adapted from McGowan KA, Li JZ, Park CY, et al. Ribosomal mutations cause p53-mediated dark skin and pleiotropic effects. Nat Genet. 2008; 40:963-70. (Figure 7)