Survivin (BIRC5) is an acknowledged
cancer therapy-resistance factor and overexpressed in
head and neck squamous cell carcinomas (
HNSCC). Driven by its
nuclear export signal (NES),
Survivin shuttles between the nucleus and the cytoplasm, and is detectable in both cellular compartments in
tumor biopsies. Although predominantly nuclear
Survivin is considered a favorable prognostic disease marker for
HNSCC patients, the underlying molecular mechanisms are not resolved. Hence, we performed immunohistochemical and mutational analyses using
laser capture microdissection on
HNSCC biopsies from patients displaying high levels of nuclear
Survivin. We found somatic BIRC5 mutations, c.278T>C (p.Phe93Ser), c.292C>T (p.Leu98Phe), and c.288A>G (silent), in
tumor cells, but not in corresponding normal tissues. Comprehensive functional characterization of the
Survivin mutants by ectopic expression and microinjection experiments revealed that p.Phe93Ser, but not p.Leu98Phe inactivated
Survivin's NES, resulted in a predominantly
nuclear protein, and attenuated
Survivin's dual cytoprotective activity against chemoradiation-induced apoptosis. Notably, in
xenotransplantation studies,
HNSCC cells containing the p.Phe93Ser mutation responded significantly better to
cisplatin-based
chemotherapy. Collectively, our results underline the disease relevance of
Survivin's nucleocytoplasmic transport, and provide first evidence that genetic inactivation of
Survivin's NES may account for predominantly nuclear
Survivin and increased
therapy response in
cancer patients.