Metabolic Brain Disease

, Volume 34, Issue 1, pp 267–282 | Cite as

Supervised machine learning to decipher the complex associations between neuro-immune biomarkers and quality of life in schizophrenia

  • Buranee Kanchanatawan
  • Sira Sriswasdi
  • Michael MaesEmail author
Original Article


Stable phase schizophrenia is characterized by altered patterning in tryptophan catabolites (TRYCATs) and memory impairments, which are associated with PHEMN (psychosis, hostility, excitation, mannerism and negative) and DAPS (depression, anxiety and physio-somatic) symptoms. This study was carried out to examine the association between TRYCAT patterning, memory impairments, psychopathological features and health-related quality of life (HR-QoL) in schizophrenia. The World Health Organization (WHO) QoL instrument-Abbreviated version (WHO-QoL-BREF), IgA/IgM responses to TRYCATs, cognitive tests, Scale for the Assessment of Negative Symptoms (SANS), Hamilton and Depression (HAMD) and Anxiety (HAMA) Rating Scales and the Fibromyalgia and Chronic Fatigue Syndrome Rating Scale (FF) were measured in 80 schizophrenia patients and 40 controls. Neural Network analysis shows that the total HR-Qol score is best predicted by (in descending order) HAMA, FF, HAMD, and psychosis. Partial least Squares (PLS) analysis shows that 56.7% of the variance in the WHO-QoL scores is explained by PHEMN / DAPS symptoms, while 64.3% of the variance in those symptoms is explained by TRYCAT patterning and episodic/semantic memory impairments. IgA responses to picolinic acid, xanthurenic acid and 3-hydroxy-kynurenine (all negatively) and anthranilic acid (positively) have highly significant indirect effects on WHO-QoL scores, which are completely mediated by cognitive impairments and PHEMN / DAPS symptoms. The results show that lowered HR-Qol in schizophrenia is strongly associated with noxious TRYCATs and that these effects are mediated by impairments in episodic / semantic memory and schizophrenia phenomenology, especially physio-somatic and anxiety symptoms. Mucosal activation of the TRYCAT pathway combined with a deficit in natural IgM isotype antibodies to TRYCATs determine cognitive impairments and DAPS/PHEMN symptoms, which together determine to a large extent lowered HR-QoL in schizophrenia.


Immune Inflammation Tryptophan catabolites Deficit schizophrenia Depression Physio-somatic 



MM and BK designed the study. BK recruited patients and completed diagnostic interviews and rating scales measurements. MM and SS carried out statistical analyses. BK, MM and SS contributed to interpretation of the data and writing of the manuscript.

Role of funding source

This research has been supported by the Asahi Glass Foundation, Chulalongkorn University Centenary Academic Development Project.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest with any commercial or other association in connection with the submitted article.

Supplementary material

11011_2018_339_MOESM1_ESM.pdf (180 kb)
ESM 1 (PDF 179 kb)


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Authors and Affiliations

  1. 1.Department of Psychiatry, Faculty of MedicineChulalongkorn UniversityBangkokThailand
  2. 2.Computational Molecular Biology GroupChulalongkorn UniversityBangkokThailand
  3. 3.Research Affairs, Faculty of MedicineChulalongkorn UniversityBangkokThailand
  4. 4.Department of PsychiatryMedical University of PlovdivPlovdivBulgaria
  5. 5.IMPACT Strategic Research Center, Barwon HealthDeakin UniversityGeelongAustralia

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