Abstract: Tumor has become one of the major diseases threatening human health at present. Conventional therapies for tumor have serious side effects and are prone to drug resistance， while new therapies are expensive and impose a heavy burden on patients. Chinese herbs effective in the treatment of tumor contain a variety of natural active ingredients， and many anti-tumor drugs used in clinical practice are derived from Chinese herbs. Polysaccharides，ubiquitous in Chinese herbs，are easy to extract and have antitumor，antiviral， and antioxidant activities. Studies have demonstrated that the polysaccharides from Chinese herbs have a significant anti-tumor effect and are characterized by multi-target and multi-mechanism functioning， which can avoid the development of drug resistance， exhibiting a great research value and the potential to be developed into novel anti-tumor drugs. Their anti-tumor mechanisms mainly include the inhibition of tumor proliferation， promotion of apoptosis， induction of autophagy， influence on cell cycle， inhibition of tumor angiogenesis， modulation of epithelial-mesenchymal transition（EMT）and immunity，promotion of tumor oxidative stress， and regulation of phosphatidylinositol 3-kinase/ protein kinase B（PI3K/Akt），Toll-like receptor 4（TLR4）， mitogen-activated protein kinase/nuclear factor-kappa B（MAPK/NF-κB），adenosine 5'-monophosphate（AMP）- activated protein kinase/mechanistic target of rapamycin（AMPK/mTOR），epidermal growth factor receptor/extracellular signal-regulated kinase（EGFR/ERK），p53，and Wnt/β-catenin signaling pathways. 

Keywords: Chinese herbs；polysaccharides；anti-tumor effect；mechanisms；signaling pathways

Tumor is the main disease that causes human death. It is predicted that by 2030, the number of cancer patients in the world will increase to 24.6 million, and the number of cancer deaths will increase to 13 million [1]. In recent years, the incidence and mortality of tumors in my country have been increasing year by year. Patients often have no obvious symptoms in the early stage, thus missing the best treatment opportunity, and the cost of advanced treatment is high, causing a heavy economic burden to patients and society. At present, conventional treatments are mainly radiotherapy, chemotherapy and surgery, but they are prone to drug resistance and serious adverse reactions. Studies have shown that tumors are resistant to various chemotherapeutic drugs and targeted drugs to varying degrees, and drug resistance has seriously affected the quality of life of tumor patients and has become one of the major challenges in tumor treatment [2].

In the aspect of tumor treatment, traditional Chinese medicine emphasizes the combination of strengthening the righteousness and eliminating pathogenic factors, and pays attention to all-round and multi-angle treatment of diseases. It can stabilize tumor lesions, improve patients' symptoms, and improve the quality of life. It has unique advantages. Modern pharmacological studies have found that the active ingredients of traditional Chinese medicine can not only effectively inhibit the growth of tumors, but also have the significant advantage of less toxic and side effects. Most of the anti-tumor drugs currently used in clinical practice, such as camptothecins, polysaccharides, harringtonines, paclitaxel, and vinblastine, are derived from Chinese herbal medicines. Traditional Chinese medicine polysaccharide is a natural macromolecule, which widely exists in a variety of Chinese medicinal materials, and has no adverse effects on the body [3-4]. A number of studies have shown that traditional Chinese medicine polysaccharides have various biological activities such as anti-tumor [5], anti-virus [6], anti-oxidation [7], and immune regulation [8], among which the anti-tumor effect is particularly prominent, with multiple perspectives and multiple mechanisms. The synergistic feature can avoid the development of drug resistance, thereby effectively inhibiting tumor proliferation, differentiation and metastasis, which has become the focus of current research.

1 Inhibit tumor cell proliferation

Under normal circumstances, human cells usually undergo orderly proliferation, differentiation, senescence and apoptosis. Due to gene mutation or chromosomal mutation, cells become cancerous, and their proliferation and differentiation activities become abnormally active. Studies have shown that traditional Chinese medicine polysaccharides can effectively inhibit the proliferation and differentiation of tumor cells. Cistanche polysaccharide inhibits prostate cancer cell PC-3 [9], psyllium polysaccharide inhibits breast cancer cell DAMB-231 [10], and Cordyceps sinensis polysaccharide inhibits colon cancer cell HCT116 [11]. Dependence, positively correlated with duration of action.

