Survivin has been implicated both in suppression of cell death and regulation of mitosis and is found in several subcellular locations such as mitochondria, cytoplasm, nucleus and the extracellular space.49 Higher circulating levels of survivin have been detected in patients with prostate and pancreatic cancer50, 51 and in patients with rheumatoid arthritis.52 The source of extracellular survivin is an intriguing but unsolved question; however, the increased expression observed in SAT from obese patients leads us to speculate about an adipose origin. The gene discussed is BIRC5; the disease is rheumatoid arthritis.