Tong Y et al., EMBO Molecular Medicine - Patient data, population genetics and iPSC-derived βcell models show INS R6C impairs preproinsulin ER translocation and causes recessive insulin-deficient diabetes in homozygotes. Study Highlights: The study integrates clinical pedigrees, large-scale population screens and patient-derived iPSC βcell models, plus in vivo transplantation and transcriptomics. AlphaFold 3 structural modeling suggested weakened SRP54 interaction and altered SEC61 orientation for the R6C signal peptide, and population data showed no enrichment of diabetes among heterozygotes. In homozygous R6C iPSC-βcells up to two-thirds of nascent preproinsulin failed to translocate, preproinsulin accumulated, and insulin content and secretion were reduced by roughly 50% with altered proinsulin processing. Functionally, homozygous R6C grafts produced minimal human C-peptide in mice and responded poorly to GLP-1 receptor agonists, while heterozygotes were largely compensated by a single wild-type allele. Conclusion: INS R6C is a recessive loss-of-function mutation that causes early-onset, insulin-deficient diabetes in homozygotes while heterozygous carriers show variable or absent glycemic phenotypes. Music: Enjoy the music based on this article at the end of the episode. Reference: Tong Y, Becker M, Schierloh U, Natividade da Silva F, Haataja L, Cai Y, Patel KA, Kobaisi F, Mirshahi UL, Colclough K, Javed MS, Wakeling MN, Fantuzzi F, Lytrivi M, Sawatani T, Arroyo MN, Yi X, Vinci C, Montaser H, Pachera N, Otonkoski T, Igoillo-Esteve M, Scharfmann R, Hattersley AT, Arvan P, De Beaufort C, Cnop M. A new form of diabetes caused by INS mutations defined by zygosity, stem cell and population data. EMBO Molecular Medicine. 2026;18:620–645. https://doi.org/10.1038/s44321-025-00362-9 License: This episode is based on an open-access article published under the Creative Commons Attribution 4.0 International License (CC BY 4.0) - https://creativecommons.org/licenses/by/4.0/ Support: Base by Base – Stripe donations: https://donate.stripe.com/7sY4gz71B2sN3RWac5gEg00 Official website https://basebybase.com On PaperCast Base by Base you’ll discover the latest in genomics, functional genomics, structural genomics, and proteomics. Episode link: https://basebybase.castos.com/episodes/ins-r6c-recessive-diabetes