ObjectiveTransforming growth factor ÎČ superfamily members are involved in the pathogenesis of systemic sclerosis (SSc). Growth differentiation factor 15 (GDFâ15) is a distant member of this family. We undertook this study to evaluate the role of GDFâ15 in SSc pathogenesis.MethodsA longitudinal prospective cohort of SSc patients was screened for serum GDFâ15 levels using enzymeâlinked immunosorbent assay, and associations with clinical data were analyzed. In vitro stimulation experiments were performed on lung fibroblasts. The role of GDFâ15 in fibrosis development in vivo was evaluated in the bleomycin lung fibrosis model in GDFâ15âdeficient mice.ResultsGDFâ15 was measured at baseline in serum samples from 119 SSc patients. An increase in GDFâ15 levels was observed in patients classified as having no skin involvement, those with limited cutaneous SSc, and those with diffuse cutaneous SSc. Moreover, baseline serum GDFâ15 levels correlated strongly with disease activity and extent of organ involvement, particularly clinical symptoms of lung fibrosis, including impact on lung function at prospective followup. This was mimicked in the bleomycin model of SSc, in which animals exposed to bleomycin had elevated expression levels of GDFâ15 in lung tissue. Lung fibroblasts isolated from GDFâ15âdeficient mice showed reduced induction of interleukinâ6 and CCL2 upon bleomycin stimulation. Surprisingly, no differences in fibrosis development were observed between wildâtype and GDFâ15âdeficient animals.ConclusionAn intriguing profile of serum GDFâ15 levels was found in SSc patients. GDFâ15 expression is induced during fibrosis development and markedly correlates with lung function impairment in this disease. The protein may participate in fibrosis initiation, but is not indispensable in the course of fibrosis development in vivo.