2 Promote tumor cell apoptosis

2.1 Mitochondrial pathway

Apoptosis is an important pathway for clearing damaged or infected cells to preserve tissue integrity and cellular homeostasis, and is characterized by cellular chromatin condensation, caspase activation, DNA fragmentation, and mitochondrial membrane changes. The pathways of TCM polysaccharide-induced tumor cell apoptosis are mainly divided into mitochondrial pathway (endogenous pathway) and death receptor pathway (exogenous pathway). In the endogenous pathway, polysaccharides often lead to changes in mitochondrial membrane potential and Caspase-9 activation in tumor cells, triggering multiple Caspase-dependent pathways including activation of Caspase-3, and ultimately the release of cytochrome C to induce apoptosis. LIU et al[12] found that Angelica polysaccharide directly acts on Gal-3, activates Caspase-9 and Caspase-3, and leads to apoptosis of leukemia cells.

Atractylodes polysaccharide reduces mitochondrial membrane potential, leading to dose-dependent apoptosis of Eca-109 cells [13].

2.2 Death receptor pathway

In the exogenous pathway, TCM polysaccharides mainly induce the binding of death receptors and their ligands, activate Caspase-8 and lead to apoptosis. YU et al. [14] used flow cytometry to detect apoptosis, and Western blot to detect death factor (Fas), death factor receptor (Fas-L), Caspase-3, and Caspase-8, indicating that Polysaccharide Polysaccharides By inducing the expression of Fas and Fas-L, PTP up-regulates Caspase-8, thereby activating Caspase-3, resulting in apoptosis of SPC-A-1 cells. In conclusion, traditional Chinese medicine polysaccharides can promote tumor cell apoptosis from endogenous or exogenous pathways by activating Caspase and death receptors.

3 Regulates autophagy in tumor cells

Autophagy is a process in which cells form double-membrane autophagic vesicles and degrade proteins and organelles in the vesicles through lysosomes. ]. Traditional Chinese medicine polysaccharides regulate tumor autophagy by acting on autophagy molecules Beclin-1 and LC3. [16] treated HeLa cells with Astragalus polysaccharides, and detected the expression levels of autophagy-related proteins by polymerase chain reaction (PCR) and Western blot, and found that Astragalus polysaccharides up-regulated Beclin-1, promoted LC3 transformation, and down-regulated autophagy-related proteins. The expression of phagocytosis marker protein p62 promotes autophagy in HeLa cells.

Studies have shown that after treatment of BxPC-3 cells with Polysaccharide Polysaccharide RP-02-1, the autophagy-related proteins LC3B and Beclin-1 were significantly decreased, indicating the inhibitory effect of RP-02-1 on autophagy in pancreatic cancer cells. On the contrary, it promotes the apoptosis of tumor cells, and with the increase of polysaccharide concentration

and gradually increased [17].

4 arrest the cell cycle

The cell cycle is a series of tightly regulated biological events that are closely related to tumor proliferation and differentiation. Traditional Chinese medicine polysaccharides have a blocking effect on the cycle of tumor cells. Astragalus polysaccharide induces autophagy-related proteins such as LC3B, Beclin-1 and p62 in hepatocellular carcinoma cells SMMC-7721.

The expression of white is blocked in the early stage of DNA synthesis (G0/G1 phase) [18]. Lycium barbarum polysaccharide LBGP-I-3 arrests the MCF-7 cell cycle in the G0/G1 phase by recognizing and binding to the Toll-like receptor 4 (TLR4) receptor on MCF-7 cells [19]. This means that traditional Chinese medicine polysaccharides inhibit the mitosis of tumor cells, thereby inhibiting tumor proliferation.

5 Inhibits tumor angiogenesis

The formation of new blood vessels can not only provide abundant nutrients for tumor growth, but also provide a new way for tumor metastasis. Inhibiting angiogenesis is a prerequisite for anti-tumor activity and inhibiting tumor metastasis. REN

et al [20] showed that dandelion polysaccharide can inhibit the expression of vascular endothelial growth factor (VEGF) and HIF-1a through Transwell, tube formation experiment, chicken embryo experiment and immunohistochemistry, thereby significantly inhibiting the angiogenesis of liver cancer. PTP inhibits ovarian cancer growth and angiogenesis by down-regulating the expression levels of CD34, epidermal growth factor receptor (EGFR), and VEGF [21]. The above studies have shown that traditional Chinese medicine polysaccharides can effectively reduce the expression of VEGF and have an inhibitory effect on tumor angiogenesis.

