The etiology and pathophysiology of schizophrenia remain unknown. A parallel transcriptomics, proteomics and metabolomics approach was employed on human brain tissue to explore the molecular disease signatures. Almost half the altered proteins identified by proteomics were associated with mitochondrial function and oxidative stress responses. This was mirrored by transcriptional and metabolite perturbations. Cluster analysis of transcriptional alterations showed that genes related to energy metabolism and oxidative stress differentiated almost 90% of schizophrenia patients from controls, while confounding drug effects could be ruled out. We propose that oxidative stress and the ensuing cellular adaptations are linked to the schizophrenia disease process and hope that this new disease concept may advance the approach to treatment, diagnosis and disease prevention of schizophrenia and related syndromes.

Transcript changes and altered pathways in schizophrenia prefrontal cortex. (a) Mitochondria are the most affected cellular components at the transcript level in schizophrenia. Cellular localization of the significantly altered genes (both up-and downregulated) that passed RMA and filtering procedures were analyzed and visualized using GO Surfer (http://biosun1.harvard.edu/complab/gosurfer/). Branches and nodes represent pathways containing greater than five genes. Significantly altered 'cellular components' (Po0.05) are highlighted in red and their categories are indicated. (b) Metabolic categories found to be most significantly altered at the transcript level. EASE (http://david.niaid.nih.gov/david/ease.htm) was used for pathway analysis of microarray results and to determine significantly up-and/or downregulated GO biological processes and KEGG metabolic pathways. (c) Hierarchical clustering tree of schizophrenia (vertical blue lines) and controls (vertical gray lines) microarray chips on the basis of 59 significantly altered genes related to energy metabolism and oxidative stress. Drug-naive schizophrenia patients are denoted by ** (n ¼ 7), while minimally treated patients are marked by * (o6000 lifetime fluphenazine units; n ¼ 4). Note that the schizophrenia group appears to fall into two subclusters with respect to lowered transcript expression as indicated by the prominent blue shading. For more information on this topic, please see the article by Prabakaran et al on pp 684-697.