Gain-of-function mutations in the genes encoding the ATPsensitive potassium (K ATP) channel subunits Kir6.2 (KCNJ11) and SUR1 (ABCC8) are a common cause of neonatal diabetes mellitus. Here we investigate the molecular mechanism by which two heterozygous mutations in the second nucleotide-binding domain (NBD2) of SUR1 (R1380L and R1380C) separately cause neonatal diabetes. SUR1 is a channel regulator that modulates the gating of the pore formed by Kir6.2. K ATP channel activity is inhibited by ATP binding to Kir6.2 but is stimulated by MgADP binding, or by MgATP binding and hydrolysis, at the NBDs of SUR1. Functional analysis of purified NBD2 showed that each mutation enhances MgATP hydrolysis by purified isolated fusion proteins of maltose-binding protein and NBD2. Inhibition of ATP hydrolysis by MgADP was unaffected by mutation of R1380, but inhibition by beryllium fluoride (which traps the ATPase cycle in the prehydrolytic state) was reduced. MgADP-dependent activation of K ATP channel activity was unaffected. These data suggest that the R1380L and R1380C mutations enhance the off-rate of P i, thereby enhancing the hydrolytic rate. Molecular modeling studies supported this idea. Because mutant channels were inhibited less strongly by MgATP, this would increase K ATP currents in pancreatic beta cells, thus reducing insulin secretion and producing diabetes.SUR1 ͉ KATP channel ͉ ATP hydrolysis ͉ sulfonylurea receptor A ctivating mutations in the ABCC8 and KCNJ11 genes are a common cause of neonatal diabetes (1-3). ABCC8 encodes the regulatory subunit of the ATP-sensitive potassium (K ATP ) channel. It coassembles with pore-forming Kir6.2 (KCNJ11) subunits to form an octameric channel, with a central tetrameric Kir6.2 pore being surrounded by four SUR1 subunits (4). Both Kir6.2 and SUR1 serve as metabolic sensors, enabling the K ATP channel to respond to changes in cellular metabolism. In addition, SUR1 endows the channel with sensitivity to the antidiabetic sulfonylurea drugs.In pancreatic beta cells, metabolic regulation of K ATP channels is crucial for glucose-stimulated insulin secretion (Fig. 1A) (3). In unstimulated cells, K ATP channels are open and hyperpolarize the membrane enough to keep voltage-gated Ca 2ϩ channels closed. When the plasma glucose concentration rises, glucose uptake and metabolism by the beta cell are enhanced, leading to K ATP channel closure. This causes a membrane depolarization that triggers opening of voltage-gated Ca 2ϩ channels and Ca 2ϩ -dependent electrical activity. The consequent Ca 2ϩ influx stimulates insulin release. Metabolic regulation of K ATP channel activity is mediated by changes in the concentration of adenine nucleotides, which interact with both Kir6.2 and SUR1 subunits. Binding of ATP to Kir6.2, in a Mg-independent fashion, shuts the channel (5). In contrast, MgADP binding to SUR1 stimulates channel opening (5, 6). Although MgATP can also stimulate K ATP channel activity by interaction with SUR1 (7) it must first be hydrolyzed to MgADP (8). K ATP channel activity...