E23K, a common polymorphism in the pore-forming subunit K IR 6.2 of pancreatic -cell ATP-sensitive K ؉ (K ATP ) channels, is functionally relevant and thus might play a major role in the pathophysiology of common type 2 diabetes. In this study, we show that in the simultaneous presence of activatory and inhibitory nucleotides, the polymorphism exerts opposite effects on the potencies of these modulators: channel opening through nucleoside diphosphates is facilitated, whereas sensitivity toward inhibition through ATP is slightly decreased. The results support the conclusion that E23K predisposes to type 2 diabetes by changing the channel's response to physiological variation of cytosolic nucleotides, resulting in K ATP overactivity and discrete inhibition of insulin release. T ype 2 diabetes is generally perceived as a polygenic disorder, with disease development being influenced by both hereditary and environmental factors (1). Genes encoding for key components of insulin secretion and glucose metabolism pathways have been widely considered as targets for defects in type 2 diabetes (2). One of these key proteins is the ATPsensitive K ϩ channel (K ATP channel) in pancreatic -cells. This channel critically controls insulin secretion by coupling metabolism to electrical activity (3). The -cell channel is assembled with a tetradimeric stoichiometry from two structurally distinct subunits: the inwardly rectifying potassium channel subunit (K IR 6.2), which forms the pore, and the regulatory sulfonylurea receptor subunit 1 (SUR1) (4,5). While hypoglycemic sulfonylureas (e.g., glibenclamide) exert their effects on channel activity by interacting with SUR1, there is strong evidence that the receptor site for inhibitory ATP is located on K IR 6.2.E23K (substitution of a lysine [K] for a glutamic acid [E] in position 23) is one of three common missense single nucleotide polymorphisms (SNPs) that have been observed in K IR 6.2 (E23K, L270V, I337V) (6 -10). Recently, we presented evidence that this polymorphism predisposes to type 2 diabetes by inducing overactivity of K ATP channels in the pancreatic -cell (11). In particular, E23K markedly affects channel gating, significantly reducing the time spent in long interburst closed states and thereby producing an evident increase of spontaneous open probability (P O ). Consistent with the idea that nucleotide-induced channel inhibition results from interaction with the interburst closed states (12,13), sensitivity toward inhibitory ATP 4Ϫ was found to be decreased (11).In intact cells, however, other factors besides inhibitory ATP contribute to regulation of channel activity, with ADP presumably representing the most important of these additional parameters (14). ADP has at least three distinct effects on channel activity: 1) Free ADP 3Ϫ inhibits channel activity in isolated patches with a potency slightly lower than that of ATP 4Ϫ (half-maximal inhibitory concentration value [IC 50 ] 49 vs. 8.9 mol/l, respectively) (11,15). 2) The Mg 2ϩ complex of ADP (MgADP) per se poten...