1--D-Arabinofuranosylcytosine (Ara-C) is a potent antineoplastic drug used in the treatment of acute leukemia. Previous biochemical studies indicated the incorporation of Ara-C into DNA reduced the catalytic activity of human topoisomerase I by decreasing the rate of single DNA strand religation by the enzyme by 2-3-fold. We present the 3.1 Å crystal structure of human topoisomerase I in covalent complex with an oligonucleotide containing Ara-C at the ؉1 position of the non-scissile DNA strand. The structure reveals that a hydrogen bond formed between the 2-hydroxyl of Ara-C and the O4 of the adjacent ؊1 base 5 to the damage site stabilizes a C3-endo pucker in the Ara-C arabinose ring. The structural distortions at the site of damage are translated across the DNA double helix to the active site of human topoisomerase I. The free sulfhydryl at the 5-end of the nicked DNA strand in this trapped covalent complex is shifted out of alignment with the 3-phosphotyrosine linkage at the catalytic tyrosine 723 residue, producing a geometry not optimal for religation. The subtle structural changes caused by the presence of Ara-C in the DNA duplex may contribute to the cytotoxicity of this leukemia drug by prolonging the lifetime of the covalent human topoisomerase I-DNA complex.Human topoisomerase I solves the DNA topological problems that arise from a wide variety of nuclear processes including replication, transcription, and recombination (1, 2). The enzyme nicks one strand of duplex DNA using a transesterification reaction that produces a transient 3Ј-phosphotyrosine linkage and guides the relaxation of either positive or negative superhelical tension by a proposed "controlled rotation" mechanism (3). The enzyme then catalyzes a second transesterification in which the free hydroxyl at the 5Ј-end of the nicked DNA strand attacks the phosphotyrosine bond, resealing the nick, and releasing a more relaxed DNA molecule. Topoisomerase I plays a vital role in maintaining DNA stability and is known to travel with active replication and transcription complexes in human cells (4,5).Human topoisomerase I is the sole target of the camptothecins (CPT), a potent class of anticancer drugs used to treat late-term solid malignancies (3,4,6). Camptothecin effectively targets the religation phase of topoisomerase I catalysis by stabilizing the covalent protein-DNA complex and trapping the enzyme on DNA (7,8). In this way, CPT converts topoisomerase I into a cellular poison. Human topoisomerase I is also affected by several forms of DNA damage, including abasic lesions, wobble base pairs, and base pair mismatches (9 -13). Such lesions can impact each stage of topoisomerase I's catalytic cycle, including DNA binding, single-strand DNA cleavage, and religation.