Background: DNA repair dysfunction leads to genomic instability and neuron death. Results: Long term alcohol exposure results in reduced DNA repair, increased DNA damage, and neuron death in adult brain. Conclusion: Long term alcohol exposure in adult brain promotes genomic instability mediated by impairment in one-carbon metabolism. Significance: This is the first demonstration of alcohol-induced genomic instability in brain.The brain is one of the major targets of chronic alcohol abuse. Yet the fundamental mechanisms underlying alcohol-mediated brain damage remain unclear. The products of alcohol metabolism cause DNA damage, which in conditions of DNA repair dysfunction leads to genomic instability and neural death. We propose that one-carbon metabolism (OCM) impairment associated with long term chronic ethanol intake is a key factor in ethanol-induced neurotoxicity, because OCM provides cells with DNA precursors for DNA repair and methyl groups for DNA methylation, both critical for genomic stability. Using histological (immunohistochemistry and stereological counting) and biochemical assays, we show that 3-week chronic exposure of adult mice to 5% ethanol (Lieber-Decarli diet) results in increased DNA damage, reduced DNA repair, and neuronal death in the brain. These were concomitant with compromised OCM, as evidenced by elevated homocysteine, a marker of OCM dysfunction. We conclude that OCM dysfunction plays a causal role in alcohol-induced genomic instability in the brain because OCM status determines the alcohol effect on DNA damage/repair and genomic stability. Short ethanol exposure, which did not disturb OCM, also did not affect the response to DNA damage, whereas additional OCM disturbance induced by deficiency in a key OCM enzyme, methylenetetrahydrofolate reductase (MTHFR) in Mthfr ؉/؊ mice, exaggerated the ethanol effect on DNA repair. Thus, the impact of long term ethanol exposure on DNA repair and genomic stability in the brain results from OCM dysfunction, and MTHFR mutations such as Mthfr 677C3 T, common in human population, may exaggerate the adverse effects of ethanol on the brain.Nearly 100 million people worldwide have alcohol use disorders. Brain damage is a common and potentially severe consequence of alcohol abuse (1). It is estimated that 50 -75% of long term alcoholics exhibit cognitive impairment and structural damage to the brain. It is also known that chronic alcohol abuse is associated with cerebral cortical atrophy (1). Neuropathological analyses have provided evidence for loss of neurons in certain brain regions such as frontal lobes, which are highly affected in the alcoholic brain (1, 2). This region is essential for executive functions, whose loss may lead to a progressive loss of these functions, as seen in people addicted to alcohol as well as in individuals with frontal cortical damage (2, 3). These structural and cognitive changes have been suggested as the primary consequence of alcohol toxicity (4).Alcohol consumption is associated with generation of genotoxic metabolit...