The inwardly rectifying potassium channel Kir6.2 is the pore-forming subunit of the ATP-sensitive potassium (K ATP ) channel, which controls insulin secretion by coupling glucose metabolism to membrane potential in -cells. Loss of channel function because of mutations in Kir6.2 or its associated regulatory subunit, sulfonylurea receptor 1, causes congenital hyperinsulinism (CHI), a neonatal disease characterized by persistent insulin secretion despite severe hypoglycemia. Here, we report a novel K ATP channel gating defect caused by CHI-associated Kir6.2 mutations at arginine 301 (to cysteine, glycine, histidine, or proline). These mutations in addition to reducing channel expression at the cell surface also cause rapid, spontaneous current decay, a gating defect we refer to as inactivation. Based on the crystal structures of Kir3.1 and KirBac1.1, Arg-301 interacts with several residues in the neighboring Kir6.2 subunit. Mutation of a subset of these residues also induces channel inactivation, suggesting that the disease mutations may cause inactivation by disrupting subunit-subunit interactions. To evaluate the effect of channel inactivation on -cell function, we expressed an alternative inactivation mutant R301A, which has equivalent surface expression efficiency as wild type channels, in the insulin-secreting cell line INS-1. Mutant expression resulted in more depolarized membrane potential and elevated insulin secretion at basal glucose concentration (3 mM) compared with cells expressing wild type channels, demonstrating that the inactivation gating defect itself is sufficient to cause loss of channel function and hyperinsulinism. Our studies suggest the importance of Kir6.2 subunit-subunit interactions in K ATP channel gating and function and reveal a novel gating defect underlying CHI.Inwardly rectifying potassium (Kir) channels are important for governing the resting membrane potential in a wide variety of cell types (1). In the islet -cell, Kir6.2 complexes with the sulfonylurea receptor 1 (SUR1) 2 to form the ATP-sensitive potassium (K ATP ) channel which regulates membrane potential according to the energetic state of the cell, thereby mediating glucose-stimulated insulin secretion (2-4). The gating properties that are critical for the physiological function of K ATP channels are their sensitivity to intracellular nucleotides ATP and ADP, whose concentrations fluctuate as glucose levels vary. Both Kir6.2 and SUR1 subunits participate in nucleotide regulation of the channel; ATP inhibits channel activity by binding to the Kir6.2 subunit, whereas Mg 2ϩ -complexed ATP and ADP stimulate channel activity by interacting with SUR1. As glucose concentrations rise, K ATP channels are driven to closure by the increase in ATP and decrease in ADP levels, resulting in membrane depolarization, activation of voltage-gated calcium channels, and insulin secretion. On the other hand, a fall in glucose concentrations promotes K ATP channel opening to stop insulin secretion. Other molecules that have emerged from recen...