Chlorambucil (CLB) treatment is used in
chronic lymphocytic leukemia (CLL) but resistance to CLB develops in association with accelerated repair of CLB-induced DNA damage. Phosphorylated
histone H2AX (gammaH2AX) is located at
DNA double-strand break (
DSB) sites; furthermore, it recruits and retains damage-responsive
proteins. This damage can be repaired by nonhomologous DNA end-joining (NHEJ) and/or homologous recombinational repair (HR) pathways. A key component of NHEJ is the
DNA-dependent protein kinase (
DNA-PK) complex. Increased
DNA-PK activity is associated with resistance to CLB in CLL. We used the specific
DNA-PK inhibitor 2-(morpholin-4-yl)-benzo[h]chomen-4-one (
NU7026) to sensitize CLL cells to
chlorambucil. Our results indicate that in a CLL cell line (I83) and in primary CLL-lymphocytes,
chlorambucil plus
NU7026 has synergistic cytotoxic activity at nontoxic doses of
NU7026. CLB treatment results in G(2)/M phase arrest, and
NU7026 increases this CLB-induced G(2)/M arrest. Moreover, a kinetic time course demonstrates that CLB-induced
DNA-PK activity was inhibited by
NU7026, providing direct evidence of the ability of
NU7026 to inhibit
DNA-PK function. DSBs, visualized as gammaH2AX, were enhanced 24 to 48 h after CLB and further increased by CLB plus
NU7026, suggesting that the synergy of the combination is mediated by
NU7026 inhibition of
DNA-PK with subsequent inhibition of
DSB repair.