Stretching the story of titin and muscle function

The Ancestor and Evolution of the Giant Muscle Protein Connectin/Titin

The emergence of connectin, also called titin, a muscular spring and the largest protein in living organisms, is critical in metazoan evolution as it enables striated muscle-based locomotion. However, its evolutionary history remains unclear. Here, we investigated the evolutionary process using genomic analysis and deduced the ancestor of connectin. The region between the HOX and WNT clusters in the human genome, where the connectin gene (CON (TTN)) is located, was quadrupled by two rounds of whole-genome duplication (WGD) in the ancestor of jawed vertebrates. However, connectin ohnologs were deleted before the advent of jawed vertebrates, resulting in a single connectin gene. Additionally, one of the connectin ohnologs created by the third round of teleost WGD disappeared, while the other was duplicated on the same chromosome. We also discovered that the connectin and connectin family genes consistently underwent local duplication on the same chromosome, though the underlying mechanism remains unknown. Using synteny analysis, we identified KALRN and its ohnolog TRIO as putative ancestral paralogs of the connectin gene. TRIO/KALRN has a connected structure of SESTD1-CCDC141-CON (TTN), and its synteny is conserved in the Drosophila genome. Furthermore, we confirmed that this connected structure, termed 'connectitin,' (connected-connectin/titin) is conserved in cnidarians and placozoans. Molecular phylogenetic analysis revealed that it diverged from TRIO/KALRN prior to the emergence of these animals, suggesting that metazoan muscle may have a single origin. These findings enhance our understanding of the evolutionary processes of striated muscles in the animal kingdom.

Residual force depression in cardiac myofibrils

History-dependent properties, such as residual force depression (rFD; i.e., the decrease in steady-state isometric force of a muscle, following active shortening, compared to the corresponding force of a purely isometric contraction) have been consistently observed in skeletal muscle. However, the corresponding work on history-dependent properties in cardiac muscle is limited and controversial, and the rFD property specifically remains unexplored. Therefore, the purpose of this study was to examine rFD in cardiac myofibrils. Myofibrils (n = 10) isolated from the left ventricle of rabbits were held at an average sarcomere length (SL) of 2.2 µm. Myofibrils were then activated, and actively shortened to an average SL of 1.8 µm, held constant at this length until the force reached a steady-state. The myofibrils were then deactivated and allowed to recover for 10 mins. Finally, myofibrils were activated again at an average SL of 1.8 µm, to measure the purely isometric force at this length. All ten myofibrils exhibited rFD, averaging 23.0 % (± 9.4 %) of the purely isometric reference force. This result suggests that rFD occurs in cardiac muscle within a physiologically relevant range of function, and that similar to skeletal muscle, the molecular mechanisms underlying cardiac rFD originate, at least in part, from the sarcomere.

Characterization of firmness in fermented sea bass (Lateolabrax japonicas) by multidimensional integration strategies: Insights from proteomic and microstructural analyses

Fermented sea bass, recognized for its firmness and chewy texture, provides a distinct sensory experience.This study investigated the texture and microstructural properties of fermented sea bass during fermentation. Proteomics analysis identified the key proteins involved in firmness development, revealing the molecular mechanisms behind these changes. Water migration and myofibril thickening were significant contributors to the increased firmness, hardness, and chewiness. Label-free proteomics revealed 881 proteins, with 426 were differentially expressed, leading to the identification of 155 key protein biomarkers linked to texture. Structural proteins such as myosin light chain and actin correlated positively with hardness, chewiness, and adhesiveness. Fermentation also increased phosphorylation, enhancing protein degradation and texture attributes. Signaling pathways such as PI3k-AkT, HIF-1, and calcium ion signaling pathways were implicated in metabolism and myosin assembly, fortifying muscle tissue firmness. This study provided critical insights into the quality control and production optimization in the fermented sea bass industry.

