Survivin has multiple functions including cytoprotection, inhibition of cell death, and cell-cycle regulation, especially at the mitotic process stage, all of which favor cancer survival. Many studies on clinical specimens have shown that survivin expression is invariably upregulated in human cancers and is associated with resistance to chemotherapy or radiation therapy, and linked to poor prognosis, suggesting that cancer cells survive with survivin. It is also reported that survivin inhibition, alone or in combination with the other therapies, induces or enhances apoptosis and mitotic catastrophe in tumor cells. Moreover, certain antitumor agents can reduce survivin expression. These findings suggest that survivin may be a promising molecular target against human malignancies. O riginally identified as a member of the IAPs, survivin was discovered to play critical roles in cell division and cell survival.(1,2) Structurally, survivin contains a single BIR (baculoviral IAP repeats) domain, which is shared by other members of the IAPs, such as XIAP, c-IAP1, c-IAP2, and livin ( Fig. 1).(3) This domain contributes to its function in apoptosis inhibition. However, instead of a carboxyl terminal RING finger shared by others, survivin contains an extended carboxylterminal alpha-helical coiled-coil which is thought to be important for its interaction with microtubules, hence its roles in cell division.(2,4) Functioning simultaneously at cell division and apoptosis inhibition, survivin obviously plays a pivotal role in determining cell survival.Cells are programmed to die when their existence is no longer required during development or when irreparable damage occurs. Survivin counteracts this process, along with other IAPs. Survivin blocks apoptosis induced by various stimuli including FAS/ CD95, (5) irradiation, (6) and chemotherapeutic drugs, such as taxol (2) or staurosporine.(7) Inhibition of apoptosis is believed to be through direct binding to caspase-3 and caspase-7, preventing their activation.(5,8) Besides being a direct inhibitor for caspases, survivin can interact with Smac/DIABLO physically.(9) Survivin also provides cytoprotection to cells against caspase-independent cell death through the inhibition of the AIF pathway, which is known to induce caspase-independent DNA fragmentation. (10) Survivin shows cell-cycle-dependent expression during cell division. Together with Aurora-B kinase, survivin forms as component of the chromosome passenger complex, which plays a role in chromosome segregation and cytokinesis in cell division.(11) Increased survivin expression is observed in the G2/M phase. The increase in survivin expression is believed to protect cells against a possible default induction of apoptosis in the case of aberrant mitosis.(2) Survivin is also required for the maintenance of the spindle assembly checkpoint to allow proper microtubule alignment to ensure cell propagation. (12) Lack of survivin during cell division causes polyploidy as well as apoptosis (13) (Fig. 2). Polyploidy occurs following i...