In eukaryotes, DNA polymerase δ (Pol δ) bound to the proliferating cell nuclear antigen (PCNA) replicates the lagging strand and cooperates with flap endonuclease 1 (FEN1) to process the Okazaki fragments for their ligation. We present the high-resolution cryo-EM structure of the human processive Pol δ-DNA-PCNA complex in the absence and presence of FEN1. Pol δ is anchored to one of the three PCNA monomers through the C-terminal domain of the catalytic subunit. The catalytic core sits on top of PCNA in an open configuration while the regulatory subunits project laterally. This arrangement allows PCNA to thread and stabilize the DNA exiting the catalytic cleft and recruit FEN1 to one unoccupied monomer in a toolbelt fashion. Alternative holoenzyme conformations reveal important functional interactions that maintain PCNA orientation during synthesis. This work sheds light on the structural basis of Pol δ's activity in replicating the human genome.Three DNA polymerases (Pols), a, d and e replicate the genomic DNA in eukaryotes, with the latter two possessing the proofreading exonuclease activity required for high fidelity DNA synthesis 1,2 . Pol d replicates the lagging strand and may share a role with Pol e in replicating the leading strand [3][4][5][6][7][8][9][10] . In contrast to the continuous leading strand synthesis, the lagging strand is synthesized discontinuously in ~200 nucleotide (nt)-long Okazaki fragments, which are then ligated to form the contiguous lagging strand 2 .Synthesis of each Okazaki fragment starts with the low fidelity Pol a synthesizing a ~30 nt RNA/DNA initiator primer. Replication factor C (RFC) then loads the homotrimeric clamp PCNA at the primer/template (P/T) junction 11 . PCNA encircles the duplex DNA 3 and tethers Pol d to the DNA enhancing its processivity from few nucleotides to hundreds of nucleotides per DNA binding event [12][13][14] . PCNA has also been shown to increase the nucleotide incorporation rate of Pol d 15 . Additionally, the interaction of PCNA with Pol d is critical for coordinating its transient replacement by other PCNA partner proteins. In the maturation of Okazaki fragments, Pol d invades the previously synthesized Okazaki fragments to gradually displace the RNA-DNA primers for their removal by the PCNA-bound FEN1 16 . In translesion DNA synthesis, Pol d is transiently replaced by a PCNA-bound translesion DNA polymerase to ensure the continuation of DNA replication 17 .Mammalian Pol d consists of a catalytic subunit and three regulatory subunits ( Figure 1a). The catalytic subunit (p125) harbours the polymerase and exonuclease activities, and a metal-binding C-terminal domain (CTD). The regulatory subunits (p50, also referred to as the B-subunit, p66 and p12) are required for optimal activity of the holoenzyme 18 and there is evidence of different context-specific subassemblies of Pol d in vivo [19][20][21] . In particular, DNA damage or replication stress triggers the degradation of the p12 subunit, resulting in the formation of a three-subunit enzyme with an...