Assessment of survivin mRNA expression level and its serum level in patients with diabetic retinopathy

Diabetic patients may suffer from diabetic retinopathy (DR) which may result in vision loss. Apoptosis is essential in vascular remodeling. Survivin inhibits endothelial cell apoptosis and enhances angiogenesis. Diabetic vasculopathy can increase survivin expression. Our aim is to measure the clinical significance of survivin mRNA expression and its serum level with DR as predictors for disease prognosis. Thirty patients with DR; thirty without DR and thirty healthy persons were included as controls (employees and attendants for checkup with normal HA1c level). Ophthalmic examination, best corrected visual acuity assessment (BCVA), slit-lamp biomicroscopy, and fundoscopy, were done for all patients. DR was diagnosed by biomicroscopic fundus examination. Serum survivin level was estimated by enzyme linked immunosorbent assay (ELISA) technique and survivin messenger ribonucleic acid (mRNA) expression by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) as potential biomarkers of DR. Serum survivin was significantly increased in DR patients than those without DR (p < 0.01). Serum survivin and its mRNA expression correlated significantly and positively with HbA1c in DM patients (r = 0.808 and 0.618, p < 0.001). Serum survivin has an AUC of 0.985 (95% CI: 0.955 - 1.000, p < 0.001) with a sensitivity of 96.67% and specificity of 93.33% at a cutoff value of >360 pg/mL. For survivin mRNA expression, the AUC was 0.907 (95% CI: 0.820 - 0.995, p < 0.001) with a sensitivity of 86.67 % and specificity of 83.33 % at a cutoff value of >1.7. In conclusion, survivin mRNA expression and its serum level are elevated in patients with DR than those without DR. They showed strong positive correlation with HbA1c level. Both survivin mRNA expression and its serum level might have a marked role in the diagnosis of DR.