Gut microbiome and mitochondrial crosstalk in Schizophrenia, a mental disability: Emerging mechanisms and therapeutic targets

Gut-mitochondria axis is an emerging paradigm in understanding the pathophysiology of complex neuropsychiatric disorders such as Schizophrenia (SCZ). This bidirectional communication network connects the gastrointestinal microbiota with mitochondrial function and brain health, offering novel insights into disease onset and progression. SCZ, characterized by hallucinations, delusions, cognitive impairments, and social withdrawal, has traditionally been attributed to genetic and neurochemical imbalances. However, growing evidence highlights the role of systemic factors specifically, gut microbiome dysbiosis and mitochondrial dysfunction as key contributors to its etiology. Gut dysbiosis in SCZ involves a decrease in health-promoting microbiota such as Faecalibacterium and Roseburia, as well as an increase in pro-inflammatory taxa such as Proteobacteria. The dysbiosis leads to elevated levels of microbial metabolites like lipopolysaccharide (LPS) and trimethylamine-N-oxide (TMAO), which can overcome the intestinal barrier, induce systemic inflammation, and activate toll-like receptors and microglia which drive neuroinflammatory cascades. Simultaneously, mitochondrial dysfunction marked by impaired oxidative phosphorylation, ATP depletion, reactive oxygen species (ROS) accumulation, and mtDNA mutations exacerbates synaptic deficits and neurotransmitter dysregulation, particularly in dopaminergic, glutamatergic, and GABAergic systems. In this review we summarize what we currently know about the gut-mitochondria axis as being core to SCZ pathogenesis via molecular biology, neuroimmunology, and the microbiome. We also identify potential diagnostic biomarkers and therapeutic options that could include the use of probiotics, prebiotics, mitochondrial-targeted antioxidants, and dietary modifications in restoring gut and mitochondrial homeostasis. If the gut-mitochondria axis is linked, such programs may provide improved personalization, efficacy, and mechanistic precision, for future treatments of SCZ.