In the sarcomeric M-band, the giant ruler proteins titin and obscurin, its small homologue obscurin-like-1 (obsl1), and the myosin cross-linking protein myomesin form a ternary complex that is crucial for the function of the M-band as a mechanical link. Mutations in the last titin immunoglobulin (Ig) domain M10, which interacts with the N-terminal Ig-domains of obscurin and obsl1, lead to hereditary muscle diseases. The M10 domain is unusual not only in that it is a frequent target of disease-linked mutations, but also in that it is the only currently known muscle Ig-domain that interacts with two ligands-obscurin and obsl1-in different sarcomeric subregions. Using x-ray crystallography, we show the structural basis for titin M10 interaction with obsl1 in a novel antiparallel Ig-Ig architecture and unravel the molecular basis of titin-M10 linked myopathies. The severity of these pathologies correlates with the disruption of the titin-obsl1/obscurin complex. Conserved signature residues at the interface account for differences in affinity that direct the cellular sorting in cardiomyocytes. By engineering the interface signature residues of obsl1 to obscurin, and vice versa, their affinity for titin can be modulated similar to the native proteins. In single-molecule force-spectroscopy experiments, both complexes yield at forces of around 30 pN, much lower than those observed for the mechanically stable Z-disk complex of titin and telethonin, suggesting why even moderate weakening of the obsl1/obscurintitin links has severe consequences for normal muscle functions.immunoglobulin domain | protein complex | x-ray crystallography | mechanosensor | myopathy S arcomeres are the smallest contractile units of striated muscles. They are highly ordered assemblies of precisely tailored actin and myosin filaments that are crosslinked at Z-disks and Mbands, respectively. The assembly of hundreds of protein subunits into ordered sarcomeres forms the structural basis for striated muscle contraction. The global layout of sarcomere assembly requires a giant ruler protein, titin, a 3000 kDa modular protein with a length of over 1.2 μm, displaying binding sites for proteins along the entire distance from Z-disk to M-band (1-3). Titin is composed of hundreds of immunoglobulin-and fibronectin-3-like (Ig and Fn3) domains that are arranged in specific patterns in the subcompartments of the sarcomere (3). The Ig-domains in sarcomeric proteins like titin, myomesin, or obscurin present a functionally versatile surface around a highly stable structural scaffold (4).At the M-band, the centers of myosin filaments are crosslinked into a mechanically stable network that involves titin, the cytoskeletal protein myomesin (5), and the giant obscurin (6), the latter acting as a linker to the sarcoplasmic reticulum (SR) (7). Obscurin, with a mass of around 800 kDa, was initially discovered as a ligand of Z-disk titin (3). Like titin, it is a modular protein composed of Ig and Fn3 domains. Intriguingly, obscurin localizes predominantly to the M-band ...