The TUNEL (Terminal deoxynucleotidyl transferase dUTP nick end labeling) assay is widely used to detect DNA fragmentation associated with apoptosis. Rather than being a gene or protein whose expression is regulated, TUNEL is a methodological marker that reveals the extent of apoptosis within tumor tissues.
TUNEL positivity is highly influenced by treatment. High apoptosis after chemotherapy or radiotherapy is generally viewed as a positive indicator of treatment effectiveness, whereas high basal apoptosis in untreated tumors can sometimes be associated with high tumor turnover and aggressiveness.
Comprehensive analysis (often combining TUNEL with proliferation markers such as Ki-67) is needed for accurate prognostication.
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