The mitochondrial ATP-sensitive K ؉ (mitoKATP) channel plays a central role in protection of cardiac and neuronal cells against ischemia and apoptosis, but its molecular structure is unknown. Succinate dehydrogenase (SDH) is inhibited by mitoK ATP activators, fueling the contrary view that SDH, rather than mitoK ATP, is the target of cardioprotective drugs. Here, we report that SDH forms part of mitoK ATP functionally and structurally. Four mitochondrial proteins [mitochondrial ATP-binding cassette protein 1 (mABC1), phosphate carrier, adenine nucleotide translocator, and ATP synthase] associate with SDH. A purified IM fraction containing these proteins was reconstituted into proteoliposomes and lipid bilayers and shown to confer mitoK ATP channel activity. This channel activity is sensitive not only to mitoK ATP activators and blockers but also to SDH inhibitors. These results reconcile the controversy over the basis of ischemic preconditioning by demonstrating that SDH is a component of mitoK ATP as part of a macromolecular supercomplex. The findings also provide a tangible clue as to the structural basis of mitoKATP channels.A lthough prolonged ischemia results in severe damage to myocardial and neuronal cells and ultimately cell death, brief ischemic episodes can recruit a mechanism that can protect against future ischemic insults. The identification of this endogenous autoprotective mechanism, known as ischemic preconditioning (IPC), has sparked considerable interest given its potential to mitigate cellular injury in heart attack and stroke (1-3). The molecular basis of IPC remains unclear. Recent evidence suggests that the mitochondrial ATP-sensitive K ϩ channel (mitoK ATP ) is a key player in the process of IPC and is an inhibitor of apoptosis.The mitoK ATP channel was first identified in 1991 from single-channel recordings of the mitochondrial inner membrane (IM) (4). Subsequent studies (5, 6) revealed that the antihypertensive agent diazoxide is an agonist of mitoK ATP channels and protects against cardiac cell death by a mechanism like that of IPC but without the need for conditioning ischemia. These observations led to the notion that mitoK ATP channels protect against ischemia by inhibiting apoptosis and necrosis, possibly as a consequence of altered mitochondrial K ϩ or Ca 2ϩ homeostasis (7-9). Nevertheless, the existence of mitoK ATP channels has been questioned (10, 11). Inhibitors of the Krebs cycle enzyme succinate dehydrogenase (SDH) have been shown to mimic the process of IPC (12). Furthermore, some drugs that activate mitoK ATP channels also inhibit SDH (13), leading to the alternative hypothesis that respiratory inhibition, rather than channel activity, underlies IPC (10). The controversy has been fostered by the lack of a molecular identity for mitoK ATP channels. Such ignorance has also stymied rational drug development of compounds to prevent or delay ischemic injury.Given the functional and pharmacological overlap between SDH and mitoK ATP channels, we hypothesized that SDH either intera...