This study shows whether increased intracellular cAMP level by cilostazol is directly coupled to its maxi-K channel activation in human endothelial cells. Cilostazol (1 M) increased the K ϩ currents in the human endothelial cells by activating maxi-K channels, which was abolished by iberiotoxin (100 nM), a maxi-K channel blocker. On incubation of human coronary artery endothelial cells with tumor necrosis factor-␣ (TNF-␣) (50 ng/ml), monocyte adhesion significantly increased with increased superoxide generation and expression of vascular cell adhesion molecule-1 (VCAM-1) and monocyte chemoattractant protein-1 (MCP-1) accompanied by increased degradation of inhibitory B␣ in cytoplasm and activation of nuclear factor-B p65 in nucleus. All these variables were significantly suppressed by cilostazol (10 M), which was antagonized by iberiotoxin (1 M) and (9R,10S,12S)-2,3,9,10,11,12-hexahydro-10-hydroxy-9-methyl-1-oxo-9,12-epoxy-1H-diindolo[1,2,3-fg:3Ј,2Ј,1Ј-kl]pyrrolo [3,4-l] [1,6]benzodiazocine-10-carboxylic acid hexyl ester (KT 5720) (300 nM, cAMP-dependent protein kinase inhibitor), but not by (9S,10R,12R)-2,3,9,10,11,12-hexahydro-10-methoxy-2,9-dimethyl-1-oxo-9,12-epoxy-1H-diindo-lo[1,2,3-fg:3Ј,2Ј,1Ј-kl]pyrrolo [3,4-I] [1,6]benzodiazocine-10-carboxylic acid methyl ester (KT 5823) (300 nM, cGMP-dependent protein kinase inhibitor). In the human endothelial cells transfected with siRNAtargeting maxi-K channels, cilostazol did not suppress the superoxide generation, VCAM-1 and MCP-1 expressions, and monocyte adhesion as contrasted with the wild-type cells. These findings were similarly evident with (3S)-(ϩ)-(5-chloro-2-methoxyphenyl)-1,3-dihydro-3-fluoro-6-(trifluoromethyl)-2H-indole-2-one (BMS-204352), a maxi-K channel opener, and forskolin and dibutyryl cAMP. In conclusion, increased cAMP level by cilostazol is directly coupled to its maxi-K channel opening action via protein kinase activation in human endothelial cells, thereby suppressing TNF-␣-stimulated superoxide production and expression of adhesion molecules.It is well established that potassium channel activity is the main determinant of membrane potential, and associated K ϩ efflux causes hyperpolarization, thereby leading to inhibition of voltage-gated calcium channels and promotion of vascular relaxation. Although multiple classes of potassium channels are expressed at varying densities in different vascular beds, the large conductance Ca 2ϩ -activated K ϩ (BKCa) channel is the predominant potassium channel species in most arteries (Nelson and Quayle, 1995). Specifically, increased cyclic nucleotide-linked protein kinase A and protein kinase G levels promote opening of the BKCa channels, which leads to the membrane hy- Article, publication date, and citation information can be found at