In this lecture we summarize some recent work on the understanding of insta
nton effects in string theories with 16 supersymmetries. In particular, we
consider F-4 couplings using the duality between the heterotic string on T-
4 and type IIA on K-3 at an orbifold point, as well as higher and lower dim
ensional versions of this string-string duality. At the perturbative level
a non-trivial test of the duality, requiring several miraculous identities,
is presented by matching a purely one-loop heterotic amplitude to a purely
tree-level type II result. A wide variety of non-perturbative effects is s
hown to occur in this setting, including D-brane instantons for type IIA on
K-3 X S-1 and NS5-brane instantons for type IIA on K-3 x T-2 Moreover, the
analysis of the three-dimensional case, which possesses a non-perturbative
SO(8, 24, Z) U-duality, reveals the presence of Kaluza-Klein 5-brane insta
nton effects, both on the heterotic and the type II side.