Circular RNAs and host genes act synergistically in regulating cellular processes and functions in skeletal myogenesis

Circular RNAs (circRNAs) are post-transcriptional regulators generated from backsplicing of pre-mRNAs of host genes. A major circRNA regulatory mechanism involves microRNA (miRNA) sequestering, relieving miRNA-blocked mRNAs for translation and functions. To investigate possible circRNA-host gene relationship, skeletal myogenesis is chosen as a study model for its developmental importance and for readily available muscle tissues from farm animals for studies at different myogenic stages. This review aims to provide an integrated interpretations on methodologies, regulatory mechanisms and possible host gene-circRNA synergistic functional relationships in skeletal myogenesis, focusing on myoblast differentiation and proliferation, core drivers of muscle formation in myogenesis, while other myogenic processes that play supportive roles in the structure, maintenance and function of muscle tissues are also briefly discussed. On literature review,thirty-two circRNAs derived from thirty-one host genes involved in various myogenic stages are identified; twenty-two (68.6 %) of these circRNAs regulate myogenesis by sequestering miRNAs to engage PI3K/AKT and other signaling pathways while four (12.5 %) are translated into proteins for functions. In circRNA-host gene relationship,ten (32.3 %) host genes are shown to regulate myogenesis,nine (29.0 %) are specific to skeletal muscle functions,and twelve (38.8 %) are linked to skeletal muscle disorders.Our analysis of skeletal myogenesis suggests that circRNAs and host genes act synergistically to regulate cellular functions. Such circRNA-host gene functional synergism may also be found in other major cellular processes. CircRNAs may have evolved later than miRNAs to counteract the suppressive effects of miRNAs and to augment host gene functions to further fine-tune gene regulation.

Neurophysiology of ACL Injury

The neurophysiology of ACL injury extends beyond the mechanical rupture of the ligament to encompass profound alterations in the central and peripheral nervous systems, impacting sensorimotor integration and neuromuscular control. The ACL, densely populated with mechanoreceptors, plays a critical role in joint proprioception, dynamically regulating knee stability through complex neural circuits that connect to the spinal cord and brain. When disrupted by injury, these neural pathways contribute to delayed muscular activation, altered motor planning, and compromised joint stability. Such neuromechanical deficits increase the likelihood of reinjury and highlight the need for comprehensive neuroplastic rehabilitation. Neuroplastic therapy, employing tools like external focus strategies, stroboscopic glasses, smartboards, and virtual reality, aims to restore and enhance neural connectivity, sensory integration, and motor coordination. These advanced tools target distinct phases of motor learning, promoting automaticity and resilience in movement patterns. By integrating visual-cognitive, proprioceptive, and reflexive controls, this therapeutic approach not only accelerates recovery but also optimizes performance and reduces the risk of re-injury, representing a paradigm shift in ACL rehabilitation.

Hypertrophic cardiomyopathy: insights into pathophysiology and novel therapeutic strategies from clinical studies

BACKGROUND

Hypertrophic cardiomyopathy (HCM) is a frequently encountered cardiac condition worldwide, often inherited, and characterized by intricate phenotypic and genetic manifestations. The natural progression of HCM is diverse, largely due to mutations in the contractile and relaxation proteins of the heart. These mutations disrupt the normal structure and functioning of the heart muscle, particularly affecting genes that encode proteins involved in the contraction and relaxation of cardiac muscle.

MAIN BODY

This review focused on understanding the role of contractile and relaxation proteins in the pathogenesis of hypertrophic cardiomyopathy. Mutations in contractile proteins such as myosin, actin, tropomyosin, and troponin are associated with hypercontractility and increased sensitivity of the heart muscle, leading to HCM. Additionally, impaired relaxation of the heart muscle, linked to abnormalities in proteins like phospholamban, sarcolipin, titin, myosin binding protein-C, and calsequestrin, contributes significantly to the disease. The review also explored the impact of targeted therapeutic approaches aimed at modulating these proteins to improve patient outcomes. Recent advances in therapeutic strategies, including novel pharmacological agents like mavacamten and aficamten, were examined for their potential to help patients manage the disease and lead more accommodating lifestyles.

CONCLUSIONS

The review underscored the significance of early diagnosis and personalized treatment approaches in managing HCM. Future research should prioritize the development of robust biomarkers for early detection and risk stratification, particularly in diverse populations, to enhance clinical outcomes. Furthermore, it is imperative to delve deeper into the genetic mutations and molecular mechanisms associated with HCM, with a focus on exploring the roles of less-studied myocardial relaxation proteins and their interactions with sarcomere constituents.

