Trend AnalysisBiology & Life Sciences

Alternative Splicing in Disease: When One Gene Makes the Wrong Protein

The human genome contains ~20,000 protein-coding genes, yet the proteome comprises over 100,000 distinct proteins. Alternative splicing (AS) β€” the process by which different exon combinations are incl...

By Sean K.S. Shin
This blog summarizes research trends based on published paper abstracts. Specific numbers or findings may contain inaccuracies. For scholarly rigor, always consult the original papers cited in each post.

The Question

The human genome contains ~20,000 protein-coding genes, yet the proteome comprises over 100,000 distinct proteins. Alternative splicing (AS) β€” the process by which different exon combinations are included or excluded from mature mRNA β€” is the primary mechanism generating this diversity. Over 95% of multi-exon human genes undergo AS, and aberrant splicing has been implicated in cancer, neurodegeneration, autoimmune disease, and metabolic disorders. Can splicing be therapeutically targeted, and what has the success of nusinersen (Spinraza) for spinal muscular atrophy taught the field?

Landscape

Tao et al. (2024) in Signal Transduction and Targeted Therapy, published a landmark review of AS and RNA-binding proteins (RBPs) in health and disease. They catalogued how RBPs (SR proteins, hnRNPs, RBFOX, MBNL, NOVA families) act as trans-acting splicing regulators whose expression, localisation, or post-translational modification changes in disease states, leading to global splicing reprogramming. Their review identified >300 disease-associated splicing events across cancer, neurological, and cardiovascular diseases.

Bao et al. (2024) examined a less-studied regulatory layer: RNA secondary structure. Pre-mRNA folding can sequester splice sites, expose enhancer/silencer elements, or create binding platforms for RBPs. They reviewed how mutations that alter RNA structure (without changing primary sequence at splice sites) can cause disease by redirecting splicing β€” a mechanism invisible to conventional mutation annotation pipelines.

Liu et al. (2025) demonstrated a circular RNA (circCNOT6L) that modulates AS of SLC7A11 via the splicing factor SRSF2 in prostate cancer, conferring ferroptosis resistance and promoting metastasis. This finding connects three RNA biology frontiers: circular RNAs, alternative splicing, and ferroptosis.

Key Claims & Evidence

<
ClaimEvidenceVerdict
>95% of multi-exon genes undergo alternative splicingRNA-seq across tissues confirms near-universal AS (Tao et al. 2024)Well-established
Splicing factor dysregulation causes global splicing changes in disease>300 disease-associated splicing events catalogued (Tao et al. 2024)Supported; cancer and neurological diseases best characterised
RNA structure regulates splicing independently of sequenceStructure-altering mutations redirect splicing (Bao et al. 2024)Supported; under-recognised in clinical variant interpretation
Circular RNAs regulate splicing factor activitycircCNOT6L modulates SRSF2-mediated SLC7A11 splicing (Liu et al. 2025)Demonstrated in prostate cancer; generalisability unknown

Open Questions

  • Therapeutic splicing modulation: Antisense oligonucleotides (ASOs) can redirect splicing (nusinersen for SMA is the proof of concept). Can this approach be generalised to other diseases with identified splicing defects?
  • Splicing biomarkers: Can tissue-specific or circulating RNA splicing patterns serve as diagnostic or prognostic biomarkers?
  • Computational prediction: Current splice-site prediction tools have high false-positive rates. Can deep learning models trained on long-read RNA-seq improve accuracy?
  • Single-cell splicing: Can single-cell isoform sequencing (scISO-seq) reveal cell-type-specific splicing programmes in disease tissues?
  • Referenced Papers

    • [1] Tao, Y. et al. (2024). Alternative splicing and related RNA binding proteins in human health and disease. Signal Transduction and Targeted Therapy, 9, 26. DOI: 10.1038/s41392-024-01734-2
    • [2] Bao, N. et al. (2024). RNA structure in alternative splicing regulation: from mechanism to therapy. Acta Biochimica et Biophysica Sinica. DOI: 10.3724/abbs.2024119
    • [3] Liu, J. et al. (2025). CircCNOT6L modulates alternative splicing of SLC7A11 via SRSF2 for ferroptosis resistance. Experimental & Molecular Medicine. DOI: 10.1038/s12276-025-01540-y
    • [4] Li, Y. & Kou, S. (2025). A Ralstonia Effector Targets SR34a to Reprogram Alternative Splicing. Plants, 14(4), 534. DOI: 10.3390/plants14040534
    • [5] Huang, Y. et al. (2025). PQBP1-dependent alternative RNA splicing in diet-induced cognitive impairment. bioRxiv. DOI: 10.1101/2025.06.02.657545

    References (5)

    Tao, Y., Zhang, Q., Wang, H., Yang, X., & Mu, H. (2024). Alternative splicing and related RNA binding proteins in human health and disease. Signal Transduction and Targeted Therapy, 9(1).
    Bao, N., Wang, Z., Fu, J., Dong, H., & Jin, Y. (2025). RNA structure in alternative splicing regulation: from mechanism to therapy. Acta Biochimica et Biophysica Sinica, 57(1), 3-21.
    Liu, J., Niraj, M., Zhu, X., Guo, Y., Zhang, Z., Kadier, A., et al. (2025). CircCNOT6L modulates alternative splicing of SLC7A11 via splicing factor SRSF2 to confer ferroptosis resistance and promote metastasis in prostate cancer. Experimental & Molecular Medicine, 57(9), 2106-2120.
    Li, Y., & Kou, S. (2025). A Ralstonia solanacearum Effector Targets Splicing Factor SR34a to Reprogram Alternative Splicing and Regulate Plant Immunity. Plants, 14(4), 534.
    Huang, Y., Homma, H., Chen, X., Tanaka, H., Fujita, K., La Spada, A. R., et al. (2025). PQBP1-dependent alternative RNA splicing underlies high calorie diet-induced cognitive impairment.

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