Cardiomyocyte antisense transcription regulates exon usage in the elastic spring region of Titin to modulate sarcomere function

Background The spring-like sarcomere protein Titin (TTN) is a key determinant of cardiac passive stiffness and diastolic function. Alternative splicing of TTN I-band exons produce protein isoforms with variable size and elasticity, but the mechanisms regulating TTN exon skipping and isoform composition in the human heart are not well studied. Non-coding RNA transcripts from the antisense strand of protein-coding genes have been shown to regulate alternative splicing of the sense gene. The TTN gene locus harbours >80 antisense transcripts with unknown function in the human heart. The aim of this study was to determine if TTN antisense transcripts play a role in alternative splicing of TTN . Methods RNA-sequencing and RNA in situ hybridization (ISH) of cardiac tissue from unused organ donor hearts (n=7) and human induced pluripotent stem cell-derived cardiomyocytes (iPS-CMs) were used to determine the expression and localization of TTN antisense transcripts. The effect of siRNA-mediated knock down of TTN antisense transcripts on TTN exon usage in iPS-CMs was determined using RNA-sequencing. Live cell imaging with sarcomere tracking was used to analyze the effect of antisense transcript knock down on sarcomere length, organization and contraction dynamics. RNA ISH, immunofluorescence and high content microscopy was performed in iPS-CMs to study the interaction between antisense transcripts, TTN mRNA and splice factor protein RBM20. Results In mapping TTN antisense transcription, we found that TTN-AS1-276 was the predominant transcript in the human heart and that it was mainly localized in cardiomyocyte nuclear chromatin. Knock down of TTN-AS1-276 in human iPS-CMs resulted in decreased interaction between the splicing factor RBM20 and TTN pre-mRNA, decreased TTN I-band exon skipping, and markedly lower expression of the less elastic TTN isoform N2B. The effect on TTN exon usage was independent of sense-antisense exon overlap and polymerase II elongation rate. Furthermore, knockdown resulted in longer sarcomeres with preserved alignment, improved fractional shortening and relaxation times. Conclusions We demonstrate a role for the cardiac TTN antisense transcript TTN-AS1-276 in facilitating alternative splicing of TTN and regulating sarcomere properties. This transcript could constitute a target for improving cardiac passive stiffness and diastolic function in conditions such as heart failure with preserved ejection fraction. ### Competing Interest Statement The authors have declared no competing interest.