Citicoline stabilizes cell membranes by stimulating S-adenosyl-L-methionine, thereby increasing dendritic complexity and spine density in motor neuron structures, enhancing neuronal plasticity in non-damaged areas, and promoting functional recovery. It repairs neuronal cell membranes by increasing phosphatidylcholine synthesis—achieved through the upregulation of phosphocholine cytidylyltransferase (CCT) to reduce water-soluble phosphocholine levels, and by inhibiting phospholipase A2 (PLA2) activity (either directly or by suppressing TNF-α/IL-1β to inhibit PLA2 activation) to reduce phospholipid loss. Additionally, it increases the expression of anti-apoptotic factors such as Bcl-2 and reduces cytotoxicity by inhibiting glutamate release; promotes the rapid repair of damaged cell surface and mitochondrial membranes, maintaining cellular integrity and biological function; reduces the release of free fatty acids, thereby decreasing the production of toxic oxygenated metabolites and free radicals; and elevates vasopressin and plasma adrenocorticotropic hormone levels while stimulating the release of growth hormone, thyrotropin, and luteinizing hormone.

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