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Background: How the sarcomeric complex is continuously turned over in long-living cardiomyocytes is unclear. According to the prevailing model of sarcomere maintenance, sarcomeres are maintained by cytoplasmic soluble protein pools with free recycling between pools and sarcomeres., Methods: We imaged and quantified the turnover of expressed and endogenous sarcomeric proteins, including the giant protein titin, in cardiomyocytes in culture and in vivo, at the single cell and at the single sarcomere level using pulse-chase labeling of Halo-tagged proteins with covalent ligands., Results: We disprove the prevailing protein pool model and instead show an ordered mechanism in which only newly translated proteins enter the sarcomeric complex while older ones are removed and degraded. We also show that degradation is independent of protein age and that proteolytic extraction is a rate-limiting step in the turnover. We show that replacement of sarcomeric proteins occurs at a similar rate within cells and across the heart and is slower in adult cells., Conclusions: Our findings establish a unidirectional replacement model for cardiac sarcomeres subunit replacement and identify their turnover principles., Competing Interests: None.

The article presents an editorial which discusses several aspects associated with the nonsense-mediated mRNA decay (NMD) in hypertrophic cardiomyopathy. The topics addressed include details on the chronic activation of NMD is the underlying mechanism by which truncating mutations in MYBPC3, encoding cardiac myosin-binding protein C (cMyBP-C) cause molecular abnormalities associated with hypertrophic cardiomyopathy (HCM).