TTN

Chr 2

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]

ResearchGenerating clinical summary…
LOFmechanismLOEUF 0.35
Clinical SummaryTTN
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Gene-Disease Validity (ClinGen)
arrhythmogenic right ventricular cardiomyopathy · ADDisputed

Disputed — evidence questions this relationship

7 total gene-disease associations curated

Population Constraint (gnomAD)
Constrained for loss-of-function variants (OE-LoF 0.33) despite low pLI — interpret in context.
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Clinical Trials
8 active or recruiting trials — potential therapeutic options may be available
Some data sources returned errors (1)

omim: Error: OMIM fetch failed: 429

Population Genetics & Constraint

gnomAD v4 — loss-of-function & missense intolerance

Moderate LoF intolerance
LoF Constraint?
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?
-1.10Z-score
OE missense 1.02 (1.011.04)
18060 obs / 17648.0 exp
Tolerant

Tolerant to missense variation

Observed / Expected Ratios?
LoF OE?0.33 (0.300.35)
00.351.4
Missense OE?1.02 (1.011.04)
00.61.4
Synonymous OE?1.00
01.21.6
LoF obs/exp: 435 / 1331.1Missense obs/exp: 18060 / 17648.0Syn Z: -0.17
Curated Mechanism (G2P)Gene2Phenotype (DDG2P) ↗
limitedTTN-related hypertrophic cardiomyopathyOTHERAD
limitedTTN-related arrhythmogenic right ventricular cardiomyopathyOTHERAD
definitiveTTN-related dilated cardiomyopathyOTHERAD
definitiveTTN-related titinopathy with arthrogryposis and/or myopathyLOFAR

This gene — mechanism propensity

DN
0.5575th %ile
GOF
0.5464th %ile
LOF
0.48top 25%

This gene has evidence for multiple mechanisms of pathogenicity (loss-of-function and dominant-negative). The Badonyi & Marsh model scores dominant-negative highest among its predictions, but genomic evidence (constraint, ClinVar variant spectrum, and literature) most strongly supports loss-of-function (haploinsufficiency). Different variants in this gene may act through different mechanisms — interpret in context of the specific variant.

LOF1 literature citation · LOEUF 0.35
DN1 literature citation

Literature Evidence

DNIn patient biopsies, NBR1 was localized abnormally diffusely in diseased muscle instead of being M band- and Z disc-associated, although in HMERF 50% of TK was expected to be wildtype. This suggested a dominant-negative mechanism of action for this mutation.1
LOFTruncated titin proteins and titin haploinsufficiency are targets for functional recovery in human cardiomyopathy due to TTN mutations.2

Predictions from Badonyi M, Marsh JA. PLoS ONE. 2024;19(8):e0307312. Mechanism ranking also informed by gnomAD constraint, ClinVar, and ClinGen data.

ClinVar Variant Classifications

0 submitted variants 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.

Clinical Trials

Active and recruiting trials from ClinicalTrials.gov

Atrial FibrillationVentricular TachycardiaPremature Ventricular Contraction

Defining the Risk of Ventricular Tachycardia in Genetic Cardiomyopathies

RECRUITING
NCT06575881Vanderbilt University Medical CenterStarted 2023-12-13
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
Duchenne Muscular Dystrophy (DMD)Becker's Muscular Dystrophy (BMD)

Urinary Titin Biomarker in DMD

RECRUITING
NCT07332013Phase NAChildren's Hospital of PhiladelphiaStarted 2026-03-04
Descending stair walk
Intracerebral HemorrhageAtrial Fibrillation

Anticoagulation in ICH Survivors for Stroke Prevention and Recovery

RECRUITING
NCT03907046Phase PHASE3Yale UniversityStarted 2020-01-28
ApixabanAspirin
Immune System Responses and Trained Immunity After AS01 AdministrationHealthy Adult

Improving Vaccine Protection for Adults

RECRUITING
NCT07527247Phase PHASE2Singapore General HospitalStarted 2025-11-06
AS01 adjuvant (0.5 mL intramuscular)YF17D (Stamaril, Sanofi-Pasteur)Placebo (NaCl 09%, 0.5mL)
CardiomyopathiesGenetic PredispositionCardiomyopathy, Primary

Biomarkers in SCOTland CardiomyopatHy Registry (Bio-SCOTCH)

RECRUITING
NCT06446271NHS Greater Glasgow and ClydeStarted 2024-06-26
Plasma biomarker levels
Cerebral Palsy (CP)

Spastic Myopathy in Adults With Cerebral Palsy

RECRUITING
NCT07293988Phase NANeurolocoStarted 2022-05-19
Guided Self-rehabilitation ContractConventional therapy group
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