6 Inhibits tumor invasion and metastasis

Tumor metastasis refers to the process in which tumor cells adhere to the extracellular matrix, invade adjacent tissues and metastasize. The ability of metastasis and invasion is the main manifestation of the malignant degree of tumor. Studies have shown that Achyranthes polysaccharide (ABP) can inhibit the metastasis of lung cancer by inhibiting the expression of invasion-related molecules matrix metalloproteinase (MMP)-2 and MMP-9, interfering with the invasive cascade reaction [22]

. ZHONG et al. [23] examined the effects of different concentrations of Atractylodes macrocephala polysaccharide (ALP) on the migration and invasion of human osteosarcoma cells U-2 OS, indicating that ALP inhibits the binding of E-selectin to sLex by competitively binding to E-selectin, thereby effectively inhibiting the binding of E-selectin to sLex. Inhibits the adhesion, migration and invasion of HUVECs by U-2 OS. Therefore, traditional Chinese medicine polysaccharides can reduce the metastasis and invasion ability of tumor cells by inhibiting MMPs or competitively binding to E-selectin.

7 Regulates epithelial-mesenchymal transition (EMT)

EMT is closely related to the ability of tumor metastasis and replication, mainly involving MMPs, fibronectin (FN), vimentin, E-cadherin and other related molecules. Inhibiting EMT is one of the important mechanisms for inhibiting tumor metastasis. ZHONG et al [22] treated A549 and A549 with Achyranthes polysaccharide.

PC-9 cells, and epithelial markers E-cadherin, β-catenin, mesenchymal markers N-cadherin and vimentin, EMT-related transcription factors Snail, EGFR and The expression of its downstream signaling pathways indicates that Achyranthes has more

Sugar can interfere with EMT by competing with EGF for binding to EGFR, thereby inhibiting the expression of mesenchymal markers. SUN et al[24] tested the effect of Acanthopanax senticosus polysaccharide on the invasion and migration ability of non-small cell lung cancer cell line NCL-H520 by Transwell and scratch experiments, and detected the expression changes of related proteins. -9, MMP-2, vimentin and FN1, up-regulate the expression of E-cadherin, and finally inhibit the epithelial-mesenchymal transition of lung cancer cells. In conclusion, traditional Chinese medicine polysaccharides inhibit MMPs, FN, vimentin, E-calcium

Mucin and other related molecules inhibit EMT and hinder tumor cell replication and metastasis.

8 Pro-oxidative stress

Oxidative stress occurs when reactive oxygen species (ROS) levels exceed cellular load, leading to an imbalance between the cellular oxidative and antioxidant systems. The content of ROS in normal cells is low. When the level of ROS increases, the metabolism of cells is accelerated and the cells proliferate rapidly, and oxidative stress may occur, which may cause DNA damage and lead to cancer. When the ability of tumor cells is increased, tumor cells undergo oxidative stress and apoptosis [25-26]. Traditional Chinese medicine polysaccharides can increase the level of ROS in tumor cells, inhibit cell energy metabolism, and promote oxidative stress, thereby inhibiting tumor proliferation. ZHANG et al. [27] treated colon cancer cell CT26 with Dendrobium officinale polysaccharide DOP, and found that DOP could significantly increase the level of intracellular ROS, inhibit mitochondrial function, and reduce the synthesis of cellular ATP, thereby inhibiting the proliferation of CT26.

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9 Regulation of immunity

9.1 Macrophages

9.1.1 Induction of macrophage polarization Tumor-associated macrophages (TAMs) are involved in regulating the tumor microenvironment. After the microenvironment is changed or TAMs receive specific signal stimulation, macrophages can be polarized into M1 and M2 types, of which M1 M2 type mainly secretes interleukin (IL)-6, IL-12, tumor necrosis factor (TNF)-α and other cytokines, which have anti-tumor effects; M2 type mainly secretes IL-10, IL-13, transforming growth factor (TGF) )-β participates in tissue repair and promotes tumor proliferation and metastasis [28-29]. Studies have shown that astragalus polysaccharide (RAP) reverses the polarization of macrophages from M2 type to M1 type by activating the Notch pathway, and at the same time promotes the expression of M1 type markers on the surface of macrophage RAW264.7, and inhibits tumor proliferation [30]. The polysaccharide POP2 of Arborvitae at 31.25-500 mg·L-1 can not only promote the secretion of IL-6 and TNF-α, but also promote the release of IL-10, indicating that POP2 can promote the polarization of macrophages [31] ].

