GDF15 and proximal spinal muscular atrophy: GDF15 was also elevated in our patients, but a wide variety of other neuromuscular diseases of nonmitochondrial origin (such as muscular dystrophy or spinal muscular atrophy) can induce high GDF15 levels; indeed, GDF15 has higher sensitivity but lower specificity.17, –, 19 Measurement of FGF21 and GDF15 concentrations in serum might be useful as a first-line diagnostic tool for PMM, whereas their role as a potential biomarker for therapeutic efficacy in future trials is still unclear.