The Role of GDF15 as a Myomitokine

Abstract

Growth differentiation factor 15 (GDF15) is a cytokine best known for affecting systemic energy metabolism through its anorectic action. GDF15 expression and secretion from various organs and tissues is induced in different physiological and pathophysiological states, often linked to mitochondrial stress, leading to highly variable circulating GDF15 levels. In skeletal muscle and the heart, the basal expression of GDF15 is very low compared to other organs, but GDF15 expression and secretion can be induced in various stress conditions, such as intense exercise and acute myocardial infarction, respectively. GDF15 is thus considered as a myokine and cardiokine. GFRAL, the exclusive receptor for GDF15, is expressed in hindbrain neurons and activation of the GDF15-GFRAL pathway is linked to an increased sympathetic outflow and possibly an activation of the hypothalamic-pituitary-adrenal (HPA) stress axis. There is also evidence for peripheral, direct effects of GDF15 on adipose tissue lipolysis and possible autocrine cardiac effects. Metabolic and behavioral outcomes of GDF15 signaling can be beneficial or detrimental, likely depending on the magnitude and duration of the GDF15 signal. This is especially apparent for GDF15 production in muscle, which can be induced both by exercise and by muscle disease states such as sarcopenia and mitochondrial myopathy.

Keywords: anorexia; appetite regulation; cardiokine; cytokine; exercise; mitochondria; muscle; myokine; myopathy; sarcopenia.

Figure 1

GDF15 induction, signaling, and metabolic effects. GDF15 expression and secretion from various organs and tissues is induced in different physiological and pathophysiological states, leading to highly variable circulating GDF15 levels. GFRAL, the exclusive receptor for GDF15 is expressed in neurons of the AP/NTS of the hindbrain, which directly project to the PBN and also activate other brain areas. Efferent signaling includes an increased sympathetic outflow and possibly an activation of the HPA axis. Human evidence also points to a peripheral, direct action of GDF15 on adipose tissue lipolysis. Metabolic and behavioral outcomes of GDF15 signaling can be beneficial or detrimental, possibly depending on the magnitude and duration of the GDF15 signaling. AP: area postrema; BNST: bed nucleus of the stria terminalis; ceA: central Amygdala, HPA: hypothalamic-pituitary-adrenal; NTS: nucleus tractus solitarius; PBN: parabrachial nuclei; PVH: paraventricular nucleus of the hypothalamus; SNS: sympathetic nervous system. Figure created with BioRender.com (28 September 2021).

Figure 2

Induction of GDF15 as a myomitokine. Different (patho)physiological conditions resulting in increased muscle mitochondrial stress activate the integrated stress response (ISR) culminating in a CHOP-dependent induction of GDF15 expression which can, but does not necessarily, result in increased secretion and circulating GDF15 levels. Figure created with BioRender.com (28 September 2021).