A lterations in diastolic myocardial mechanics, such as slowed left-ventricular relaxation and elevated left-ventricular stiffness, cause diastolic dysfunction and can lead to heart failure (HF).1 Diastolic left-ventricular stiffness is determined, among others, by the extracellular matrix and the cardiomyocytes, 2 and both components can be stiffer than normal in HF, particularly in HF with preserved ejection fraction (HFpEF). 3,4 In cardiomyocytes, passive stiffness (F passive ) is attributable largely to the giant elastic protein titin.2 The mechanical properties of titin are altered in HF, including human HF with reduced ejection fraction (HFrEF) and HFpEF.
Methods and Results:Titin phosphorylation was assessed in CaMKIIδ/γ double-knockout (DKO) mouse, transgenic CaMKIIδC-overexpressing mouse, and human hearts, by Pro-Q-Diamond/Sypro-Ruby staining, autoradiography, and immunoblotting using phosphoserine-specific titin-antibodies. CaMKII-dependent sitespecific titin phosphorylation was quantified in vivo by mass spectrometry using stable isotope labeling by amino acids in cell culture mouse heart mixed with wild-type (WT) or DKO heart. F passive of single permeabilized cardiomyocytes was recorded before and after CaMKII-administration. All-titin phosphorylation was reduced by >50% in DKO but increased by up to ≈100% in transgenic versus WT hearts. Conserved CaMKII-dependent phosphosites were identified within the PEVK-domain of titin by quantitative mass spectrometry and confirmed in recombinant human PEVK-fragments. CaMKII also phosphorylated the cardiac titin N2B-unique sequence. Phosphorylation at specific PEVK/titin N2B-unique sequence sites was decreased in DKO and amplified in transgenic versus WT hearts. F passive was elevated in DKO and reduced in transgenic compared with WT cardiomyocytes. CaMKII-administration lowered F passive of WT and DKO cardiomyocytes, an effect blunted by titin antibody pretreatment. Human end-stage failing hearts revealed higher CaMKII expression/activity and phosphorylation at PEVK/titin N2B-unique sequence sites than nonfailing donor hearts.
Conclusions: