Growth differentiation factor 15: A novel biomarker with high clinical potential

Initially considered as a macrophage inhibitor (macrophage inhibitory cytokine-1), growth differentiation factor 15 (GDF-15) has been identified as a pleiotropic protein that plays key roles in prenatal development, in inflammation, in the regulation of cellular responses to stress signals, and in tissue repair after acute injuries in adult life. Multiple studies have revealed that GDF-15, a distant member of the transforming growth factor β (TGF-β) family, acts as a critical hormone to regulate lipid and carbohydrate metabolism. Besides its role in the tumorigenesis and diagnosis of cancer, serum GDF-15 concentrations reflect a "systemic response" and are predictive of all-cause mortality. Based on the knowledge from animal studies of its involvement in multiple inflammatory processes, we will focus in this review on the current clinical data on GDF-15 as a biomarker for cardiovascular disease, kidney disease, liver disease, the metabolic syndrome, diabetes mellitus, and sepsis.