Large conductance Ca 2ϩ -activated K ϩ (BK) channel activity and its potentiation by ethanol are both critically modulated by bilayer phosphatidylserine (PS), a phospholipid involved in membrane-bound signaling. Whether PS is uniquely required for ethanol to modify channel activity is unknown. Furthermore, the structural determinants in membrane phospholipid molecules that control alcohol action remain to be elucidated. We addressed these questions by reconstituting BK channels from human brain (hslo) into bilayers that contained phospholipids differing in headgroup size, charge, and acyl chain saturation. Data demonstrate that ethanol potentiation of hslo channels is blunted by conical phospholipids but favored by cylindrical phospholipids, independently of phospholipid charge. As found with ethanol action, basal channel activity is higher in bilayers containing cylindrical phospholipids. Basal activity and its ethanol potentiation in bilayers containing phosphatidylcholine, however, are not as robust as in those containing PS. These results are best interpreted as resulting from the relief of bilayer stress caused by inclusion of cylindrical phospholipids, with this relief being synergistically evoked by molecular shape and negative headgroup charge. Present findings suggest that hslo gating structures targeted by ethanol are accessible to sense changes in bilayer stress. In contrast, hslo unitary conductance is significantly higher in bilayers that contain negatively charged phospholipids independently of molecular shape, a result that is likely to be dependent on an interaction between anionic phospholipids and deep channel residues coupled to the selectivity filter.Large conductance, Ca 2ϩ -activated K ϩ (BK) channels play a pivotal role in both the behavioral response to acute EtOH exposure (Davies et al., 2003) and the cell adaptations that accompany protracted drug administration (Knott et al., 2002). BK channel activity in neurons and neuroendocrine cell types is usually potentiated by EtOH (Dopico et al., 1996(Dopico et al., , 1999Jakab et al., 1997;Knott et al., 2002;Martin et al., 2004). However, EtOH potentiation of BK channels is not universal. In hormone-releasing supraoptic neurons, nerve terminal BK channels are potentiated by EtOH, whereas cell body BK channels are refractory to similar concentrations of the drug (Dopico et al., 1999). Furthermore, BK channels from vascular tissues are primarily inhibited by EtOH (Walters et al., 2000;Liu et al., 2003Liu et al., , 2004b. Experimental conditions make it unlikely that the reported differences in EtOH action on BK channels can be explained by differential modulation of drug action by cytosolic messengers. Differences in EtOH action on BK channels across different tissues and cell domains may be orchestrated by a variety of molecular mechanisms, including expression of different isoforms Preliminary data were presented at the 33rd ABBREVIATIONS: BK channel, large conductance Ca 2ϩ -activated K ϩ channel; POPE, 1-palmitoyl-2-oleoyl-phosphati...