Summary K562 leukaemia cells were selected for resistance using 0.5 tiLM etoposide (VP-16). Cloned K/VP.5 cells were 30-fold resistant to growth inhibition by VP-16 and 5-to 13-fold resistant to m-AMSA, adriamycin and mitoxantrone. K/VP.5 cells did not overexpress P-glycoprotein; VP-16 accumulation was similar to that in K562 cells. VP-16-induced DNA damage was reduced in cells and nuclei from K/VP.5 cells compared with K562 cells. Topoisomerase II protein was reduced 3-to 7-fold and topoisomerase IIa and topoisomerase IIP mRNAs were each reduced 3-fold in resistant cells. After drug removal, VP-16-induced DNA damage disappeared 1.7 times more rapidly and VP-16-induced DNA-topoisomerase II adducts dissociated 1.5 times more rapidly in K/VP.5 cells than in K562 cells. ATP (I mM) was more effective in enhancing VP-16-induced DNA damage in nuclei isolated from sensitive cells than in nuclei from resistant cells. In addition, ATP (0.3-5 mM) stimulated VP-16-induced DNA-topoisomerase II adducts to a greater extent in K562 nuclei than in K/VP.5 nuclei. Taken together, these results indicate that resistance to VP-16 in a K562 subline is associated with a quantitative reduction in topoisomerase II protein and, in addition, a distinct qualitative alteration in topoisomerase II affecting the stability of drug-induced DNA-topoisomerase II complexes.DNA topoisomerase II (topoisomerase II) is a nuclear matrix-associated DNA-binding protein responsible for transient cleavage of DNA, allowing the passage of DNA double strands through formed DNA breaks to relieve torsional stress during replication and transcription (Wang, 1985;Liu, 1989;Osheroff, 1989). Topoisomerase II also allows for separation of daughter DNA strands during mitosis and is thought to play a role in recombinational events (Wang, 1985). Topoisomerase II is a target for a number of clinically effective antineoplastic agents including m-AMSA, doxorubicin, mitoxantrone, VM-26 and VP-16 (Chen et al., 1984; Tewey et al., 1984a,b;Zwelling, 1985;Minford et al., 1986;Zhang, 1990). These drugs interfere with topoisomerase II activity by stabilising topoisomerase II/DNA binding and strand breakage, a result of blockade of the religation/ resealing reaction which follows topoisomerase 1I-mediated strand breakage (Chen et al., 1984;Nelson et al., 1984). Drug resistance associated with alterations in the level, activity and/or phosphorylation state of topoisomerase II has been reported in both murine and human malignant cell lines selected for resistance in the presence of topoisomerase II inhibitors (Glisson et al