Phosphatidylinositol 4,5-bisphosphate (PIP 2 ) is necessary for the function of various ion channels. The potassium channel, I Ks , is important for cardiac repolarization and requires PIP 2 to activate. Here we show that the auxiliary subunit of I Ks , KCNE1, increases PIP 2 sensitivity 100-fold over channels formed by the pore-forming KCNQ1 subunits alone, which effectively amplifies current because native PIP 2 levels in the membrane are insufficient to activate all KCNQ1 channels. A juxtamembranous site in the KCNE1 C terminus is a key structural determinant of PIP 2 sensitivity. Long QT syndrome associated mutations of this site lower PIP 2 affinity, resulting in reduced current. Application of exogenous PIP 2 to these mutants restores wild-type channel activity. These results reveal a vital role of PIP 2 for KCNE1 modulation of I Ks channels that may represent a common mechanism of auxiliary subunit modulation of many ion channels.K CNQ1 α-subunits coassemble with KCNE1 β-subunits to form the cardiac slow-delayed rectifier channel, I Ks , which conducts a potassium current that is important for the termination of the cardiac action potential. Although exogenous expression of KCNQ1 alone is sufficient to produce a voltage-gated channel, coexpression of KCNE1 with KCNQ1 leads to changes in current properties to resemble the physiologically important cardiac I Ks current ( Fig. 1A) (1, 2). These changes include increased current amplitude, shift of the voltage dependence of activation toward more positive potentials, slowed activation and deactivation kinetics, and suppressed inactivation, all of which are essential for the physiological role of I Ks (3). After many years of investigation, it is still poorly understood how the KCNE1 peptide exerts such a dramatic effect on the I Ks current. Loss-offunction mutations in I Ks lead to delayed cardiac cell repolarization that manifests clinically as long QT (LQT) syndrome. Patients with LQT syndrome are predisposed to ventricular arrhythmia and suffer from syncope and a high risk of sudden cardiac death. At present, the molecular mechanisms of disease pathogenesis are still unknown for many LQT-associated mutations in I Ks .Phosphatidylinositol 4,5-bisphosphate (PIP 2 ) is a minor acidic membrane lipid found primarily in the inner leaflet of the plasma membrane. PIP 2 has been shown to be a necessary cofactor for a wide variety of ion channels, e.g., voltage-gated K þ and Ca 2þ channels, transient receptor potential channels, inward rectifying K þ channels, and epithelial Na þ channels (4). Recently, I Ks has been shown to require PIP 2 for channel activity, and several LQTassociated mutations located in KCNQ1 have been suggested to decrease the PIP 2 affinity of I Ks (5, 6). Here we provide evidence that KCNE1, as a β-subunit, alters the function of I Ks by modulating the interaction between PIP 2 and the heteromeric ion channel complex. Knowledge of the molecular mechanisms of channel modulation by KCNE1 is of great importance as at least 36 LQT-associated muta...