Current Insights of Muscone: Source, Quality Control, and Protection Mechanism of Cerebral Ischemic Injury

OBJECTIVE: This review systematically summarizes the sources and quality control standards of muscone, with particular emphasis on elucidating its neuroprotective mechanisms in cerebral ischemic injury and current research advancements in its investigation and clinical applications. INTRODUCTION: Stroke is a prevalent cerebrovascular disorder caused by insufficient blood supply or occlusion of cerebral vessels, characterized by a high occurrence rate, mortality, and disability rates, profoundly impacting the quality of life of patients and their families. Musk, as the primary drug for "inducing resuscitation and restoring consciousness," is traditionally used to treat febrile coma and stroke with phlegm syncope. Modern pharmacological studies have revealed that its core active component, muscone, exhibits significant neuroprotective properties. METHOD: Through searching keywords including "musk," "muscone," "cerebral ischemia," "stroke," "cerebral stroke," " ischemic stroke," "apoplexy," "Ischemia-reperfusion injury," "protection mechanism," and "neuroprotection," relevant Chinese and English literature published between 1982 and 2025 was collected from databases such as Web of Science, PubMed, Elsevier, and China National Knowledge Infrastructure (CNKI). The following types of literature were excluded: non-peerreviewed articles, low-quality studies, publications with unclear research objectives, duplicate publications, editorials, and conference abstracts. A rigorous screening and data extraction process was conducted for review articles and experimental studies within the valid research scope. The quality and relevance of each study's objectives were comprehensively evaluated to significantly enhance the verifiability of conclusions. RESULTS: It has been demonstrated that muscone exhibits multi-dimensional mechanisms of action in both animal models of stroke and cellular experiments: (1) inhibition of excitotoxicity via modulation of glutamate metabolic pathways; (2) suppression of neuronal apoptosis through activation of the PI3K/Akt signaling pathway; (3) exertion of anti-inflammatory effects by regulating the NF- κB/NLRP3 inflammasome; (4) scavenging of oxygen free radicals and enhancement of antioxidant enzyme activity; (5) promotion of neurogenesis through stimulation of neural stem cell proliferation and differentiation; and (6) protection of blood-brain barrier integrity via maintenance of tight junction protein expression. CONCLUSION: Muscone exhibits remarkable neuroprotective efficacy against cerebral ischemic injury. Mechanistic studies on its neuroprotective effects may provide a multi-target paradigm for the development of novel neuroprotective agents, demonstrating profound translational value in the field of stroke therapy.