Unit Converter
Growth Differentiation Factor‐15 (GDF‐15)
(Stress-Induced Cytokine – Marker for Inflammation, Heart Failure, Mitochondrial Disease & Cancer)
Synonyms
- GDF-15
- MIC-1 (Macrophage Inhibitory Cytokine-1)
- PTGFB (Placental Transforming Growth Factor-β)
- NAG-1 (Non-steroidal anti-inflammatory gene-1)
- PLAB (Prostate differentiation factor)
- TGF-β superfamily cytokine
Units of Measurement
- pg/mL
- pg/dL
- pg/100 mL
- pg%
- pg/L
- ng/L
Key Conversions
1 pg/mL = 1 ng/L
1 pg/dL = 0.01 pg/mL
pg/100 mL = pg% = pg/dL
1 ng/L = 1 pg/mL
GDF-15 is always reported as mass concentration (not activity units).
Description
GDF-15 is a stress-response cytokine belonging to the TGF-β superfamily.
It is produced by:
- Cardiomyocytes
- Macrophages
- Liver & kidney cells
- Placenta
- Adipocytes
- Tumor cells
GDF-15 rises with:
- Inflammation
- Oxidative stress
- Tissue injury
- Hypoxia
- Mitochondrial dysfunction
Clinically important as a biomarker for heart failure, cardiometabolic disease, cancer, and mitochondrial disorders.
Physiological Role
- Anti-inflammatory signaling
- Regulation of appetite (via GFRAL receptor in brainstem)
- Cellular stress response
- Tissue injury repair
- Placental development (very elevated in pregnancy)
GDF-15 is considered a general “stress cytokine”.
Clinical Sig
nificance
High GDF-15 (most relevant)
1. Cardiovascular Disease
Strongly elevated in:
- Heart failure (HF)
- Acute coronary syndrome (ACS)
- Atherosclerosis
- Hypertension-related cardiac stress
Higher levels predict:
- HF progression
- Hospitalization
- Mortality
- Reinfarction
- Cardiovascular death
2. Mitochondrial Disorders (Very Important)
One of the best biomarkers for mitochondrial dysfunction.
Marked elevation in:
- Mitochondrial myopathies
- Respiratory chain disorders
- Mitochondrial DNA depletion syndromes
3. Cancer
Increased in:
- Pancreatic cancer
- Prostate cancer
- Colorectal carcinoma
- Lung cancer
- Ovarian cancer
Correlates with:
- Tumor burden
- Cachexia
- Poor prognosis
4. Pregnancy
Extremely elevated due to placental secretion:
- 10–100× higher than non-pregnant
(Not pathological.)
5. Kidney Disease
Reduced clearance → elevated GDF-15.
6. Systemic Inflammation
- Sepsis
- Autoimmune disease
- Chronic infection
Low GDF-15
Usually not clinically significant; normal range indicates minimal stress/inflammation.
Reference Intervals
(Based on Mayo, ARUP, ESC Heart Failure biomarker data)
Adults (General Population)
- < 600 pg/mL = Typical healthy range
- 600–1200 pg/mL = Mild elevation (metabolic stress, obesity, smoking)
- 1200–1800 pg/mL = Moderate inflammation or cardiac strain
- >1800 pg/mL = High cardiovascular risk
- >3000 pg/mL = Heart failure, kidney disease, cancer, severe inflammation
- >5000 pg/mL = Strong indicator of mitochondrial disease or advanced malignancy
Pregnancy
- 10,000 – 100,000 pg/mL (normal, trimester-dependent)
Mitochondrial Disorders
- >5000–10,000 pg/mL strongly suggestive
- Often >20,000 pg/mL in severe cases
Diagnostic Uses
1. Heart Failure (Primary Clinical Use)
- Predicts morbidity & mortality
- Independent prognostic marker (ESC/ACC)
- Complements NT-proBNP & troponin
2. Mitochondrial Disease Screening
One of the best biomarkers for:
- mtDNA depletion
- Mitochondrial myopathy
- Oxidative phosphorylation defects
3. Oncology
Marker for:
- Pancreatic cancer
- Prostate cancer
- Lung carcinoma
- Ovarian cancer
- Cancer cachexia
- Tumor progression monitoring
4. Chronic Kidney Disease
Predicts:
- CKD progression
- Mortality risk
5. Obesity & Metabolic Syndrome
Mild–moderate elevation due to metabolic stress.
6. Pregnancy
Used mainly in research, not routine clinical care.
Analytical Notes
- EDTA plasma or serum
- Immunoassay-based measurement (CLIA, ELISA)
- Fasting not required
- GDF-15 is stable for several days refrigerated
- Biotin supplements may interfere with some immunoassays
Clinical Pearls
- One of the strongest independent predictors of mortality in heart failure.
- Extremely high GDF-15 (>5000 pg/mL) is a hallmark of mitochondrial disease.
- Mild elevation is common in obesity, smoking, diabetes, and elderly.
- GDF-15 is not specific—interpret in clinical context.
- Pregnancy increases GDF-15 massively → do not compare with non-pregnant ranges.
Interesting Fact
GDF-15 signals through the GFRAL receptor in the brainstem, regulating appetite and illness-related anorexia - explaining its role in cancer cachexia.
References
- Tietz Clinical Chemistry & Molecular Diagnostics, 8th Edition - Cytokines & Novel Biomarkers.
- ESC Heart Failure Guidelines - Biomarker-based Prognosis.
- ACC/AHA Heart Failure Biomarker Consensus.
- Mayo Clinic Laboratories - GDF-15.
- ARUP Consult - Mitochondrial Disease Markers.
- NIH - GDF-15 Physiology in Metabolic Stress.
- Peer-reviewed literature on GDF-15 in oncology & cardiometabolic disease.