. Mechanisms by which opening the mitochondrial ATP-sensitive K ϩ channel protects the ischemic heart. Am J Physiol Heart Circ Physiol 283: H284-H295, 2002. First published February 14, 2002 10.1152/ajpheart. 00034.2002-Diazoxide opening of the mitochondrial ATPsensitive K ϩ (mitoKATP) channel protects the heart against ischemia-reperfusion injury by unknown mechanisms. We investigated the mechanisms by which mitoKATP channel opening may act as an end effector of cardioprotection in the perfused rat heart model, in permeabilized fibers, and in rat heart mitochondria. We show that diazoxide pretreatment preserves the normal low outer membrane permeability to nucleotides and cytochrome c and that these beneficial effects are abolished by the mitoKATP channel inhibitor 5-hydroxydecanoate. We hypothesize that an open mitoK ATP channel during ischemia maintains the tight structure of the intermembrane space that is required to preserve the normal low outer membrane permeability to ADP and ATP. This hypothesis is supported by findings in mitochondria showing that small decreases in intermembrane space volume, induced by either osmotic swelling or diazoxide, increased the half-saturation constant for ADP stimulation of respiration and sharply reduced ATP hydrolysis. These effects are proposed to lead to preservation of adenine nucleotides during ischemia and efficient energy transfer upon reperfusion. mitochondria; metabolism; creatine kinase; membrane transport; cytochrome c; ischemic preconditioning THERE IS NOW GENERAL AGREEMENT that the mitochondrial ATP-sensitive K ϩ (mitoK ATP ) channel plays a pivotal role in cardioprotection against ischemia-reperfusion injury (16,17,20,21,36,64); however, little is known about the mechanism of this protection. It has been proposed that mitoK ATP channel opening triggers protection by increasing the generation of reactive oxygen species (ROS) (13, 47), and this effect has now been demonstrated by several laboratories (10,13,44,57). We proposed that the mitoK ATP channel is also an end effector of protection (16), and many studies have confirmed that the mitoK ATP channel is required to be open during the ischemic phase (11,46,58,59,64). Thus the mitoK ATP channel is both a trigger and an end effector of cardioprotection, and these two roles are temporally and mechanistically distinct.We have previously suggested that cardioprotection by mitoK ATP channel opening is due in part to volume regulation, which serves to preserve the structurefunction of the intermembrane space (IMS) and the low permeability of the outer membrane to nucleotides (31). Nucleotide transport across the outer membrane occurs primarily through the voltage-dependent anion channel (VDAC) (2, 34, 49, 50). We hypothesize that VDAC permeability to nucleotides is regulated in part by IMS volume, which in turn is regulated by K ϩ flux across the inner membrane.This study focuses on the end effector mechanisms by which an open mitoK ATP channel protects the heart during ischemia and reperfusion. We show, in sapon...