A loss-of-function variant in GFRAL associates with increased alcohol consumption in humans

Alcohol is an ancient and enduring component of the human diet, yet it is a dose-dependent cytotoxin and teratogen, raising the possibility that endogenous, state-dependent mechanisms constrain intake. Growth differentiation factor 15 (GDF15) is an endocrine hormone that rises during pregnancy--predominantly via secretion from blastocyst-derived placental trophoblasts into the maternal circulation--and is also induced in other tissues, particularly hepatocytes, by toxins and cellular stress. However, its function in humans remains unclear. Here, we show that circulating GDF15 levels are elevated 5-fold in individuals with alcohol dependence, identify a rare loss-of-function variant in the GDF15 receptor gene GFRAL associated with approximately 2.6 additional UK alcohol units ([~]21 g ethanol) per week, and demonstrate that recombinant GDF15 reduces alcohol drinking in mice. Collectively, these findings support a model in which GDF15 acts as an endocrine signal induced by chronic alcohol exposure--and potentially during pregnancy--to limit alcohol intake in humans. HighlightsO_LIGDF15 is markedly elevated in humans with alcohol dependence C_LIO_LIA truncating GFRAL variant associates with higher alcohol intake in UK Biobank C_LIO_LIGFRAL frameshift disrupts GDF15-RET signaling in vitro C_LIO_LIRecombinant GDF15 suppresses voluntary alcohol intake in mice C_LI Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=152 SRC="FIGDIR/small/709997v1_ufig1.gif" ALT="Figure 1"> View larger version (50K): org.highwire.dtl.DTLVardef@86706aorg.highwire.dtl.DTLVardef@3e800borg.highwire.dtl.DTLVardef@14868deorg.highwire.dtl.DTLVardef@dce53a_HPS_FORMAT_FIGEXP M_FIG C_FIG