{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T18:34:40Z","timestamp":1770143680779,"version":"3.49.0"},"reference-count":47,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:00Z","timestamp":1702339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Multiple system atrophy (MSA) is a neurodegenerative disease with characteristic motor and autonomic symptoms. Impaired brain serotonergic innervation can be associated with various clinical indices of MSA; however, the relationship between clinical symptoms and cerebrospinal fluid (CSF) levels of 5\u2010hydroxyindole acetic acid (5\u2010HIAA), a main serotonin metabolite, has not been fully elucidated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>To compare CSF 5\u2010HIAA levels between patients with MSA and healthy controls, we included 33 controls and 69 MSA patients with either predominant parkinsonian or cerebellar ataxia subtypes. CSF 5\u2010HIAA levels were measured using high\u2010performance liquid chromatography. Additionally, we investigated correlations between CSF 5\u2010HIAA and various clinical indices in 34 MSA patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CSF 5\u2010HIAA levels were significantly lower in MSA patients than in controls (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). Probable MSA patients had lower CSF 5\u2010HIAA levels than possible MSA patients (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In MSA patients, CSF 5\u2010HIAA levels were inversely correlated with scores in Parts 1, 2, and 4 of the Unified Multiple System Atrophy Rating Scale, and with systolic and diastolic blood pressure in Part 3. Structural equation modeling revealed significant paths between serotonin and clinical symptoms, and significance was highest for activities of daily living, walking, and body sway.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Serotonin dysfunction, as assessed by CSF 5\u2010HIAA levels, may implicate greater MSA severity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.16158","type":"journal-article","created":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T01:30:34Z","timestamp":1702431034000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Correlations between serotonin impairments and clinical indices in multiple system atrophy"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4412-3892","authenticated-orcid":false,"given":"Ryunosuke","family":"Nagao","sequence":"first","affiliation":[{"name":"Department of Neurology Fujita Health University 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