The DNA mismatch repair (MMR) pathway recognizes and repairs errors in base pairing and acts to maintain genome stability. Cancers that have lost MMR function are common and comprise an important clinical subtype that is resistant to many standard of care chemotherapeutics such as cisplatin. We have identified a family of rhodium metalloinsertors that bind DNA mismatches with high specificity and are preferentially cytotoxic to MMR-deficient cells. Here, we characterize the cellular mechanism of action of the most potent and selective complex in this family, [Rh(chrysi)(phen)(PPO)]
2+(Rh-PPO). We find that Rh-PPO binding induces a lesion that triggers the DNA damage response (DDR). DDR activation results in cellcycle blockade and inhibition of DNA replication and transcription. Significantly, the lesion induced by Rh-PPO is not repaired in MMRdeficient cells, resulting in selective cytotoxicity. The Rh-PPO mechanism is reminiscent of DNA repair enzymes that displace mismatched bases, and is differentiated from other DNA-targeted chemotherapeutics such as cisplatin by its potency, cellular mechanism, and selectivity for MMR-deficient cells.cancer | DNA damage response | metalloinsertor | mismatch repair D NA mismatch repair (MMR) corrects mismatched base pairs that arise from replication errors and is involved in the recognition and processing of DNA damage induced by chemotherapeutics such as cis-diamminedichloroplatinum(II) (cisplatin) (1, 2). Loss of function of the MMR pathway is an important mechanism for mutation generation and predisposition to cancer. Lynch syndrome, an inherited condition characterized by susceptibility to develop colon cancer, results from germline inactivation of the MMR pathway (3). Somatic loss of function of the MMR pathway occurs in 10-25% of cancers of the colon, endometrium, ovary, and other tissue types (3-5). MMR-deficient cancer cells display a 100-to 1,000-fold increase in mutation rate and are resistant to many DNA-targeted chemotherapeutics (6, 7). Because of this, patients with MMR-deficient cancers do not benefit from standard of care therapy including cisplatin (8, 9). New therapies that target these patient populations are needed.We have previously described a class of octahedral rhodium(III) complexes, termed metalloinsertors, as a strategy toward the targeted therapy of MMR-deficient cancers. These compounds contain a sterically expansive 5,6-chrysenequinone diimine ligand (chrysi; Fig. 1A) that binds with high specificity to DNA mismatches, independent of sequence context (10). X-ray crystal structures demonstrate that the chrysi ligand is capable of inserting at the mismatch from the DNA minor groove; this binding mode, called metalloinsertion, maintains duplex stacking but displaces the mismatched bases into the major or minor groove (11, 12). As a consequence, metalloinsertor binding preferentially inhibits DNA synthesis and growth of cell lines that are MMR-deficient (13-15). Structureactivity relationship studies reveal that compound selectivity and cell potency...