N-nitroso compounds are alkylating agents, which occur widespread in diet and environment. They induce DNA alkylation adducts such as O 6-methylguanine (O 6-MeG), which is repaired by O 6-methylguanine-DNA methyltransferase (MGMT). Persistent O 6-MeG lesions have detrimental biological consequences like mutagenicity and cytotoxicity. Due to its pivotal role in the etiology of cancer and in cytotoxic cancer therapy, it is important to detect and quantify O 6-MeG in biological specimens in a sensitive and accurate manner. Here, we used immunological approaches and established an ultra-performance liquid chromatographytandem mass spectrometry (UPLC-MS/MS) to monitor O 6-MeG adducts. First, colorectal cancer (CRC) cells were treated with the methylating anticancer drug temozolomide (TMZ). Immunofluorescence microscopy and an immuno-slot blot assay, both based on an adductspecific antibody, allowed for the semi-quantitative, dose-dependent assessment of O 6-MeG in CRC cells. Using the highly sensitive and specific UPLC-MS/MS, TMZ-induced O 6-MeG adducts were quantified in CRC cells and even in peripheral blood mononuclear cells exposed to clinically relevant TMZ doses. Furthermore, all methodologies were used to detect O 6-MeG in wildtype (WT) and MGMT-deficient mice challenged with the carcinogen azoxymethane. UPLC-MS/MS measurements and dose-response modeling revealed a nonlinear formation of hepatic and colonic O 6-MeG adducts in WT, whereas linear O 6-MeG formation without a threshold was observed in MGMT-deficient mice. Collectively, the UPLC-MS/MS analysis is highly sensitive and specific for O 6-MeG, thereby allowing for the first time for the determination of thresholds upon exposure to O 6-methylating agents. We envision that this method will be instrumental to monitor the efficacy of methylating chemotherapy and to assess dietary exposures. MATERIAL AND METHODS Material All solutions were made with deionized water (18.2 MΩ resistivity). O 6-methyl-d3-guanine (O 6-Me-d3-G) was from Toronto Research Chemicals (Toronto, Canada). O 6-MeG, ammonium hydroxide (ACS Reagent 28-30 %), hydrochloric acid (ACS Reagent 37 %), and acetic acid (HPLC grade) were purchased from Sigma-Aldrich (Buchs, Switzerland). Guanine was obtained from Acros Organics (New Jersey, USA) and Strata-X polymeric columns (30 μm) were from Phenomenex (Torrance, USA). Methanol (HPLC Gradient Grade) was bought at VWR (Dietikon, Switzerland).