Mitochondrial ATP-sensitive K + (mitoK ATP ) and Ca 2+ -activated K + (mitoK Ca ) channels exist in cardiac myocytes, and they play key roles in cardioprotection. We have recently reported that K + influx through mitoK ATP or mitoK Ca channels occurs independently of each other and confers cardioprotection in a similar manner. Activation of mitoK ATP channel is augmented by protein kinase C (PKC), whereas mitoK Ca channel is activated by protein kinase A (PKA). However, phosphatidylinositol 3-kinase (PI3-K) is linked to neither mitoK ATP nor mitoK Ca channels. We have demonstrated that bioactive substances modulate the opening of mitoK ATP channels via a PKC-dependent pathway or opening of mitoK Ca channels via a PKA-dependent pathway and thereby protecting the heart from ischemia/reperfusion injury. Several endogenous substances such as adenosine and bradykinin can reduce infarct size by activation of mitoK ATP channels in a PKC-dependent manner. Adrenomedullin, a potent vasodilator peptide, potentiates the opening of mitoK Ca channels by PKA activation. Treatment with adrenomedullin prior to ischemia results in the reduction of infarct size via a PKA-mediated activation of mitoK Ca channels. Thus, some endogenous substances confer cardioprotection via PKA-or PKC-mediated activation of mitoK ATP or mitoK Ca channels.