Topoisomerase II is an essential enzyme that is targeted by a number of clinically valuable anticancer drugs. One class referred to as topoisomerase II poisons works by increasing the cellular level of topoisomerase II-mediated DNA breaks, resulting in apoptosis. Another class of topoisomerase II-directed drugs, the bis-dioxopiperazines, stabilizes the conformation of the enzyme where it attains an inactive salt-stable closed clamp structure. Bis-dioxopiperazines, similar to topoisomerase II poisons, induce cell killing, but the underlying mechanism is presently unclear. In this study, we use three different biochemically well characterized human topoisomerase II␣ mutant enzymes to dissect the catalytic requirements needed for the enzyme to cause dominant sensitivity in yeast to the bis-dioxopirazine ICRF-193 and the topoisomerase II poison m-AMSA. We find that the clamp-closing activity, the DNA cleavage activity, and even both activities together are insufficient for topoisomerase II to cause dominant sensitivity to ICRF-193 in yeast. Rather, the strand passage event per se is an absolute requirement, most probably because this involves a simultaneous interaction of the enzyme with two DNA segments. Furthermore, we show that the ability of human topoisomerase II␣ to cause dominant sensitivity to m-AMSA in yeast does not depend on clamp closure or strand passage but is directly related to the capability of the enzyme to respond to m-AMSA with increased DNA cleavage complex formation.DNA topoisomerase II is an abundant enzyme able to regulate DNA topology by making transient double strand breaks in the DNA helix. It fulfills an essential function in chromosome segregation (1) and is moreover the primary target for many cancer chemotherapeutics and antibiotics. The dimeric topoisomerase II mediates topological changes in DNA by introducing a transient gate in one DNA duplex, the G-segment, whereas another duplex, the T-segment, is transported coordinately through the gated DNA. The topoisomerase II-mediated DNA cleavage reaction involves a transesterification between a pair of phosphodiester bonds in the DNA backbone and the phenolic oxygens from the active site tyrosine of each monomer identified as Tyr-805 in human topoisomerase II␣ (2). Besides DNA cleavage, a change in DNA topology catalyzed by topoisomerase II also requires a strand passage step. This is initiated by the closure of an ATP-operated clamp composed of the N-terminal region from each subunit. Upon clamp closure, the T-segment is trapped and transported concomitantly through the cleaved G-segment (3-6). The subsequent ligation of the G-segment fulfills the topoisomerase II-mediated topological change in DNA, leaving the DNA strands intact.One class of chemotherapeutic agents targeting topoisomerase II, the topoisomerase II poisons, are believed to act primarily by enhancing the concentration of topoisomerase II-mediated double strand breaks in cellular DNA. In this way, the topoisomerase becomes a cellular toxin that eventually will trigger apopt...