TTN

Chr 2ADAR

titin

Also known as: CMD1G, CMH9, CMPD4, CMYO5, CMYP5, EOMFC, HMERF, LGMD2J

This gene encodes a large abundant protein of striated muscle. The product of this gene is divided into two regions, a N-terminal I-band and a C-terminal A-band. The I-band, which is the elastic part of the molecule, contains two regions of tandem immunoglobulin domains on either side of a PEVK region that is rich in proline, glutamate, valine and lysine. The A-band, which is thought to act as a protein-ruler, contains a mixture of immunoglobulin and fibronectin repeats, and possesses kinase activity. An N-terminal Z-disc region and a C-terminal M-line region bind to the Z-line and M-line of the sarcomere, respectively, so that a single titin molecule spans half the length of a sarcomere. Titin also contains binding sites for muscle associated proteins so it serves as an adhesion template for the assembly of contractile machinery in muscle cells. It has also been identified as a structural protein for chromosomes. Alternative splicing of this gene results in multiple transcript variants. Considerable variability exists in the I-band, the M-line and the Z-disc regions of titin. Variability in the I-band region contributes to the differences in elasticity of different titin isoforms and, therefore, to the differences in elasticity of different muscle types. Mutations in this gene are associated with familial hypertrophic cardiomyopathy 9, and autoantibodies to titin are produced in patients with the autoimmune disease scleroderma. [provided by RefSeq, Feb 2012]

Primary Disease Associations & Inheritance

?Cardiomyopathy, familial hypertrophic, 9MIM #613765
AD
Cardiomyopathy, dilated, 1GMIM #604145
AD
Congenital myopathy 5 with cardiomyopathyMIM #611705
AR
Muscular dystrophy, limb-girdle, autosomal recessive 10MIM #608807
AR
Myopathy myofibrillar, 9, with early respiratory failureMIM #603689
AD
Tibial muscular dystrophy, tardiveMIM #600334
AD
UniProtMyopathy, myofibrillar, 9, with early respiratory failure
UniProtTardive tibial muscular dystrophy
391
ClinVar variants
75
Pathogenic / LP
0.00
pLI score
8
Active trials
Clinical SummaryTTN
🧬
Gene-Disease Validity (ClinGen)
TTN-related myopathy · ARDefinitive

Definitive — sufficient evidence for diagnostic panels

6 total gene-disease associations curated

Population Constraint (gnomAD)
Constrained for loss-of-function variants (OE-LoF 0.33) despite low pLI — interpret in context.
📋
ClinVar Variants
75 Pathogenic / Likely Pathogenic· 55 VUS of 391 total submissions
💊
Clinical Trials
8 active or recruiting trials — potential therapeutic options may be available

Population Genetics & Constraint

gnomAD v4 — loss-of-function & missense intolerance

Moderate LoF intolerance
LoF Constraint?LOEUF (Loss-of-function Observed/Expected Upper bound Fraction) is the upper bound of the 90% CI for LoF OE — the preferred gnomAD v4 metric. Lower = more intolerant to LoF. LOEUF < 0.35 = highly constrained.
0.35LOEUF
pLI 0.000
Z-score 22.76
OE 0.33 (0.300.35)
Moderately constrained

More LoF-intolerant than ~75% of genes

Missense Constraint?Missense Z-score: standard deviations fewer missense variants observed vs. expected. Z > 3.09 (p < 0.001) = gene does not tolerate missense variation. OE missense < 0.6 is also considered constrained.
-1.10Z-score
OE missense 1.02 (1.011.04)
18060 obs / 17648.0 exp
Tolerant

Tolerant to missense variation

Observed / Expected Ratios?Shaded band = 90% confidence interval. Vertical tick = point estimate. Grey threshold line = gnomAD constraint cutoff for that variant class.
LoF OE?Ratio of observed to expected LoF variants. Upper CI bound (LOEUF) ≤ 0.35 = strong LoF constraint signal.0.33 (0.300.35)
00.351.4
Missense OE?Ratio of observed to expected missense variants. OE ≤ 0.6 = fewer missense variants than expected by chance.1.02 (1.011.04)
00.61.4
Synonymous OE?Control metric — synonymous variants are largely neutral and expected near OE = 1.0. Significant deviation may indicate annotation issues.1.00
01.21.6
LoF obs/exp: 435 / 1331.1Missense obs/exp: 18060 / 17648.0Syn Z: -0.17

ClinVar Variant Classifications

391 submitted variants in ClinVar

Classification Summary

Pathogenic11
Likely Pathogenic64
VUS55
Likely Benign260
Benign1
11
Pathogenic
64
Likely Pathogenic
55
VUS
260
Likely Benign
1
Benign

Curated Variants Distribution

Classified variants from ClinVar · 5 ACMG categories

ClassificationLoFMissense + InframeNon-codingSynonymousTotal
Pathogenic
6
0
5
0
11
Likely Pathogenic
42
1
21
0
64
VUS
4
45
4
2
55
Likely Benign
0
0
90
170
260
Benign
0
0
1
0
1
Total5246121172391

LoF = frameshift, stop gained/lost, canonical splice · Counts from ClinVar esearch · Updated hourly

View in ClinVar →

Protein Context — Lollipop Plot

TTN · protein map & ClinVar variants

Showing all ClinVar variants across the protein. Search a specific variant to highlight its position.

