Normative Modelling of Molecular-based Functional Neurocircuits Captures Clinical Heterogeneity Transdiagnostically in Neuropsychiatric Patients

Clinical neuroscience principally aims to delineate the neurobiology underpinning the symptoms of various disorders, with the ultimate goal of developing mechanistically informed treatments for these conditions. This has been hindered by the complex hierarchical organisation of the brain and extreme heterogeneity of neuropsychiatric disorders. However, recent advances in multimodal analytic techniques - such as Receptor Enriched Analysis of Connectivity by Targets (REACT) - have allowed to integrate the functional dynamics seen in fMRI with the brains receptor landscape, providing novel trans-hierarchical insights. Similarly, normative modelling of brain features has allowed translational neuroscience to move beyond group average differences between patients and controls and characterise deviations from health at an individual level. Here, we bring these novel methods together for the first time in order to address these two longstanding translational barriers in clinical neuroscience. REACT was used create functional networks enriched with the main modulatory (noradrenaline, dopamine, serotonin, acetylcholine), inhibitory (GABA), and excitatory (glutamate) neurotransmitter systems in a large group of healthy participants [N=607]. Next, we generated normative models of these networks across the spectrum of healthy ageing and demonstrated that these capture deviations within and across patients with Schizophrenia, Bipolar-disorder, and ADHD [N=119]. Our results align with prior accounts of excitatory-inhibitory imbalance in schizophrenia and bipolar disorder, with the former also related to deviations within the cholinergic system. Our transdiagnostic analyses also emphasised the substantial overlap in symptoms and deviations across these disorders. Altogether, this work provides impetus for the development of novel biomarkers that characterise both molecular- and systems-level dysfunction at the individual level, helping facilitate the transition towards mechanistically targeted treatments. Significance statementHuman beings show enormous variability, with inter-individual differences spanning from neurotransmitters to networks. Understanding how these mechanisms interact across scales and produce heterogenous symptomatology within psychiatric disorders presents an enormous challenge. Here, we provide a novel analytic framework to overcome these barriers, combining molecular-enriched neuroimaging with normative modelling to examine neuropathology across scales at the individual level. Our results converge on prior neurobiological accounts of schizophrenia and bipolar disorder as well as the heterogeneity of ADHD. Moreover, we map symptomatology to molecular-enriched functional networks transdiagnostically across these disorders. By bridging the gap between dysfunctional brain networks and underlying neurotransmitter systems, these methods can facilitate the transition from one-size-fits-all approaches to personalized pharmacological interventions at the individual level.