Tamoxifen, a synthetic triphenyl-ethylene compound, is a member of a class of anticancer drugs known as selective estrogen receptor modulators. It may block tumor growth by mimicking estrogen and binding to the estrogen receptors, preventing cancerous growth. Clinical studies have demonstrated that a combination chemo/hormonal therapy regimen with tamoxifen and O 6 -alkylating drugs increased the tumor response rate in cancer patients. The mechanism of action of this combined regimen remains undefined. In this study, we demonstrated that treatment of human colorectal HT-29 carcinoma cells with tamoxifen decreased the repair activity and expression level of O 6 -methylguanine DNA methyltransferase (MGMT) protein in a concentration-and timedependent manner. This inhibition was also shown in other malignant human cells, regardless of their estrogen receptor status. Furthermore, MGMT inactivation by tamoxifen was associated with a significantly increased susceptibility of cells to 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU). No alteration in MGMT mRNA levels was observed in tamoxifen-treated cells. The halflife of MGMT protein was markedly decreased in the presence of tamoxifen. Tamoxifen-induced MGMT degradation could be blocked by MG-132, a proteasome inhibitor. An increased level of ubiquitinated MGMT protein was found after tamoxifen treatment. We conclude that tamoxifen decreased the MGMT protein level by accelerating protein degradation through the ubiquitindependent proteasomal pathway. These findings provide a strong rationale for combined chemo/hormonal therapy with tamoxifen and BCNU in the treatment of human cancers. ' 2007 Wiley-Liss, Inc.Key words: tamoxifen; MGMT; ubiquitination; proteasomal pathway; BCNU Tamoxifen, a synthetic triphenyl-ethylene compound, is a member of a class of anticancer drugs known as selective estrogen receptor modulators (SERMs). It is used to treat patients with all stages of hormone-responsive breast cancer. 1 It has also been shown to prevent breast cancer in women who are at high risk for this disease, by mimicking estrogen and binding to the estrogen receptor (ER). 2 Although the primary mechanism of action of tamoxifen is believed to be through inhibition of the ER, research over the years has indicated that additional, non-ER-mediated mechanisms exist. These include modulation of signaling proteins, such as protein kinase C (PKC), 3,4 calmodulin, 3,5 transforming growth factor-b 3 and insulin-like growth factor I. 3,6 The antitumor effect of tamoxifen is thus believed to be a combination of ER-mediated and non-ER-mediated mechanisms. 5 In addition, tamoxifen has been used in the treatment of malignancies other than breast carcinomas, including hepatocellular, colorectal, ovarian, pancreatic, and renal cell carcinomas, malignant gliomas and melanomas.O 6 -methylguanine-DNA methyltransferase (MGMT), a ubiquitous DNA repair protein, is responsible for removal of alkyl adducts from the O 6 -position of guanine in a reaction that transfers the alkyl group from the DNA to an i...