Edited by Norma M. AllewellNeuroendocrine-type ATP-sensitive K ؉ (K ATP ) channels are metabolite sensors coupling membrane potential with metabolism, thereby linking insulin secretion to plasma glucose levels. They are octameric complexes, (SUR1/Kir6.2) 4 , comprising sulfonylurea receptor 1 (SUR1 or ABCC8) and a K ؉ -selective inward rectifier (Kir6.2 or KCNJ11). Interactions between nucleotide-, agonist-, and antagonist-binding sites affect channel activity allosterically. Although it is hypothesized that opening these channels requires SUR1-mediated MgATP hydrolysis, we show here that ATP binding to SUR1, without hydrolysis, opens channels when nucleotide antagonism on Kir6.2 is minimized and SUR1 mutants with increased ATP affinities are used. We found that ATP binding is sufficient to switch SUR1 alone between inward-or outward-facing conformations with low or high dissociation constant, K D , values for the conformation-sensitive channel antagonist [ 3 H]glibenclamide ([ 3 H]GBM), indicating that ATP can act as a pure agonist. Assembly with Kir6.2 reduced SUR1's K D for [ 3 H]GBM.ThisreductionrequiredtheKirNterminus(KNtp), consistent with KNtp occupying a "transport cavity," thus positioning it to link ATP-induced SUR1 conformational changes to channel gating. Moreover, ATP/GBM site coupling was constrained in WT SUR1/WT Kir6.2 channels; ATP-bound channels had a lower K D for [ 3 H]GBM than ATP-bound SUR1. This constraint was largely eliminated by the Q1179R neonatal diabetes-associated mutation in helix 15, suggesting that a "swapped" helix pair, 15 and 16, is part of a structural pathway connecting the ATP/GBM sites. Our results suggest that ATP binding to SUR1 biases K ATP channels toward open states, consistent with SUR1 variants with lower K D values causing neonatal diabetes, whereas increased K D values cause congenital hyperinsulinism.Neuroendocrine-type ATP-sensitive K ϩ (K ATP ) 2 channels comprise an ATP-binding cassette (ABC) protein (1), ABCC8/ SUR1, and a K ϩ -selective inward rectifier (2), KCNJ11/Kir6.2, assembled as heterooctamers (3-5), (SUR1/Kir6.2) 4 . In pancreatic -cells, these channels are metabolite sensors that couple cellular metabolism with membrane electrical activity to link insulin secretion with blood glucose levels. This coupling is critical for normal physiology; loss of channel function is a cause of congenital hyperinsulinism (Ref. 6; for reviews, see Refs. 7 and 8), whereas gain-of-function mutations in Kir6.2 (9) and SUR1 (10) cause neonatal diabetes (ND) (for reviews, see Refs. 11 and 12). Gain of function is one cause of mature-onset diabetes of the young (13), whereas a ABCC8/SUR1 polymorphism, the Ala amino acid allele at p.A1369S, is associated with an increased risk for type 2 diabetes (14).Channel activity is regulated positively by ATP and ADP binding to SUR1 and negatively by nucleotide binding to . Additionally, multiple metabolites, including phosphoinositides (21-23) and long-chain acyl-CoA esters (24 -26), and phosphorylation (27-29) positively modulate ch...