A TTN mutation Gln4053ter found in a patient with DCM decreased the binding to α-actinin (12). We also reported that DCM-associated TCAP mutations Arg87Gln and Glu132Gln decreased binding to titin/connectin, MLP and calsarcin-1 (13). Likewise, DCM-associated CSRP3 mutations Trp4Arg and Lys69Arg decreased binding to T-cap/telethonin and α-actinin, respectively (21, 22). It should also be noted

here that a DCM-associated ACTN2 mutation Gln9Argreduced binding to MLP (22). These observations suggested that the impaired interaction among cytoskeletal Inhibitors,research,lifescience,medical Z-band components caused DCM; i.e., the decreased interaction might lead to loose sarcomere assembly and reduce the stretch response

of cardiomyocytes as shown in MLP-knock out mice with DCM phenotype (21). In this regard, it is of interest that stretch and passive tension of sarcomere can regulate Ca2+-sensitivity of cardiac muscle contraction (23), suggesting that the impaired interaction might alter the Ca2+-sensitivity Inhibitors,research,lifescience,medical of muscle contraction. The molecular mechanisms due to the genetic abnormalities of sarcomere components, especially the troponin complex, have been investigated. The troponin complex, composed of the Ca2+-binding subunit troponin C, inhibitory subunit troponin I and an elongated molecule Inhibitors,research,lifescience,medical troponin T, is an essential modulator of Ca2+-stimulated actomyosin interaction or ATPase activity in the striated muscle. It has been reported that a DCM-associated mutation in troponin T showed Ca2+-desensitization and decreased maximal force (24, Inhibitors,research,lifescience,medical 25). The decreased Ca2+-sensitivity of muscle contraction may well explain the systolic dysfunction, a common pathophysiological alteration in DCM. Another functional

study showed significant impairment of troponin complex assembly due to the mutant troponin I or C (26). On the other hand, a DCM-associated LDB3 mutation increased the binding ability to protein kinase C which plays a key role in the cell signaling pathway Inhibitors,research,lifescience,medical (27). In addition, we recently identified novel DCM-associated mutations in the genes for αB-crystallin (CRYAB) and four-and-a-half LIM domains 2 (FHL2, FHL2), which serve as a Cabozantinib cell line chaperon against stress and as a scaffold of signaling proteins localizing to the crotamiton sites of energy consumption in the cardiac sarcomere, respectively. As for the functional alteration due to the mutations, the mutations of αB-crystallin and FHL2 impaired the binding ability to titin/connectin (28, 29). Although the molecular mechanisms of DCM due to these abnormalities remain to be elucidated, the cardiac dysfunction may be associated not only with the alteration of mechanical stretch response but also with the impairment/perturbation of the interaction between sarcomere/Z-band and signaling molecules.