The product of the HDMX (or MDM4) gene is structurally related to the MDM2 oncoprotein and is also capable of interacting with the tumor suppressor protein p53. The aim of our study was to determine the amplification status of the HDMX gene and the expression of the HDMX mRNA (particularly that of the HDMX-S splice variant) in soft-tissue sarcomas (STS). Patients with STS were evaluated for the status of HDMX gene amplification (n 5 66) and HDMX-S mRNA expression (n 5 57) within their tumors. DNA, total RNA and protein were isolated from frozen tumor tissue. We determined that the HDMX-S splice variant transcript was predominant in a subset (14%) of tumor samples and that its expression was correlated with decreased patient survival (15 vs. 53 months, p < 0.0001, log-rank test) and with a 17-fold increased risk of a tumor-related death (p < 0.0001, multivariate Cox's regression model). The tumors from these patients also expressed elevated levels of HDMX-S protein. The HDMX gene was amplified in 17% of STSs, and the gene amplification was associated with poor prognosis (RR 5 6.5, p < 0.0001). There was no correlation between the HDMX gene amplification and overexpression of the HDMX-S splice variant. In summary, our data indicate that both the overexpression of the HDMX-S transcript as well as HDMX gene amplification are important prognostic markers for STS. ' 2005 Wiley-Liss, Inc.Key words: HDMX; amplification; overexpression; oncogene; prognosis; alternative splicing; cancer Recently, a protein related to the product of the murine double minute gene 2 (MDM2), designated as HDMX, has been identified, and the HDMX gene was mapped to chromosome region 1q32. 1,2 It has been shown that HDMX (also referred to as MDM4 or MDMX in the mouse) is able to bind to p53, thereby inhibiting its activity. However, it fails to induce the nuclear export of p53 or its proteosomal degradation. 3 Although HDMX bears resemblance to MDM2, it has some distinct features. For example, whereas expression of MDM2 can be induced by DNA damaging agents, HDMX levels are not. 1 This suggests that the HDMX promoter, unlike the P2-promoter of the MDM2 gene, is not transcriptionally transactivated by p53. Data from gene knockout experiments indicate that embryonic lethality of both MDMX 2/2 and MDM2 2/2 mice can be rescued by the loss of p53. 4,5 Therefore, it seems likely that MDM2 and MDMX act in nonoverlapping pathways to regulate p53. 5 However, data also show that HDMX actively regulates p53 activity through its interaction with MDM2, 6 suggesting that HDMX/MDMX is another important regulator of the p53-MDM2 network (reviewed in Michael and Oren 7 ). These data raise the possibility that increased levels of HDMX result in the inactivation of p53 that may contribute to tumor development. In fact, several studies have revealed that the HDMX gene is a target of amplification at the 1q32 gene locus in malignant gliomas that have no p53 mutations or MDM2 amplification. 8,9 In addition, the HDMX gene has been shown to be amplified in breast canc...