We examined the influence of two K ATP channel openers, diazoxide and an analog (NNC 55-0118), on experimental -cell damage induced by streptozotocin (STZ; 0.5 mmol/l). Rat pancreatic islets were exposed to diazoxide or NNC 55-0118 for 30 min and were further incubated for 30 min after the addition of STZ. The islets were then washed and cultured for 24 h. Islets exposed to STZ alone showed extensive morphological damage, reduced glucose oxidation, low insulin content, and severely impaired glucose-stimulated insulin secretion and proinsulin biosynthesis. Islets treated with STZ in the presence of the channel openers (0.03-0.30 mmol/l) showed dose-dependent preservation of the morphology and improved glucose oxidation rates, insulin content, and secretion. NNC 55-0118 was capable of fully counteracting the STZ impairment, whereas diazoxide had a less protective effect. NNC 55-0118 did not counteract STZ-induced depression of islet NAD levels when examined 2 h after STZ exposure, which suggests that the mechanism of action by NNC 55-0118 is not through an inhibition of poly(ADP-ribose) polymerase. The results illustrate that K ATP channel openers can protect insulinproducing cells against toxic damage, an effect that may be of use in subjects with ongoing insulitis. Diabetes 49:1131-1136, 2000 I n human autoimmune diabetes, the insulin-producing -cells are generally thought to be destroyed by cytotoxic T-cells that are driven by an antigen-specific process (1,2). In experiments with isolated islets, we have found that glucose increases the expression of -cell autoantigens (3) and that diazoxide lowers the antigen amount (4). Against this background, we conducted a clinical trial and observed that a 3-month supplementary treatment with diazoxide had a beneficial effect on residual -cell function in patients with new-onset type 1 diabetes (5). "-cell rest" may thus protect islet cells from autoimmune destruction (6) and may help to explain the remission phenomenon often noted subsequent to the initiation of insulin treatment.Diazoxide and other K ATP channel openers such as cromakalim and pinacidil have been used in experimental studies of the ischemic heart, and beneficial cardioprotective effects have been observed (7-9). Although the exact mechanism of this phenomenon is not understood, an opening of mitochondrial K + channels seems to be involved that results in dissipation of the inner mitochondrial membrane potential. This leads to net oxidation of the mitochondria with an apparent reduction in energy wastage (7,9,10).Diazoxide is known to act on K ATP channels in the plasma membrane of -cells (11). It hyperpolarizes the membrane and inhibits the energy-consuming process of insulin secretion (12). Recently, exposure of -cells to diazoxide has also been found to engage mitochondrial K ATP channels (13). In the present study, we examined the influence of diazoxide and NNC 55-0118, a new K ATP channel opener analog, on experimental -cell damage induced by streptozotocin (STZ), an agent known to cause ene...