Double-strand breaks (DSBs) arise endogenously during normal cellular processes and exogenously by genotoxic agents such as ionizing radiation (IR). DSBs are one of the most severe types of DNA damage, which if left unrepaired are lethal to the cell. Several different DNA repair pathways combat DSBs, with nonhomologous endjoining (NHEJ) being one of the most important in mammalian cells. Competent NHEJ catalyses repair of DSBs by joining together and ligating two free DNA ends of little homology (microhomology) or DNA ends of no homology. The core components of mammalian NHEJ are the catalytic subunit of DNA protein kinase (DNA-PK cs ), Ku subunits Ku70 and Ku80, Artemis, XRCC4 and DNA ligase IV. DNA-PK is a nuclear serine/threonine protein kinase that comprises a catalytic subunit (DNA-PK cs ), with the Ku subunits acting as the regulatory element. It has been proposed that DNA-PK is a molecular sensor for DNA damage that enhances the signal via phosphorylation of many downstream targets. The crucial role of DNA-PK in the repair of DSBs is highlighted by the hypersensitivity of DNA-PK À/À mice to IR and the high levels of unrepaired DSBs after genotoxic insult. Recently, DNA-PK has emerged as a suitable genetic target for molecular therapeutics such as siRNA, antisense and novel inhibitory small molecules. This review encompasses the recent literature regarding the role of DNA-PK in the protection of genomic stability and focuses on how this knowledge has aided the development of specific DNA-PK inhibitors, via both small molecule and directed molecular targeting techniques. This review promotes the inhibition of DNA-PK as a valid approach to enhance the tumor-cell-killing effects of treatments such as IR. The double-strand break (DSB) is generally regarded as the most lethal of all DNA lesions, which if unrepaired severely threatens not only the integrity of the genome but also survival of the organism (Hoeijmakers, 2001;van Gent et al., 2001;Vilenchik and Knudson, 2003). DSBs can arise endogenously by cellular processes such as cleavage during immunoglobulin gene rearrangement (V(D)J recombination) and meiotic recombination. DSBs are also produced by exposure to ionizing radiation (IR), radiomimetic drugs, such as bleomycin, and the collapse of replication forks when the replication machinery encounters singlestranded breaks (SSBs) (Haber, 2000;Karran, 2000;Norbury and Hickson, 2001;Bassing et al., 2002). Unrepaired DSBs can activate cell cycle checkpoint arrests and signal for cell death (Jackson, 2001;Norbury and Hickson, 2001). Possibly even more detrimental to the cell are the unrepaired or misrepaired DSBs that lead to genomic rearrangements which ultimately destabilize the genome, a phenotype observed in a large number of malignancies (Lengauer et al., 1998;Hoeijmakers, 2001;Elliott and Jasin, 2002;Thompson and Schild, 2002;Shiloh, 2003;Vilenchik and Knudson, 2003). To complicate matters further, the location of the DSBs and the structure of the damaged DNA ends can vary depending on the damaging agent....