Mechanism-based myofilament manipulation to treat diastolic dysfunction in HFpEF

Heart failure with preserved ejection fraction (HFpEF) is a major public health challenge, affecting millions worldwide and placing a significant burden on healthcare systems due to high hospitalization rates and limited treatment options. HFpEF is characterized by impaired cardiac relaxation, or diastolic dysfunction. However, there are no therapies that directly treat the primary feature of the disease. This is due in part to the complexity of normal diastolic function, and the challenge of isolating the mechanisms responsible for dysfunction in HFpEF. Without a clear understanding of the mechanisms driving diastolic dysfunction, progress in treatment development has been slow. In this review, we highlight three key areas of molecular dysregulation directly underlying impaired cardiac relaxation in HFpEF: altered calcium sensitivity in the troponin complex, impaired phosphorylation of myosin-binding protein C (cMyBP-C), and reduced titin compliance. We explore how targeting these pathways can restore normal relaxation, improve diastolic function, and potentially provide new therapeutic strategies for HFpEF treatment. Developing effective HFpEF therapies requires precision targeting to balance systolic and diastolic function, avoiding both upstream non-specificity and downstream rigidity. This review highlights three rational molecular targets with a strong mechanistic basis and potential for therapeutic success.

Perfluorooctanesulfonic acid (PFOS) induced cancer related DNA methylation alterations in human breast cells: A whole genome methylome study

DNA methylation plays a pivotal role in cancer. The ubiquitous contaminant perfluorooctanesulfonic acid (PFOS) has been epidemiologically associated with breast cancer, and can induce proliferation and malignant transformation of normal human breast epithelial cells (MCF-10A), but the information about its effect on DNA methylation is sparse. The aim of this study was to characterize the whole-genome methylome effects of PFOS in our breast cell model and compare the findings with previously demonstrated DNA methylation alterations in breast tumor tissues. The DNA methylation profile was assessed at single CpG resolution in MCF-10A cells treated with 1 μM PFOS for 72 h by using Enzymatic Methyl sequencing (EM-seq). We found 12,591 differentially methylated CpG-sites and 13,360 differentially methylated 100 bp tiles in the PFOS exposed breast cells. These differentially methylated regions (DMRs) overlapped with 2406 genes of which 494 were long non-coding RNA and 1841 protein coding genes. We identified 339 affected genes that have been shown to display altered DNA methylation in breast cancer tissue and several other genes related to cancer development. This includes hypermethylation of GACAT3, DELEC1, CASC2, LCIIAR, MUC16, SYNE1 and hypomethylation of TTN and KMT2C. DMRs were also found in estrogen receptor genes (ESR1, ESR2, ESRRG, ESRRB, GREB1) and estrogen responsive genes (GPER1, EEIG1, RERG). The gene ontology analysis revealed pathways related to cancer phenotypes such as cell adhesion and growth. These findings improve the understanding of PFOS's potential role in breast cancer and illustrate the value of whole-genome methylome analysis in uncovering mechanisms of chemical effects, identifying biomarker candidates, and strengthening epidemiological associations, potentially impacting risk assessment.

Force re-development after shortening reveals a role for titin in stretch-shortening performance enhancement in skinned muscle fibres

Stretch-shortening cycles (SSCs) involve muscle lengthening (eccentric contractions) instantly followed by shortening (concentric contractions). This combination enhances force, work and power output compared with pure shortening contractions, which is known as the SSC effect. Recent evidence indicates both cross-bridge (XB)-based and non-XB-based (e.g. titin) structures contribute to this effect. This study analysed force re-development following SSCs and pure shortening contractions to gain further insight into the roles of XB and non-XB structures regarding the SSC effect. Experiments were conducted on rat soleus muscle fibres (n=16) with different SSC velocities (30%, 60% and 85% of maximum shortening velocity) and constant stretch-shortening magnitudes (18% of optimum length). The XB inhibitor blebbistatin was used to distinguish between XB and non-XB contributions to force generation. The results showed SSCs led to significantly greater [mean±s.d. 1.02±0.15 versus 0.68±0.09 (ΔF/Δt); t62=8.61, P<0.001, d=2.79) and faster (75 ms versus 205 ms; t62=-6.37, P<0.001, d=-1.48) force re-development compared with pure shortening contractions in the control treatment. In the blebbistatin treatment, SSCs still resulted in greater [0.11±0.03 versus 0.06±0.01 (ΔF/Δt); t62=8.00, P<0.001, d=2.24) and faster (3010±1631 versus 7916±3230 ms; t62=-8.00, P<0.001, d=-1.92) force re-development compared with pure shortening contractions. These findings deepen our understanding of the SSC effect, underscoring the involvement of non-XB structures such as titin in modulating force production. This modulation is likely to involve complex mechanosensory coupling from stretch to signal transmission during muscle contraction.

