The ATP-sensitive potassium (K ATP ؉ ) channel is crucial for the regulation of insulin secretion from the pancreatic -cell, and mutations in either the sulfonylurea receptor type 1 (SUR1) or Kir6.2 subunit of this channel can cause persistent hyperinsulinemic hypoglycemia of infancy (PHHI). We analyzed the functional consequences of the PHHI missense mutation R1420C, which lies in the second nucleotide-binding fold ( ATP-sensitive potassium (K ATP ϩ ) channels link the metabolic state of the cell to its membrane potential in many tissues including pancreatic -cells, heart, brain, and skeletal muscle (1-4). It is believed that metabolic regulation is mediated by changes in ATP and Mg 2ϩ -nucleotides (such as MgADP), which inhibit and activate the channel, respectively. In pancreatic -cells, metabolically induced changes in K ATP ϩ channel activity play a key role in glucose-stimulated insulin secretion. At substimulatory glucose concentrations, K ATP ϩ channels are open, and their activity serves to maintain the resting membrane potential at a hyperpolarized level. Elevation of blood glucose concentration increases glucose uptake and metabolism by the -cell producing changes in cytosolic nucleotide concentrations that result in closure of the K ATP ϩ channels. This leads to depolarization of the -cell membrane potential and thus to activation of voltage-gated calcium channels and Ca 2ϩ influx. The resulting rise in the intracellular Ca 2ϩ concentration triggers insulin release.The -cell K ATP ϩ channel is a hetero-octamer composed of pore-forming Kir6.2 subunits and regulatory sulfonylurea receptor (SUR1) subunits that coassemble with 4:4 stoichiometry (5-8). Kir6.2 is a member of the inwardly rectifying potassium channel family (9, 10), whereas SUR1 belongs to the ATPbinding cassette transporter superfamily (11). Like other members of this family, SUR1 has two intracellular nucleotidebinding folds (NBFs), 1 each containing a Walker A and a Walker B motif that is involved in Mg 2ϩ -nucleotide binding and hydrolysis. Nucleotides interact with both Kir6.2 and SUR1 subunits; ATP inhibits the channel by binding to , whereas Mg 2ϩ -nucleotides stimulate channel activity by binding to the NBFs of SUR1 (1,(15)(16)(17)(18)(19)(20).Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is an autosomal recessive disorder characterized by inappropriate insulin secretion despite severe hypoglycemia. In the absence of clinical treatment, PHHI may be lethal or result in irreversible neurologic sequelae. To date, three mutations responsible for PHHI have been identified in the Kir6.2 gene (21-23) and in numerous mutations in the SUR1 gene (1, 24 -30). Some of the SUR1 mutations are nonsense or frameshift mutations that produce a truncated form of SUR1. Others are missense mutations, many of which are found within the NBFs of SUR1 and impair K ATP ϩ channel activity by affecting Mg 2ϩ -nucleotide interactions with SUR1 (1, 29). As a consequence, the K ATP ϩ channel remains closed even in the absence of glucose, which...