Edited by Karin Musier-Forsyth Perfectly accurate translation of mRNA into protein is not a prerequisite for life. Resulting from errors in protein synthesis, mistranslation occurs in all cells, including human cells. The human genome encodes >600 tRNA genes, providing both the raw material for genetic variation and a buffer to ensure that resulting translation errors occur at tolerable levels. On the basis of data from the 1000 Genomes Project, we highlight the unanticipated prevalence of mistranslating tRNA variants in the human population and review studies on synthetic and natural tRNA mutations that cause mistranslation or de-regulate protein synthesis. Although mitochondrial tRNA variants are well known to drive human diseases, including developmental disorders, few studies have revealed a role for human cytoplasmic tRNA mutants in disease. In the context of the unexpectedly large number of tRNA variants in the human population, the emerging literature suggests that human diseases may be affected by natural tRNA variants that cause mistranslation or de-regulate tRNA expression and nucleotide modification. This review highlights examples relevant to genetic disorders, cancer, and neurodegeneration in which cytoplasmic tRNA variants directly cause or exacerbate disease and disease-linked phenotypes in cells, animal models, and humans. In the near future, tRNAs may be recognized as useful genetic markers to predict the onset or severity of human disease. This work was supported in part by Natural Sciences and Engineering Research Council of Canada Grants RGPIN 04282-2014 (to P. O.), 530175-2018 (to P. O.), and RGPIN-2015-04394 (to C. J. B.); Canada Foundation for Innovation Grant 229917 (to P. O.); the Ontario Research Fund 229917 (to P. O.); Canada Research Chairs 950-229917 (to P. O.); and the Ontario Centres of Excellence Grant 28922 (to P. O.). This is the first article in the "tRNAs and aminoacyl-tRNA synthetases in human disease" JBC Reviews series. The authors declare that they have no conflicts of interest with the contents of this article. This article contains Tables S1 and S2 and supporting Refs. 1-8. 1 Recipient of a Postgraduate Studies Doctoral Scholarship and supported by the Natural Sciences and Engineering Research Council of Canada. 2 Recipient of a(Canada Graduate Scholarship and supported by the Natural Sciences and Engineering Research Council of Canada and by generous donations from Graham Wright and James Robertson.