Unlocking the benefit of active stretch: the eccentric muscle action, not the preload, maximizes muscle-tendon unit stretch-shortening cycle performance

Stretch-shortening cycles (SSCs) outperform shortening contractions preceded by isometric contractions in terms of enhanced force/torque, work, and power production during shortening. This so-called SSC effect is presumably related to the active muscle stretch before shortening in SSCs. However, it remains unclear whether the effects of stretch-induced higher preload level or stretch-induced history dependence maximize the SSC effect. Therefore, we analyzed fascicle behavior, muscle-tendon unit (MTU) shortening work, and torque/force (n = 12 participants) via ultrasound and dynamometry during electrically stimulated submaximal plantar flexion contractions from 10° plantarflexion to 15° dorsiflexion. To elucidate the effects of preload level and preload modality (i.e., contraction type) on shortening performance, muscle-tendon unit shortening was preceded by fixed-end (SHO), active stretch (SSC), and preload-matched fixed-end (MATCHED) contractions. Before shortening, MATCHED and SCC had the same preload level (1% torque difference), similar joint position, and muscle fascicle lengths. Compared with SHO, shortening work was significantly (P < 0.001, partial η2 = 0.749) increased by 85% and 55% for SSC and MATCHED, respectively, with SSC shortening work being significantly higher than MATCHED (P = 0.016). This indicates that preload contributes by 65% to the overall SSC effect so that 35% needs to be referred to stretched-induced history-dependent mechanisms. In addition, SSC showed larger fascicle forces at the end of shortening (P < 0.001) and 20% less depressed isometric torque following shortening compared with MATCHED (P < 0.001). As potential decoupling effects by the series elastic element were controlled by matching the preload levels, we conclude that the difference between SSC and MATCHED is related to stretch-induced long-lasting history-dependent effects.NEW & NOTEWORTHY Using a torque-matched preload protocol, we found that 2/3 of the performance enhancement in muscle-tendon unit stretch-shortening cycles (SSCs) is caused by the increased preload level. The remaining 1/3 is owed to the long-lasting history-dependent effects triggered during the stretch in SSCs. This increased performance output is attributed to passive elastic structures within the contractile element that do not require additional muscle activation, therefore contributing to the higher efficiency of the neuromuscular system in SSCs.

Effect of high-fat diet on isometric, concentric and eccentric contractile performance of skeletal muscle isolated from female CD-1 mice

Despite evidence inferring muscle and contractile mode-specific effects of high-fat diet (HFD), no study has yet considered the impact of HFD directly on eccentric muscle function. The present work uniquely examined the effect of 20-week HFD on the isometric, concentric and eccentric muscle function of isolated mouse soleus (SOL) and extensor digitorum longus (EDL) muscles. CD-1 female mice were randomly split into a control (n = 16) or HFD (n = 17) group and for 20 weeks consumed standard lab chow or HFD. Following this period, SOL and EDL muscles were isolated and assessments of maximal isometric force and concentric work loop (WL) power were performed. Each muscle was then subjected to either multiple concentric or eccentric WL activations. Post-fatigue recovery, as an indicator of incurred damage, was measured via assessment of concentric WL power. In the EDL, absolute concentric power and concentric power normalised to muscle mass were reduced in the HFD group (P < 0.038). HFD resulted in faster concentric fatigue and reduced eccentric activity-induced muscle damage (P < 0.05). For the SOL, maximal isometric force was increased, and maximal eccentric power normalised to muscle mass and concentric fatigue were reduced in the HFD group (P < 0.05). HFD effects on eccentric muscle function are muscle-specific and have little relationship with changes in isometric or concentric function. HFD has the potential to negatively affect the intrinsic concentric and eccentric power-producing capacity of skeletal muscle, but a lack of a within-muscle uniform response indicates disparate mechanisms of action which require further investigation.

