DSB repair pathways. (A) Homologous recombination repair (HRR). After the initial sensing of the DSB by MRN and the activation of ATM, H2AX is phosphorylated, which in turn elicits a sequence of signaling events thought to ultimately cause the activation of nucleases such as Mre11 and CtIP to process the DNA ends and generate ssDNA with 3′ overhangs. ssDNA is bound by RPA, which is subsequently exchanged by Rad51 and Rad51 paralogs. This exchange is facilitated by Rad52, Rad54 and BRCA2. The Rad51-decorated DNA fiber initiates strand invasion into an intact homologous DNA molecule that leads to the formation of a Holiday junction. The DNA sequence around the DSB is copied by DNA synthesis associated with branch migration, and the process is completed by resolution of the Holiday junction. HRR is a templated repair process and is therefore error free (15–17). (B) DNA-PK-dependent nonhomologous end joining (D-NHEJ). DNA ends are recognized by Ku, which recruits, after processing by Tdp1 or PNKP, DNA-PKcs. Upon end-binding, DNA-PKcs is activated and phosphorylates itself and possibly also other proteins (like H2AX on an adjacent nucleosome). Phosphorylated DNA-PKcs is thought to be released from the DNA end, which allows the DNA ligase IV/XRCC4/XLF complex to mediate end-ligation possibly with the help of a DNA polymerase that catalyzes gap filling (19,149,150). (C) Back up pathway of nonhomologous end joining (B-NHEJ). There is evidence that cells of higher eukaryotes with defects in D-NHEJ rejoin the majority of DSBs using an alternative repair pathway that is not utilizing any of the HRR-associated activities (19). This pathway is therefore termed backup NHEJ (B-NHEJ). Although details of this pathway remain to be elucidated, there is evidence that it utilizes the PARP-1/DNA Ligase III/XRCC1 repair module known to be involved in the repair of SSB and base damages (151–155), and that its function is facilitated by the linker histone H1 (156). (D) Single strand annealing (SSA). This repair pathway shares features of HRR and NHEJ, and is best described in yeast (17). After the initial sensing of the DSBs and processing of the ends by an exonuclease, possibly the MRN complex, the generated ssDNA tails are loaded with RPA. Ends are resected until homologous regions are exposed on the two DNA strands and pairing of these regions is facilitated by Rad52. After appropriate gap filling and removal of the overhangs by the ERCC1/XPF nuclease, a ligation step restores DNA integrity. The repair pathways described in B, C and D are associated with loss (and sometimes gain) of DNA material and are by nature error prone.