Intercellular communication through gap junctions is essential for the regulation of normal cellular processes. In the diseased state, however, gap junctions may be decreased, inappropriately expressed, or constitutively expressed in either the open or closed state. Thus, it may prove important to develop therapeutic agents to either induce or prevent channel closure. To address this dilemma, the mechanisms that cause channel gating as well as the structure-function and permeability determinants of connexins provide useful information. Residues in the C-terminal tail of Connexin 43 are implicated as sites for phosphorylation by kinases that directly mediate channel gating as well as binding sites that influence gating properties. Gating of gap junctions by pH, insulin, and other growth factors has also been associated with the C-terminal domain. The rational design of inhibitors to channel gating may prove useful for the development of therapeutic agents to maintain Connexin 43 in the open state, with potential benefits in diseases such as cancer, arrhythmias, and the diabetic lens. Alternatively, modeling approaches to obtain gap junctions that are constitutively closed might be targeted to designing compounds that could potentially occlude the pore. In this case, knowledge of the pore-lining residues, as well as permeability determinants, would be useful for developing connexin-specific inhibitors that may have future therapeutic potential for tumor invasiveness and stroke treatment. Thus, information from existing and future studies may lead to the development of site-directed, specific modulators of gap junction communication with potential implications in the therapeutic treatment of disease.