β-hydroxybutyrate, pyruvate and metabolic profiles in patients with schizophrenia: A case control study

The disturbances of β-hydroxybutyrate (β-HB) and pyruvate are linked with impaired brain energy utilization which involves in the psychopathology of schizophrenia. This study investigates the difference in levels of β-HB and pyruvate between patients with schizophrenia and healthy controls, and explores their relationship with metabolic profiles and disease characteristics. We recruited 54 physically-health schizophrenic patients and 54 age- and gender-matched healthy control subjects. Blood samples were gathered to determine the serum levels of β-HB and pyruvate and plasma levels of metabolic profiles, including fasting glucose, triglycerides, total cholesterol, high- and low-density lipoprotein-cholesterol and adiponectin. The disease characteristics and psychopathology of patients with schizophrenia were assessed by using the Positive and Negative Syndrome Scale. Of patients with schizophrenia, serum levels of β-HB were significantly correlated with fasting glucose (p=0.007) and triglycerides (p=0.021). Pyruvate was significantly correlated with fasting glucose (p=0.018), total cholesterol (p=0.005), triglycerides (p=0.014) and LDL-C (p=0.006). After controlling the metabolic profiles, β-HB was still significantly higher in schizophrenia patients than in controls (p<0.001), but no difference in pyruvate was observed. Neither β-HB nor pyruvate was significantly correlated with disease characteristics. However, pyruvate was higher in patients treated with olanzapine or clozapine than in those treated with other antipsychotics (p=0.048). Findings suggest that schizophrenic patients had significantly higher serum levels of β-HB than control subjects, possibly reflecting higher demands in energy utilization. Serum levels of β-HB, rather than pyruvate, may act as a potential indicator of energy utilization impairment for schizophrenia.