Survivin an Important Determinant for Prognosis in Adult T-cell Leukemia: A Novel Biomarker in Practical Hemato-oncology

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Abstract
Survivin is a 16.5-kDa protein that belongs to the inhibitor of apoptosis (IAP) family. It is expressed at high levels in the G 2 /M phase and is rapidly down-regulated after cell-cycle arrest. It was suggested that survivin plays a pivotal role in linking cell death and cell proliferation. Although present during fetal development, survivin disappears in terminally differentiated adult tissues. Its expression is aberrantly enhanced in transformed cell lines, and in all the most common human cancers. Adult T-cell leukemia (ATL), which is abundant with Fas (Apo-1/CD95), has the characteristic feature of high tumor burden, suggesting that ATL cells probably prolong their lives as a result of escape from apoptosis. Survivin is prominently and consistently expressed in all cases of ATL and ATL cell lines. Its mRNA expression levels among the subtypes of ATL and ATL cell lines are characteristic and informative, low in chronic type, low to high in acute type and extremely high in ATL cell lines. In addition, when the survivin mRNA expression is higher, the survival of the patient is shorter. Its overexpression may account for a growth advantage in vivo and subsequently the malignant behavior of ATL. So quantification of survivin mRNA is important for clinical laboratory examinations. Among all of the current clinical tests for survivin mRNA quantification, the real time PCR is desirable. Despite some technological problems of standardization, quantification of survivin mRNA was shown to be a biological marker for clinical stages or minimal residual disease (MRD).