Agents that target topoisomerase I are widely utilized to treat human cancer. Previous studies have indicated that both the ataxia telangiectasia mutated (ATM)/ checkpoint kinase (Chk) 2 and ATM-and Rad 3-related (ATR)/Chk1 checkpoint pathways are activated after treatment with these agents. The relative contributions of these two pathways to survival of cells after treatment with topoisomerase I poisons are currently unknown. To address this issue, we assessed the roles of ATR, Chk1, ATM, and Chk2 in cells treated with the topoisomerase I poisons camptothecin and 7-ethyl-10-hydroxycamptothecin (SN-38), the active metabolite of irinotecan. Colony forming assays demonstrated that down-regulation of ATR or Chk1 sensitized cells to SN-38 and camptothecin. In contrast, ATM and Chk2 had minimal effect of sensitivity to SN-38 or camptothecin. Additional experiments demonstrated that the Hsp90 inhibitor 17-allylamino-17-demethoxygeldanamycin, which down-regulates Chk1, also sensitized a variety of human carcinoma cell lines to SN-38. Collectively, these results show that the ATR/Chk1 pathway plays a predominant role in the response to topoisomerase I inhibitors in carcinoma cells and identify a potential approach for enhancing the efficacy of these drugs.In response to different types of DNA damage, a number of cell cycle checkpoint pathways are activated. These pathways typically involve detection of damage by one or more DNA damage sensors followed by activation of a series of kinases that regulate cellular responses, including cell cycle arrest and DNA repair (reviewed in Refs. 1 and 2).One of these pathways involves the sequential action of the kinases ATM 1 and Chk2. According to current understanding, DNA double-strand breaks and other changes in chromatin structure lead to autophosphorylation of the ATM homodimer (3), which activates ATM and facilitates phosphorylation of a number of substrates (2, 4), including Chk2. Once activated by phosphorylation on Thr 68 (5), Chk2 then phosphorylates p53, contributing to stabilization of this transcription factor and subsequent expression of the cyclin-dependent kinase inhibitor p21 (1, 2, 6). Chk2 also phosphorylates members of the Cdc25 family, contributing to inhibition (Cdc25C) or degradation (Cdc25A) of these phosphatases and preventing them from activating cyclin-dependent kinase complexes that drive cell cycle progression.A second but related cell cycle checkpoint pathway involves sequential action of the kinases ATR and Chk1. When replication forks stall, regions of single-stranded DNA are produced by continued helicase action (7). The exposed single-stranded DNA is bound by replication protein A (7-10), which facilitates the binding of the ATR-ATRIP complex to chromatin (9, 10). At the same time, the preassembled clamp-like Rad9-Hus1-Rad1 complex (the 9-1-1 complex) (11-13) is loaded onto the chromatin by a clamp loader consisting of Rad17 and the four replication factor C small subunits (14, 15). The chromatin-bound 9-1-1 complex facilitates ATR-mediated phospho...