Having a crucial role in the oxygen-dependent metabolism of striated muscle fibres, we suggest that higher concentrations in ALS are presumably caused by secondary myopathy and subsequent release as previously hypothesized for other neuromuscular diseases.44 Our findings of elevated TnT levels in ALS confirm the results of a previous large cohort study.30 Elevated TnT concentrations are discussed as an upregulated re-expression in diseased muscle cells.28,45 Conclusively, TnT and Mb should rather be regarded as valuable supplementary biomarkers than confounders in the diagnosis of ALS. This evidence concerns the gene MB and amyotrophic lateral sclerosis.