GDF15 antagonism limits severe heart failure and prevents cardiac cachexia in mice

Heart failure and associated cachexia is an unresolved and important problem. We report a new model of severe heart failure that consistently results in cachexia. Mice lacking the integrated stress response (ISR) induced eIF2α phosphatase, PPP1R15A, exhibit a dilated cardiomyopathy and severe weight loss following irradiation, whilst wildtype mice are unaffected. This is associated with increased expression of Gdf15 in the heart and increased levels of GDF15 in the circulation. We provide evidence that blockade of GDF15 activity prevents cachexia and slows the progression of heart failure. Our data suggests that cardiac stress mediates a GDF15 dependent pathway that drives weight loss and worsens cardiac function. We show relevance of GDF15 to lean mass and protein intake with patients with heart failure. Blockade of GDF15 could constitute a novel therapeutic option to limit cardiac cachexia and improve clinical outcomes in patients with severe systolic heart failure. ### Competing Interest Statement Stephen O'Rahilly has provided remunerated consultancy services to the following pharmaceutical companies with an active or potential interest in GDF15: Pfizer, AstraZeneca, MedImmune, and Novo-Nordisk. Adriaan A. Voors and Jasper Tromp received consultancy fees and research support from Roche Diagnostics.