Titin mutation in familial restrictive cardiomyopathy

Yael Peled, Michael Gramlich, Guy Yoskovitz, Micha S. Feinberg, Arnon Afek, Sylvie Polak-Charcon, Elon Pras, Ben Ami Sela, Eli Konen, Omer Weissbrod, Dan Geiger, Paul M.K. Gordon, Ludwig Thierfelder, Dov Freimark, Brenda Gerull, Michael Arad

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78 Scopus citations


Background Familial restrictive cardiomyopathy (RCM) caused by a single gene mutation is the least common of the inherited cardiomyopathies. Only a few RCM-causing mutations have been described. Most mutations causing RCM are located in sarcomere protein genes which also cause hypertrophic cardiomyopathy (HCM). Other genes associated with RCM include the desmin and familial amyloidosis genes. In the present study we describe familial RCM with severe heart failure triggered by a de novo mutation in TTN, encoding the huge muscle filament protein titin. Methods and results Family members underwent physical examination, ECG and Doppler echocardiogram studies. The family comprised 6 affected individuals aged 12-35 years. Linkage to candidate loci was performed, followed by gene sequencing. Candidate loci/gene analysis excluded 18 candidate genes but showed segregation with a common haplotype surrounding the TTN locus. Sequence analysis identified a de novo mutation within exon 266 of the TTN gene, resulting in the replacement of tyrosine by cysteine. p.Y7621C affects a highly conserved region in the protein within a fibronectin-3 domain, belonging to the A/I junction region of titin. No other disease-causing mutation was identified in cardiomyopathy genes by whole exome sequencing. Conclusions Our study shows, for the first time, that mutations in TTN can cause restrictive cardiomyopathy. The giant filament titin is considered to be a determinant of a resting tension of the sarcomere and this report provides genetic evidence of its crucial role in diastolic function.

Original languageEnglish
Pages (from-to)24-30
Number of pages7
JournalInternational Journal of Cardiology
Issue number1
StatePublished - 15 Jan 2014


  • Autosomal dominant
  • Diastolic
  • Heart failure
  • Restrictive cardiomyopathy
  • Titin


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