ATP-sensitive potassium (K ATP ) channels play a key role in mediating glucose-stimulated insulin secretion by coupling metabolic signals to -cell membrane potential. Loss of K ATP channel function due to mutations in ABCC8 or KCNJ11, genes encoding the sulfonylurea receptor 1 (SUR1) or the inwardly rectifying potassium channel Kir6.2, respectively, results in congenital hyperinsulinism. Many SUR1 mutations prevent trafficking of channel proteins from the endoplasmic reticulum to the cell surface. Channel inhibitors, including sulfonylureas and carbamazepine, have been shown to correct channel trafficking defects. In the present study, we identified 13 novel SUR1 mutations that cause channel trafficking defects, the majority of which are amenable to pharmacological rescue by glibenclamide and carbamazepine. By contrast, none of the mutant channels were rescued by K ATP channel openers. Cross-linking experiments showed that K ATP channel inhibitors promoted interactions between the N terminus of Kir6.2 and SUR1, whereas channel openers did not, suggesting the inhibitors enhance intersubunit interactions to overcome channel biogenesis and trafficking defects. Functional studies of rescued mutant channels indicate that most mutants rescued to the cell surface exhibited WT-like sensitivity to ATP, MgADP, and diazoxide. In intact cells, recovery of channel function upon trafficking rescue by reversible sulfonylureas or carbamazepine was facilitated by the K ATP channel opener diazoxide. Our study expands the list of K ATP channel trafficking mutations whose function can be recovered by pharmacological ligands and provides further insight into the structural mechanism by which channel inhibitors correct channel biogenesis and trafficking defects.Protein function relies on the proper folding, assembly, and trafficking to specific cellular compartments. In the case of plasma membrane proteins, such as ion channels and receptors, they must pass quality surveillance in the endoplasmic reticulum (ER) 3 to enter the secretory pathway and ultimately reach the cell surface. Numerous diseases arise due to mutations that disrupt protein folding, assembly, and subsequent trafficking to the cell surface (1), hereafter referred to as trafficking mutations. Small molecules termed pharmacological chaperones hold promise as a means of therapy for such diseases by interacting with mutant proteins and correcting their folding and trafficking defects (2-4).Congenital hyperinsulinism (HI) is a rare, life-threatening disease characterized by persistent insulin secretion despite extreme hypoglycemia (5). The most common cause of HI is loss-of-function mutations in the ABCC8 or KCNJ11 genes encoding the sulfonylurea receptor 1 (SUR1) and inwardly rectifying potassium channel Kir6.2 proteins, respectively (5-7). SUR1 and Kir6.2 form the pancreatic subtype of the ATP-sensitive K ϩ (K ATP ) channel, which plays a key role in glucosestimulated insulin secretion by coupling glucose metabolism to -cell membrane excitability (7-9). SUR1 or Kir...