Gene2Phenotype Curations

TTN-related hypertrophic cardiomyopathy

limited
ADUndeterminedUncertain
Cardiac
G2P ↗

TTN-related arrhythmogenic right ventricular cardiomyopathy

limited
ADUndeterminedUncertain
Cardiac
G2P ↗

TTN-related dilated cardiomyopathy

definitive
ADUndeterminedAltered Gene Product Structure, Decreased Gene Product Level
Cardiac
G2P ↗
splice acceptor variantsplice donor variantframeshift variantstop gainedmissense variantstop gained NMD triggeringframeshift variant NMD triggering

TTN-related titinopathy with arthrogryposis and/or myopathy

definitive
ARLoss Of FunctionAbsent Gene Product
Dev. Disorders
G2P ↗
splice region variantsplice acceptor variantsplice donor variantstop gained NMD triggeringframeshift variant NMD triggering

Gene2Phenotype curations · DECIPHER consortium patient cohort (public variants) · deciphergenomics.org

OMIM — Genotype-Phenotype Relationships

1 OMIM entry

TITIN; TTN
MIM #188840 · *

?Cardiomyopathy, familial hypertrophic, 9

MIM #613765

Molecular basis of disorder known

Autosomal dominant

Cardiomyopathy, dilated, 1G

MIM #604145

Molecular basis of disorder known

Autosomal dominant

Congenital myopathy 5 with cardiomyopathy

MIM #611705

Molecular basis of disorder known

Autosomal recessive

Muscular dystrophy, limb-girdle, autosomal recessive 10

MIM #608807

Molecular basis of disorder known

Autosomal recessive

Myopathy myofibrillar, 9, with early respiratory failure

MIM #603689

Molecular basis of disorder known

Autosomal dominant

Tibial muscular dystrophy, tardive

MIM #600334

Molecular basis of disorder known

Autosomal dominant
📖
GeneReview available — TTN
Authoritative clinical overview · NCBI Bookshelf · Recommended first read
Open GeneReview ↗
Clinical Literature
Landmark / reviewRecent case evidence

Clinical Trials

Active and recruiting trials from ClinicalTrials.gov

Ventricular TachycardiaAtrial Fibrillation

Defining the Risk of Ventricular Tachycardia in Genetic Forms of Early-onset Atrial Fibrillation

RECRUITING
NCT06647459Vanderbilt University Medical CenterStarted 2023-12-13
EP Study
Cerebral Palsy (CP)

Spastic Myopathy in Adults With Cerebral Palsy

RECRUITING
NCT07293988Phase NANeurolocoStarted 2022-05-19
Guided Self-rehabilitation ContractConventional therapy group
Duchenne Muscular Dystrophy (DMD)Becker's Muscular Dystrophy (BMD)

Urinary Titin Biomarker in DMD

RECRUITING
NCT07332013Phase NAChildren's Hospital of PhiladelphiaStarted 2026-03-01
Descending stair walk
Inherited Non-Duchenne Myopathies

Clinical and Functional Assessment of Patients With Inherited Non-Duchenne Myopathies in Sohag University Hospital

RECRUITING
NCT06574919Sohag UniversityStarted 2024-08-01
CardiomyopathiesGenetic PredispositionCardiomyopathy, Primary

Biomarkers in SCOTland CardiomyopatHy Registry (Bio-SCOTCH)

RECRUITING
NCT06446271NHS Greater Glasgow and ClydeStarted 2024-06-26
Plasma biomarker levels
Colon AdenocarcinomaStage IIA Colon Cancer AJCC v7Stage IIB Colon Cancer AJCC v7

Oxaliplatin, Leucovorin, and Fluorouracil With or Without Bevacizumab in Treating Patients Who Have Undergone Surgery for Stage II Colon Cancer

ACTIVE NOT RECRUITING
NCT00217737Phase PHASE3National Cancer Institute (NCI)Started 2005-09-06
BevacizumabFluorouracilLeucovorin
Intracerebral HemorrhageAtrial Fibrillation

Anticoagulation in ICH Survivors for Stroke Prevention and Recovery

RECRUITING
NCT03907046Phase PHASE3Yale UniversityStarted 2020-01-28
ApixabanAspirin
Atrial FibrillationVentricular TachycardiaPremature Ventricular Contraction

Defining the Risk of Ventricular Tachycardia in Genetic Cardiomyopathies

RECRUITING
NCT06575881Vanderbilt University Medical CenterStarted 2023-12-13