Anthracyclines (ANT) are used in the treatment of leukemia and other cancers. These drugs have been shown to intercalate between the strands of DNA. In the present study, we show that the amount of ANT intercalated into DNA can be determined by measuring the fluorescence resonance energy transfer (FRET) between Hoechst 33342 1H33342) and ANT bound to DNA. The transfer efficiency was found to depend on the amount of disposable ANT but was independent of the amount of H33342 bound to DNA over a wide range of H33342 concentrations. The method was adapted for flow cytometric measurement of FRET in whole living cells and was used to evaluate the degree of intercalation of daunorubicin (DAU) and idarubicine (IDA) into DAUsensitive and DAU-resistant leukemic cell lines. ANT intercalation into DNA was affected by factors which modify the intracytoplasmic concentration of ANT, and it was shown that the action of ANT and the resistance to ANT could not be attributed solely to the intercalative effect of the drugs. The method has advantages over previously described methods and represents a useful complementary tool in studies on the mode of action of ANT and the mechanisms of chemoresistance. Q 1992 Wiley-Kiss, Inc.Key terms: Multidrug resistance, fluorescence resonance energy transfer, Hoechst 33342, daunorubicin, idarubicin Anthracyclines (ANT) are highly active cytotoxic drugs widely used in the treatment of leukemia and other cancers. Their cytotoxic effects have been attributed variously to the production of reactive free radicals (1,221, binding to topoisomerase I1 (6,8,13) or intercalation into DNA (5,21,27). This last mechanism is thought to be responsible for the inhibition of RNA and/or DNA synthesis (3,20,21). Resistance to cytotoxic drugs or chemoresistance could, in principle, be gauged by measuring the amount of ANT intercalated into DNA, which would have considerable clinical interest. Various methods for measuring total cellular ANT have been described, such as the use of radiolabelled ANT (4,12,19), HPLC (2), or fluorimetry (8,24) on extracts of cell lysates. Studies on isolated nuclei have also been reported (6), although none of these methods are strictly representative of the conditions in the living cells. A spectrofluorometric method for estimating intercalation in living cells or DNA solutions based on fluorescence quenching of ANT has been described (32). Such methods enable calculation of binding affinity constants but are not readily applicable to heterogeneous cell populations such those in bone marrow or other clinical samples. A method of measurement in situ offers a better approach to processes occuring a t the cellular level (29). Microspectrofluorometry has been shown to be a n efficient and promising method (1 1) but needs sophisticated computer analysis to split up the complex spectra obtained on cells selected arbitrarily by the operator.We report here the measurement of ANT intercalation into DNA of living cells by flow cytometry (FCM). FCM has been employed to measure ANT fluorescence ...