Discussing Conflicting Explanatory Approaches in Flexibility Training Under Consideration of Physiology: A Narrative Review

The mechanisms underlying range of motion enhancements via flexibility training discussed in the literature show high heterogeneity in research methodology and study findings. In addition, scientific conclusions are mostly based on functional observations while studies considering the underlying physiology are less common. However, understanding the underlying mechanisms that contribute to an improved range of motion through stretching is crucial for conducting comparable studies with sound designs, optimising training routines and accurately interpreting resulting outcomes. While there seems to be no evidence to attribute acute range of motion increases as well as changes in muscle and tendon stiffness and pain perception specifically to stretching or foam rolling, the role of general warm-up effects is discussed in this paper. Additionally, the role of mechanical tension applied to greater muscle lengths for range of motion improvement will be discussed. Thus, it is suggested that physical training stressors can be seen as external stimuli that control gene expression via the targeted stimulation of transcription factors, leading to structural adaptations due to enhanced protein synthesis. Hence, the possible role of serial sarcomerogenesis in altering pain perception, reducing muscle stiffness and passive torque, or changes in the optimal joint angle for force development is considered as well as alternative interventions with a potential impact on anabolic pathways. As there are limited possibilities to directly measure serial sarcomere number, longitudinal muscle hypertrophy remains without direct evidence. The available literature does not demonstrate the necessity of only using specific flexibility training routines such as stretching to enhance acute or chronic range of motion.

Effects of Stretching or Strengthening Exercise on Spinal and Lumbopelvic Posture: A Systematic Review with Meta-Analysis

BACKGROUND

Abnormal posture (e.g. loss of lordosis) has been associated with the occurrence of musculoskeletal pain. Stretching tight muscles while strengthening the antagonists represents the most common method to treat the assumed muscle imbalance. However, despite its high popularity, there is no quantitative synthesis of the available evidence examining the effectiveness of the stretch-and-strengthen approach.

METHODS

A systematic review with meta-analysis was conducted, searching PubMed, Web of Science and Google Scholar. We included controlled clinical trials investigating the effects of stretching or strengthening on spinal and lumbopelvic posture (e.g., pelvic tilt, lumbar lordosis, thoracic kyphosis, head tilt) in healthy individuals. Effect sizes were pooled using robust variance estimation. To rate the certainty about the evidence, the GRADE approach was applied.

RESULTS

A total of 23 studies with 969 participants were identified. Neither acute (d = 0.01, p = 0.97) nor chronic stretching (d=-0.19, p = 0.16) had an impact on posture. Chronic strengthening was associated with large improvements (d=-0.83, p = 0.01), but no study examined acute effects. Strengthening was superior (d = 0.81, p = 0.004) to stretching. Sub-analyses found strengthening to be effective in the thoracic and cervical spine (d=-1.04, p = 0.005) but not in the lumbar and lumbopelvic region (d=-0.23, p = 0.25). Stretching was ineffective in all locations (p > 0.05).

CONCLUSION

Moderate-certainty evidence does not support the use of stretching as a treatment of muscle imbalance. In contrast, therapists should focus on strengthening programs targeting weakened muscles.

Retrofitting the Heart: Explaining the Enigmatic Septal Thickening in Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy is the most common genetic cardiac disease and is characterized by left ventricular hypertrophy. Although this hypertrophy often associates with sarcomeric gene mutations, nongenetic factors also contribute to the disease, leading to diastolic dysfunction. Notably, this dysfunction manifests before hypertrophy and is linked to hypercontractility, as well as nonuniform contraction and relaxation (myofibril asynchrony) of the myocardium. Although the distribution of hypertrophy in hypertrophic cardiomyopathy can vary both between and within individuals, in most cases, it is primarily confined to the interventricular septum. The reasons for septal thickening remain largely unknown. In this article, we propose that alterations in muscle fiber geometry, present from birth, dictate the septal shape. When combined with hypercontractility and exacerbated by left ventricular outflow tract obstruction, these factors predispose the septum to an isometric type of contraction during systole, consequently constraining its mobility. This contraction, or more accurately, this focal increase in biomechanical stress, prompts the septum to adapt and undergo remodeling. Drawing a parallel, this is reminiscent of how earthquake-resistant buildings are retrofitted with vibration dampers to absorb the majority of the shock motion and load. Similarly, the heart adapts by synthesizing viscoelastic elements such as microtubules, titin, desmin, collagen, and intercalated disc components. This pronounced remodeling in the cytoskeletal structure leads to noticeable septal hypertrophy. This structural adaptation acts as a protective measure against damage by attenuating myofibril shortening while reducing cavity tension according to Laplace Law. By examining these events, we provide a coherent explanation for the septum's predisposition toward hypertrophy.

