Karusheva Y, Ratcliff M, Mörseburg A, Barker P, Melvin A, Sattar N, Burling K, Backmark A, Roth R, Jermutus L, Guiu-Jurado E, Blüher M, Welsh P, Hyvönen M, and O'Rahilly S
Background: There is growing interest in the measurement of growth differentiation factor 15 (GDF-15) in a range of disorders associated with cachexia. We undertook studies to determine whether a common histidine (H) to aspartate (D) variant at position 202 in the pro-peptide (position 6 in the mature peptide) interfered with its detection by 3 of the most commonly used immunoassays., Methods: Three synthetic GDF-15-forms (HH homo-, HD hetero-, and DD-homodimers) were measured after serial dilution using Roche Elecsys®, R&D QuantikineTM ELISA, and MSD R&D DuoSet® immunoassays. GDF-15 concentrations were measured by the Roche and the MSD R&D immunoassays in 173 genotyped participants (61 HH homozygotes, 59 HD heterozygotes, and 53 DD homozygotes). For the comparative statistical analyses of the GDF-15 concentrations, we used non-parametric tests, in particular Bland-Altman difference (bias) plots and Passing-Bablok regression. The bioactivity of the 2 different homodimers was compared in a cell-based assay in HEK293S-SRF-RET/GFRAL cells., Results: The Roche assay detected H- and D-containing peptides similarly but the R&D reagents (Quantikine and DuoSet) consistently underreported GDF-15 concentrations in the presence of the D variant. DD dimers had recoveries of approximately 45% while HD dimers recoveries were 62% to 78%. In human serum samples, the GDF-15 concentrations reported by the R&D assay were a median of 4% lower for HH, a median of 36% lower for HD, and a median of 61% lower for DD compared to the Roche assay. The bioactivities of the HH and DD peptides were indistinguishable., Conclusions: The D variant of GDF-15 substantially affects its measurement by a commonly used immunoassay, a finding that has clear implications for its interpretation in research and clinical settings., Competing Interests: Authors’ Disclosures or Potential Conflicts of Interest: Upon manuscript submission, all authors completed the author disclosure form. Disclosures and/or potential conflicts of interest: Employment or Leadership: M. Ratcliff is an AstraZeneca employee; M. Hyvönen is a CSO (0.1 FTE time commitment, paid as salaried employee) and founder of Qkine. Qkine produces and sells GDF-15 protein; A. Backmark is an Astrazeneca employee; R. Roth is employed by AstraZeneca; L. Jermutus is an AstraZeneca employee. Consultant or Advisory Role: M. Hyvönen, consultancy contract through Cambridge University Technical Services of Ansh Labs LLC, which develops GDF-15 ELISA kits; M. Blueher received consulting fees from Amgen (personal honoraria), AstraZeneca (personal honoraria), Bayer (personal honoraria), Boehringer-Ingelheim (personal honoraria), Daiichi-Sankyo (personal honoraria), Lilly (personal honoraria), Novo Nordisk (personal honoraria), Novartis (personal honoraria), Pfizer (personal honoraria), and Sanofi (personal honoraria), and participated on a Data Safety Monitoring Board or Advisory Board with Boehringer-Ingelheim and Eli Lilly; N. Sattar received consulting fees from Afimmune, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Hanmi Pharmaceuticals, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, and Sanofi. Stock Ownership: M. Ratcliff received stock/stock options paid to himself; A. Backmark is a shareholder in AstraZeneca; R. Roth has stock/stock options in AstraZeneca; L. Jermutus has stock/stock options in AstraZeneca; M. Hyvönen, major shareholder for Qkine Ltd. Honoraria: P. Welsh has honoraria from Novo Nordisk; M. Blueher, Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Lilly, Novo Nordisk, Novartis, Pfizer, and Sanofi. Research Funding: Y. Karusheva received funding from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) (project number 447713146); M. Ratcliff received a BBSRC iCase PhD studentship with AstraZeneca. This work was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) through CRC 1052, project number 209933838, subproject B1 to M. Blueher and by Deutsches Zentrum für Diabetesforschung (DZD, Grant: 82DZD00601) to M. Blueher and E. Guiu-Jurado. E. Guiu-Jurado, Deutsches Zentrum für Diabetesforschung e.V. (DZD) Postdoctoral fellowship, Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) through CRC 1052, project number 209933838, Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig; N. Sattar received grants contracts from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche Diagnostics and funding support from the British Heart Foundation Research Excellence Award (RE/18/6/34217); P. Welsh has grants/contracts with Roche Diagnostics, AstraZeneca, Boehringer Ingelheim, and Novartis. The research was funded by the MRC grants MC.UU.00014.1 and MC.UU.00014.5 and supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014*). Expert Testimony: None declared. Patents: None declared. Other Remuneration: M. Hyvönen, royalties from Qkine Ltd for technologies for production of TGF-β growth factors, including GDF-15., (© American Association for Clinical Chemistry 2022.)