The TREX1 enzyme processes DNA ends as the major 3 3 5 exonuclease activity in human cells. Mutations in the TREX1 gene are an underlying cause of the neurological brain disease Aicardi-Goutières syndrome implicating TREX1 dysfunction in an aberrant immune response. TREX1 action during apoptosis likely prevents autoimmune reaction to DNA that would otherwise persist. To understand the impact of TREX1 mutations identified in patients with Aicardi-Goutières syndrome on structure and activity we determined the x-ray crystal structure of the dimeric mouse TREX1 protein in substrate and product complexes containing single-stranded DNA and deoxyadenosine monophosphate, respectively. The structures show the specific interactions between the bound nucleotides and the residues lining the binding pocket of the 3 terminal nucleotide within the enzyme active site that account for specificity, and provide the molecular basis for understanding mutations that lead to disease. Three mutant forms of TREX1 protein identified in patients with AicardiGoutières syndrome were prepared and the measured activities show that these specific mutations reduce enzyme activity by 4 -35,000-fold. The structure also reveals an 8-amino acid polyproline II helix within the TREX1 enzyme that suggests a mechanism for interactions of this exonuclease with other protein complexes.Processing of DNA ends is an important step in many DNA metabolic pathways such as replication, repair, and recombination. The 3Ј 3 5Ј exonucleases play a critical role in correcting fragmented, modified, mispaired, or even normal nucleotides to generate 3Ј termini suitable for downstream events. The drastic consequences that result from impaired 3Ј exonuclease activities underscore the importance of these enzymes for cell survival. Proofreading of DNA synthesis by 3Ј exonucleases is one of the major determinants of mutagenesis and genome stability and cells lacking this ability show a high incidence of cancers (1-3) (for review, see Ref. 4). Cells with defects in proteins containing 3Ј exonuclease activity, such as the Werner syndrome protein, MRE11, APE1, and p53 proteins display chromosomal instability, cell cycle checkpoint defects, and sensitivity to ionizing radiation (5-9).The major 3Ј 3 5Ј exonuclease activity detected in human cell extracts is catalyzed by the TREX1 enzyme. The genes encoding the TREX1 and closely related TREX2 proteins have been identified and cloned (10, 11), and the recombinant proteins confirm the robust catalytic nature of these enzymes (12, 13). Amino acid sequence analysis reveals the TREX proteins belong to the DnaQ family of 3Ј 3 5Ј exonucleases; a structurally conserved group of exonucleases that span Archaea and bacteria to humans and includes such proteins as the exonuclease domains of Werner syndrome protein, the bacterial ⑀ subunit of DNA polymerase III (⑀ subunit), and exonuclease I (Exo I) 2 (14 -17). A hallmark of the DnaQ family exonucleases is three conserved sequence motifs known as Exo I, II, and III. These motifs contain four ...