This study investigates the association between voxel-mirrored homotopic connectivity (VMHC) disruptions and gene expression in schizophrenia. Using a meta-analysis of 9 studies (386 patients and 357 controls) and replication datasets from two independent studies (258 patients and 287 controls), the authors identified 1287 genes significantly associated with VMHC alterations in schizophrenia. These genes were enriched in biological processes such as regulation of cell communication, nervous system development, and cell communication. The identified genes were overexpressed in astrocytes and immune cells and were specifically expressed in various brain regions and developmental stages. The study also found that illness duration negatively correlated with VMHC abnormalities in the cerebellum and postcentral/precentral gyrus. Neurosynth decoding analysis revealed that VMHC alterations in schizophrenia were correlated with cognitive processes such as somatosensory, visual, and coordination functions. The findings provide insights into the molecular mechanisms underlying VMHC disruptions in schizophrenia and their potential links to cognitive impairments.This study investigates the association between voxel-mirrored homotopic connectivity (VMHC) disruptions and gene expression in schizophrenia. Using a meta-analysis of 9 studies (386 patients and 357 controls) and replication datasets from two independent studies (258 patients and 287 controls), the authors identified 1287 genes significantly associated with VMHC alterations in schizophrenia. These genes were enriched in biological processes such as regulation of cell communication, nervous system development, and cell communication. The identified genes were overexpressed in astrocytes and immune cells and were specifically expressed in various brain regions and developmental stages. The study also found that illness duration negatively correlated with VMHC abnormalities in the cerebellum and postcentral/precentral gyrus. Neurosynth decoding analysis revealed that VMHC alterations in schizophrenia were correlated with cognitive processes such as somatosensory, visual, and coordination functions. The findings provide insights into the molecular mechanisms underlying VMHC disruptions in schizophrenia and their potential links to cognitive impairments.