DNA interstrand cross-links (ICLs) are cytotoxic products of common anti-cancer drugs and cellular metabolic processes, whose mechanism(s) of repair remain poorly understood. In this study, we show that cross-link structure affects ICL repair in non-replicating reporter plasmids that contain a mispaired N 4 C-ethyl-N 4 C (C-C), N3T-ethyl-N3T (T-T), or N1I-ethyl-N3T (I-T) ICL. The T-T and I-T cross-links obstruct the hydrogen bond face of the base and mimic the N1G-ethyl-N3C ICL created by bis-chloroethylnitrosourea, whereas the C-C cross-link does not interfere with base pair formation. Host-cell reactivation (HCR) assays in human and hamster cells showed that repair of these ICLs primarily involves the transcription-coupled nucleotide excision repair (TC-NER) pathway. Repair of the C-C ICL was five-fold more efficient than repair of the T-T or I-T ICLs, suggesting the latter's cross-links hinder lesion bypass following initial ICL unhooking. Luciferase expression from plasmids containing a C-C crosslink remnant on either the transcribed or nontranscribed strand increased in NER-deficient cells, indicating NER involvement occurs at a step prior to remnant removal, whereas expression from similar T-T remnant plasmids was inhibited in NER-deficient cells, demonstrating NER is required for remnant removal. Sequence analysis on repaired plasmids showed a high proportion of Cs inserted at the site of the T-T and I-T cross-links and HCR assays showed that Rev1 was likely responsible for these insertions. In contrast, both Cs and Gs were inserted at the C-C cross-link site and Rev1 was not required for repair, suggesting replicative or other translesion polymerases can bypass the C-C remnant.Interstrand cross-links (ICLs) covalently link two bases on opposite strands of the DNA helix and can be formed by both endogenous and exogenous sources. ICLs are among the most cytotoxic DNA lesions to cells because they prevent the two DNA strands from separating, thereby inhibiting DNA replication and transcription. Additionally, DNA ICLs are cytotoxic products of bifunctional alkylating agents commonly used in cancer chemotherapy (1-3). If left unrepaired, ICLs signal cell death pathways. However, some cancer patients can become † This research was supported by grants from the National Cancer Institute (CA082785, CA016783, and T32CA09110), the Natural Sciences and Engineering Research Council (NSERC) of Canada, the Canada Research Chair program, and the American Heart Association (103527). *Correspondence should be addressed to Paul S. Miller, pmiller@jhsph.edu, Phone: (410)-955-3489, Fax: (410)-955-2926. Supporting Information Available: Figure S1 shows the sequences of non-damaged, cross-linked, and cross-link remnant containing duplexes used to construct the reporter plasmids. Figure S2 illustrates the structure of a N 4 C-ethyl-N 4 C interstrand cross-link placed in a -CG-sequence and characterization of a -CG-cross-linked plasmid. Figure S3 displays repair efficiencies of ICLs transfected into wild type and XRCC3-d...