The tumor suppressor protein p53 is stabilized and activated to induce cell cycle arrest or apoptosis in response to diverse stress, including DNA damage and oncogenic stress, thus preventing cell from genomic instability and malignant transformation (1-3). Studies over the past decade have revealed that p53 also plays a crucial role in mediating the cellular response to a newly defined stress called ribosomal stress (4), which is induced by perturbation of ribosomal biogenesis. By doing so, p53 coordinates ribosomal biogenesis (cell growth) with cell cycle progression (cell division). Ribosomal biogenesis includes coordinated synthesis of ribosomal RNA (rRNA) and ribosomal proteins (RPs), 2 rRNA processing, and the assembly of the mature ribosome subunits in the nucleolus and their transport into the cytoplasm (4, 5). Disturbing any one of the steps perturbs ribosomal biogenesis and triggers ribosomal stress (4). Because ribosomal stress is often accompanied by the disruption of nucleolar integrity, it is also referred as to nucleolar stress (6). Examples of ribosomal stress include inhibition of rRNA synthesis by treatment with a low dose of actinomycin D (Act D) (7-9) or mycophenolic acid (MPA) (10), inhibition of rRNA processing by treatment with 5-fluorouracil (5-FU) (11), genetic disruption of the RNA polymerase I transcription initiation factor TIF-IA (12), and knockdown of individual RPs (13-15) or nucleolar factors such as nucleostemin (16).Emerging evidence has established a critical role for a group of RPs, including L5, L11, L23, L26, S7, and S27 (8, 9, 17-24), in mediating p53 signaling in response to ribosomal stress. These RPs, when overexpressed or in response to ribosomal stress, bind to MDM2 and inhibit MDM2-mediated p53 ubiquitination and degradation, leading to stabilization and activation of p53. It is well known that MDM2 forms an elegant feedback regulatory loop with p53, as MDM2 is transcriptionally induced by p53 (25-27), whereas it in turn directly inhibits p53 transcriptional activity (28, 29) and mediates p53 ubiquitination and proteasomal degradation (30, 31). Interestingly, knockdown of certain RPs including L5, L11, and S7 attenuates p53 signaling after ribosomal stress (7-11, 18, 24), indicating that these RPs play a non-redundant role in ribosomal stress-induced p53 activation. Furthermore, mice with a knockin of the cancer-associated MDM2 mutant, C305F (MDM2 C305F ), which fails to bind to L5 and L11 (32), displayed a specific defect in p53 signaling in response to ribosomal stress but not DNA damage, compellingly validating the ribosomal stress-induced RPs-MDM2-p53 signaling pathway in vivo (33).Multiple RPs are required for p53 activation in response to ribosomal stress, suggesting that they may form a multi-RP-MDM2 protein complex to optimally suppress MDM2 function. Supporting this notion, L5 and L11 synergistically inhibit MDM2, leading to robust activation of p53 compared with overexpression of L5 or L11 individually (34). Additionally, many of these RPs appear to bind to ...