Titin as a modular spring: emerging mechanisms for elasticity control by titin in cardiac physiology and pathophysiology

Titin is a giant elastic protein that functions as a molecular spring that develops passive muscle stiffness. Here we discuss the molecular basis of titin's extensibility, how titin's contribution to passive muscle stiffness may be adjusted and how adjustment of titin's stiffness may influence muscle contraction. We also focus on ligands that link titin to membrane channel activity, protein turnover and gene expression.