Familial childhood onset, slowly progressive myopathy plus cardiomyopathy expands the phenotype related to variants in the TTN gene

This report describes a novel TTN -related phenotype in two brothers, both affected by a childhood onset, very slowly progressive myopathy with cores, associated with dilated cardiomyopathy only in their late disease stages. Clinical exome sequencing documented in both siblings the heterozygous c.2089A>T and c.19426+2T>A variants in TTN. The c.2089A>T, classified in ClinVar as possibly pathogenic, introduces a premature stop codon in exon 14, whereas the c.19426+2T>A affects TTN alternative splicing. The unfeasibility of segregation studies prevented us from establishing the inheritance mode of the muscle disease in this family, although the lack of any reported muscle or heart symptoms in both parents might support an autosomal recessive transmission. In this view, the occurrence of cardiomyopathy in both probands might be related to the c.2089A>T truncating variant in exon 14, and the childhood onset, slowly progressive myopathy to the c.19426+2T>A splicing variant, possibly allowing translation of an almost full length TTN protein.

Bruno 1/CELF regulates splicing and cytoskeleton dynamics to ensure correct sarcomere assembly in Drosophila flight muscles

Muscles undergo developmental transitions in gene expression and alternative splicing that are necessary to refine sarcomere structure and contractility. CUG-BP and ETR-3-like (CELF) family RNA-binding proteins are important regulators of RNA processing during myogenesis that are misregulated in diseases such as Myotonic Dystrophy Type I (DM1). Here, we report a conserved function for Bruno 1 (Bru1, Arrest), a CELF1/2 family homolog in Drosophila, during early muscle myogenesis. Loss of Bru1 in flight muscles results in disorganization of the actin cytoskeleton leading to aberrant myofiber compaction and defects in pre-myofibril formation. Temporally restricted rescue and RNAi knockdown demonstrate that early cytoskeletal defects interfere with subsequent steps in sarcomere growth and maturation. Early defects are distinct from a later requirement for bru1 to regulate sarcomere assembly dynamics during myofiber maturation. We identify an imbalance in growth in sarcomere length and width during later stages of development as the mechanism driving abnormal radial growth, myofibril fusion, and the formation of hollow myofibrils in bru1 mutant muscle. Molecularly, we characterize a genome-wide transition from immature to mature sarcomere gene isoform expression in flight muscle development that is blocked in bru1 mutants. We further demonstrate that temporally restricted Bru1 rescue can partially alleviate hypercontraction in late pupal and adult stages, but it cannot restore myofiber function or correct structural deficits. Our results reveal the conserved nature of CELF function in regulating cytoskeletal dynamics in muscle development and demonstrate that defective RNA processing due to misexpression of CELF proteins causes wide-reaching structural defects and progressive malfunction of affected muscles that cannot be rescued by late-stage gene replacement.

The history-dependent features of muscle force production: A challenge to the cross-bridge theory and their functional implications

The cross-bridge theory predicts that muscle force is determined by muscle length and the velocity of active muscle length changes. However, before the formulation of the cross-bridge theory, it had been observed that the isometric force at a given muscle length is enhanced or depressed depending on active muscle length changes before that given length is reached. These enhanced and depressed force states are termed residual force enhancement (rFE) and residual force depression (rFD), respectively, and together they are known as the history-dependent features of muscle force production. In this review, we introduce early attempts in explaining rFE and rFD before we discuss more recent research from the past 25 years which has contributed to a better understanding of the mechanisms underpinning rFE and rFD. Specifically, we discuss the increasing number of findings on rFE and rFD which challenge the cross-bridge theory and propose that the elastic element titin plays a role in explaining muscle history-dependence. Accordingly, new three-filament models of force production including titin seem to provide better insight into the mechanism of muscle contraction. Complementary to the mechanisms behind muscle history-dependence, we also show various implications for muscle history-dependence on in-vivo human muscle function such as during stretch-shortening cycles. We conclude that titin function needs to be better understood if a new three-filament muscle model which includes titin, is to be established. From an applied perspective, it remains to be elucidated how muscle history-dependence affects locomotion and motor control, and whether history-dependent features can be changed by training.