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. 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. Of the many titin variants identified, five are described with complete transcript information available. Dominant mutation in TTN causes predisposition to hernias. Titin interacts with many sarcomeric proteins including: Z line region: telethonin and alpha-actinin I band region: calpain-3 and obscurin M line region: myosin-binding protein C, calmodulin 1, CAPN3, and MURF1 Clinical relevance Mutations anywhere within the unusually long sequence of this gene can cause premature stop codons or other defects. Titin mutations are associated with hereditary myopathy with early respiratory failure, early-onset myopathy with fatal cardiomyopathy, core myopathy with heart disease, centronuclear myopathy, limb-girdle muscular dystrophy type 2J, familial dilated cardiomyopathy 9, hypertrophic cardiomyopathy and tibial muscular dystrophy. Further research also suggests that no genetically linked form of any dystrophy or myopathy can be safely excluded from being caused by a mutation on the TTN gene. Truncating mutations in dilated cardiomyopathy patients are most commonly found in the A region; although truncations in the upstream I region might be expected to prevent translation of the A region entirely, alternative splicing creates some transcripts that do not encounter the premature stop codon, ameliorating its effect. mRNA splicing factors such as RBM20 and SLM2 (KHDRBS3) were shown to mediated alternative mRNA splicing of titin mRNA contributing to the development of heart failure due to cardiomyopathies. Autoantibodies to titin are produced in patients with the autoimmune disease Myasthenia gravis. Interactions Titin has been shown to interact with: ANK1, ANKRD1, ANKRD23 CAPN3, FHL2, OBSCN, TCAP, and TRIM63. Linguistic significance The name titin is derived from the Greek Titan (a giant deity, anything of great size). As the largest known protein, titin also has the longest IUPAC name of a protein. The full chemical name of the human canonical form of titin, which starts methionyl... and ends ...isoleucine, contains 189,819 letters and is sometimes stated to be the longest word in the English language, or of any language. However, lexicographers regard generic names of chemical