Equilin and equilenin, components of the hormone replacement therapy drug Premarin, can be metabolized to the catechol 4-hydroxyequilenin (4-OHEN). The quinoids produced by 4-OHEN oxidation react with dC, dA and dG to form unusual stable cyclic adducts, which have been found in human breast tumor tissue. Four stereoisomeric adducts have been identified for each base. These twelve Premarin-derived adducts provide a unique opportunity for analyzing effects of stereochemistry and base damage on DNA structure, and consequently its function. Our computational studies have shown that these adducts, with obstructed Watson-Crick hydrogen bond edges and near-perpendicular ring systems, have limited conformational flexibility, and near-mirror image conformations in stereoisomer pairs. The dC and dA adducts can adopt major and minor groove positions in the double helix, but the dG adducts are positioned only in the major groove. In all cases, opposite orientations of the equilenin rings with respect to the 5'→3' direction of the damaged strand are found in stereoisomer pairs derived from the same base, and no Watson-Crick pairing is possible. However, detailed structural properties in DNA duplexes are distinct for each stereoisomer of each damaged base. These differences may underlie observed differential stereoisomer and basedependent mutagenicities and repair susceptibilities of these adducts.The hormone replacement drug Premarin, whose use has been shown to increase breast cancer risk (1-6), contains the equine estrogens equilin and equilenin ( Figure 1). This pair of substances can be metabolized to highly reactive 4-OHEN quinoids that can form unusual stable cyclic adducts with dC, dA and dG (7-9). There are four different stereoisomers for each base adduct (9-11), for a total of twelve distinct lesions (Figure 1). The structural properties of this set of twelve DNA adducts present a fascinating opportunity for elucidating how the stereochemical features and the nature of the damaged base differentially distort and destabilize the local structure of double-stranded DNA molecules around the lesion sites. Such differences *Corresponding author: Suse Broyde, tel. (212)998-8231, fax (212)995-4015, email broyde@nyu.edu. Supporting Information Available: Details of the molecular dynamics protocol of 4-OHEN-G adducts in duplexes are provided. Table S1 gives glycosidic torsion χ values of the modified guanine, box sizes and numbers of waters in the MD simulation starting models. Table S2 gives added force field parameters for the modified guanine. Table S3 gives AMBER atom type, connection type, and partial charge assignments for the 4-OHEN-G adducts. Table S4 gives MM-PBSA free energy components of the lowest free energy conformation for each 4-OHEN-G stereoisomer modified duplexes. Table S5 gives solvent accessible surfaces of the equilenin rings of 4-OHEN adducts in 11mer duplexes. Table S6 gives hydrogen bonds and occupancies at the lesion sites of 4-OHEN-G modified duplexes. Table S7 gives van der Waals interact...