The “Permeability transition” (PT) is one of the most studied events that may trigger cell death and is due to a Ca2+- and ROS-dependent opening of a nonspecific pore, called PTP, whose molecular nature has been long debated. Recently, our research group has demonstrated that PTP forms from FoF1 ATP synthase dimers, demonstrating the ability of this complex to switch from the key enzyme for the aerobic synthesis of ATP into a potential cell death mediator. The goal of this PhD thesis has been to define which structural changes of ATP synthase are responsible for the pH modulation of PTP. Indeed, it is well known from nineties that the optimum matrix pH for PT occurrence is about 7.3, and a decrease leads to decreased probability of PTP opening. The pH effect has been ascribed to reversible protonation of His residues located on the PTP that can be blocked by the histidine modifying reagent diethyl pyrocarbonate (DPC). Moreover, in mammalian cells, similarly to the drug Cyclosporin A (CsA), acidic pH also promotes release from the inner membrane of the matrix protein Cyclophilin D (CyPD), which is a well-known PTP activator. As our group demonstrated that CyPD binds to the ATP Synthase OSCP subunit, mainly through electrostatic interactions and resulting in partial enzyme inhibition, the hypothesis has been advanced that the unique histidine located on OSCP, His112 according to bovine numbering, may be responsible for both the pH effects on CyPD (un)binding to ATP synthase and on PTP/ATP synthase opening. OSCPHis112 is exposed to the solvent and is located in the flexible linker region between the structured N- and C-terminal domains of OSCP. The results obtained by ATP synthase immunoprecipitation from bovine heart mitochondria showed that acidic pH induces CyPD release that is prevented by DPC, perfectly matching the effect of DPC on CyPD-PTP interaction. DPC also prevented the binding at low pH of the inhibitor protein IF1 to ATP synthase, but this effect is probably not relevant to PTP modulation. ESI-MS and ESI-MS/MS analyses of the OSCP isolated from DPC-treated mitochondria revealed that the 95-113 peptide shows a mass shift of +72 Da, which is indicative of carbethoxylation of the unique His112. These data therefore strongly support the hypothesis that OSCP His112 is part of the binding site of CyPD on the protein, so that its protonation by lowering pH favors CyPD release. Of note, this region contains several residues of glutamic acid conferring a low potential surface, which is complementary to the mainly high potential surface of CyPD. Consistently to this model, DPC inhibits the ATPase activity of ATP synthase only when CyPD is released from OSCP, i.e. in the presence of CsA and in mitochondria from CyPD-null mice. Replacement of OSCPHis112 with a Gln in HEK cells, by the CRISPR/Cas9 system, showed its involvement even in the effect of low pH on PTP opening. Indeed, the PTP open probability is not affected by acidic pH only in mutated cells, while DPC reverts the pH inhibition exclusively in wild type cells. Finally, evaluation of the structural stability of the ATP Synthase dimers at low pH by Blue-native PAGE excluded their destabilization, which could affect PTP formation. In summary, these data provide a convincing model for the pH modulation of PTP, as well as a compelling evidence that ATP synthase and PTP are the same molecular entity.