Overexpression of N-methylpurine DNA glycosylase (MPG) has been suggested as a possible gene therapy approach to sensitize tumor cells to the cell-killing effects of temozolomide, an imidazotetrazine-class chemotherapeutic alkylating agent. In the present study, we show that both elevated MPG expression and short hairpin RNA-mediated loss of DNA polymerase  (Pol ) expression in human breast cancer cells increases cellular sensitivity to temozolomide. Resistance to temozolomide is restored by complementation of either wild-type human Pol  or human Pol  with an inactivating mutation specific to the polymerase active site yet functional for 5Ј-deoxyribosephosphate (5ЈdRP) lyase activity. These genetic and cellular studies uniquely demonstrate that overexpression of MPG causes an imbalance in base excision repair (BER), leading to an accumulation of cytotoxic 5ЈdRP lesions, and that the 5ЈdRP lyase activity of Pol  is required to restore resistance to temozolomide. These results imply that Pol -dependent 5ЈdRP lyase activity is the rate-limiting step in BER in these cells and suggests that BER is a tightly balanced pathway for the repair of alkylated bases such as N7-methylguanine and N3-methyladenine. Furthermore, we find that 5ЈdRP-mediated cell death is independent of caspase-3 activation and does not induce the formation of autophagosomes, as measured by green fluorescent protein-light chain 3 localization. The experiments presented herein suggest that it will be important to investigate whether an active BER pathway could be partially responsible for the temozolomide-mediated resistance seen in some tumors and that balanced BER protein expression and overall BER capacity may help predict sensitivity to temozolomide.Base excision repair (BER) is the predominant pathway for the repair of base damage mediated by endogenous and exogenous stressors (Lindahl and Wood, 1999;Almeida and Sobol, 2007). The repair of DNA bases damaged by alkylation is initiated in mammalian cells by N-methylpurine DNA glycosylase (MPG), also known as alkyladenine DNA glycosylase (Wood et al., 2001). The majority of repair that is initiated by MPG occurs via short-patch BER, a mechanism whereby only one nucleotide is replaced. Once the modified base is removed by MPG, the resulting abasic site is hydrolyzed by AP endonuclease (APE1) (Wood et al., 2001), catalyzing the incision of the damaged strand, leaving a 3ЈOH and a 5Ј-deoxyribose-phosphate moiety (5ЈdRP) at the margins of the repair site. DNA polymerase  (Pol ) subsequently hydrolyzes the 5ЈdRP moiety and fills the single nucleotide gap, preparing the strand for ligation by either DNA ligase I or a complex of DNA ligase III␣ and XRCC1.As with many DNA repair processes, BER functions via a series of repair complexes that assemble at the site of the DNA lesion. For the repair of DNA damaged by alkylation, MPG, APE1, Pol , and XRCC1 are essential, with little evidence of effective complementary repair capacity (Almeida and Sobol, 2007). This would suggest that inhibition...