Increased pulmonary artery endothelial cell (PAEC) endotheliumdependent nitric oxide synthase (eNOS) activity mediates perinatal pulmonary vasodilation. Compromised eNOS activity is central to the pathogenesis of persistent pulmonary hypertension of the newborn (PPHN). Voltage-derived anion channel (VDAC)-1 was recently demonstrated to bind eNOS in the systemic circulation. We hypothesized that VDAC isoforms modulate eNOS activity in the pulmonary circulation, and that decreased VDAC expression contributes to PPHN. In PAECs derived from an ovine model of PPHN: (1) there is eNOS activity, but not expression; and (2) VDAC1 and -2 proteins are decreased. Immunocytochemistry, coimmunoprecipitation, and in situ proximity ligation assays in human PAECs (hPAECs) demonstrate binding between eNOS and both VDAC1 and -2, which increased upon stimulation with NO agonists. The ability of agonists to increase the eNOS/VDAC interaction was significantly blunted in hypertensive, compared with normotensive, ovine PAECs. Depletion of VDAC2, but not VDAC1, blocked the agonist-induced increase in eNOS activity in hPAECs. Overexpression of VDAC2 in hypertensive PAECs increased eNOS activity. Binding of VDAC2 enhances eNOS activity in the pulmonary circulation, and diminished VDAC2 constrains eNOS in PAECs derived from fetal lambs with chronic intrauterine pulmonary hypertension. We speculate that decreases in VDAC2 may contribute to the limited eNOS activity that characterizes pulmonary hypertension.Keywords: pulmonary hypertension; vasodilation; fetal; protein-protein interactions At birth, the pulmonary vasculature dilates in response to ventilation, oxygenation, and an increase in shear stress (1-4). Each of these stimuli acts, to a significant degree, through an increase in endothelium-dependent nitric oxide synthase (eNOS) activity and elaboration of nitric oxide (NO) (5). NO, in turn, causes activation of pulmonary artery smooth muscle cell soluble guanylate cyclase (6) and subsequent vasodilation through activation of a calcium-sensitive K 1 channel (7). NO production from pulmonary artery endothelial cells (PAECs) is essential for the successful transition from fetal to air-breathing life (5, 8).In the absence of sufficient NO production, pulmonary vascular resistance remains elevated and blood is shunted away from the lungs, resulting in severe central hypoxemia and a syndrome called persistent pulmonary hypertension of the newborn (PPHN), a significant cause of neonatal morbidity and mortality (9).Clinical and experimental evidence demonstrates that impaired eNOS activity contributes to the pathogenesis of PPHN. However, the molecular mechanisms leading to insufficient NO production are incompletely understood. In PPHN, constrained NO production may result not only from diminished eNOS expression (10, 11), but also from modulation of eNOS activity by posttranslational modifications, protein-protein interactions, and sequestration into subcellular compartments. For example, myristoylation and palmitoylation enhance eNOS act...