Multi-omics graph attention network reveals neuro-immune-tumor pathways in breast cancer liver depression syndrome.

Background: Liver depression syndrome (LDS) is a core Chinese medicine (CM) syndrome implicated in the onset and progression of breast cancer, whose molecular mechanisms remain poorly understood, hindering further investigation. Methods: We prospectively enrolled 146 participants and conducted transcriptomic, proteomic, and metabolomic analyses using peripheral blood samples. A graph-attention-based multi-omics model embedded with a Transformer-derived multi-head self-attention module served as an exploratory tool to integrate multi-omics datasets. The identified candidate molecules were subsequently validated via enzyme-linked immunosorbent assay (ELISA). Results: In internal five-fold cross-validation, the Multi-Omics Graph Attention Network (MOGAT) achieved 96.6% accuracy in distinguishing LDS in breast cancer patients for biomarker-screening purposes, with proteomic features contributing predominantly to the classification. Moreover, both conventional multi-omics analyses and MOGAT analyses identified stimulator of interferon genes (STING), single immunoglobulin IL-1 receptor-related molecule (SIGIRR), tripartite motif-containing protein 56 (TRIM56), and anexelekto (AXL) as pivotal hub proteins, and subsequent ELISA validation confirmed differential expression of TRIM56 and AXL across pairwise comparisons. Multi-omics analysis identified noradrenaline as a candidate metabolite associated with BC-LDS related molecular alterations. The pathways underlying LDS in breast cancer were predominantly implicated in cytokine-cytokine receptor interactions, neuroactive ligand-receptor interaction, immune response regulation, and steroid hormone biosynthesis. These findings suggest candidate molecular features and a potential "neuro-immune-tumor-related" pathways associated with LDS in breast cancer. Conclusion: This study examined the integration of multi-omics data with MOGAT to investigate the biological underpinnings of CM syndrome. These findings provide a preliminary paradigm that combines CM syndrome omics data with deep learning approaches, offering a hypothesis-generating framework for deciphering the scientific mechanisms of CM syndrome. Clinical Trial Registration: http://itmctr.ccebtcm.org.cn/, identifier ITMCTR2025000446.