9.1.2 Stimulation of macrophage phagocytosis

Macrophages generally clear pathogens by direct phagocytosis, and traditional Chinese medicine polysaccharides have obvious phagocytosis effects on macrophages. DONG et al.[32] observed the effect of pueraria polysaccharide on the ability of macrophage RAW264.7 to phagocytose FITC-labeled Escherichia coli by fluorescence microscopy, and found that with the increase of polysaccharide concentration, the fluorescence intensity gradually increased. The pinocytosis ability of macrophages was detected by ingesting neutral red, and it was found that compared with the control group, pueraria polysaccharide Ge-1 (62.5~500 mg·L-1) promoted macrophages to neutralize in a concentration-dependent manner The uptake of red indicates that pueraria polysaccharide Ge-1 has obvious phagocytic and pinocytotic effects on macrophages. Acanthopanax senticosus polysaccharide AHP-II activates macrophages and promotes the phagocytosis of neutral red by macrophages, indicating that AHP-II significantly improves the phagocytosis of macrophages [33].

9.1.3 Raising nitric oxide NO levels

NO is a cell proliferation inhibitory molecule produced by macrophages. It is mainly produced when activated macrophages express a large amount of NO synthase. It mainly regulates apoptosis-related signaling pathways by inducing protein or lipid peroxidation and DNA damage, resulting in tumor cells. death [34]. Astragalus polysaccharide APS up-regulates the levels of NO and TNF-α by activating macrophages [35]. MA et al[36] extracted peony polysaccharides PSAP-1 and PSAP-2 from peony, and intervened macrophages in vitro, and found that peony polysaccharides significantly promoted the proliferation of macrophages, stimulated macrophages to produce NO, and produced stronger immunity. active.

The above experimental studies show that traditional Chinese medicine polysaccharides can promote the polarization of TAMs, improve the phagocytic ability, induce them to produce the cell proliferation inhibitory molecule NO and various immune factors, regulate the tumor microenvironment, and improve the body's anti-tumor immunity.

9.2 Activation of NK cells

NK cells are lymphoid-derived innate immune cells that mainly produce interferon (IFN)-γ and activate T and B cells, and have the ability to kill various tumors. Traditional Chinese medicine polysaccharides can activate NK cells

cells, activate the body's non-adaptive immunity to kill tumors. SUN et al. [37] fed ginseng polysaccharide GPS to cyclophosphamide-induced immunosuppression model mice, and isolated NK cells in the spleen. They found that compared with the control group, the proportion of NK cells in the polysaccharide model mice was significantly increased, and the cells The proliferation inhibition was significantly enhanced, indicating that ginseng polysaccharide has a promoting effect on the killing ability of NK cells. Rehmannia polysaccharide promotes the proliferation and activation of NK cells in mice, and has a significant inhibitory effect on CT26 mouse xenografts [38].

9.3 Activating DCs

Cells DC cells are professional antigen-presenting cells that differentiate and mature after being stimulated or ingested antigens to stimulate the body's immune response. Astragalus polysaccharide PG2 promotes the differentiation and maturation of splenic DC cells, thereby enhancing the anti-tumor effect mediated by T cells [39]. Traditional Chinese medicine polysaccharides mainly activate DC cells by regulating TLR4 and trigger the body's adaptive anti-tumor immunity. Lycium barbarum polysaccharide LBP up-regulates TLR4, p38, extracellular signal-regulated kinase (ERK) 1/2, amino terminal kinase

The expression of Blimp1 (JNK) and Blimp1 promotes the secretion of major histocompatibility complex (MHC) class II molecules and CD80 and CD86, and increases the production of IL-4 and IL-6, thereby inducing DC cell maturation [40]. Portulaca oleracea polysaccharide induces the activation of DC cells by regulating the TLR4/MyD88/nuclear factor (NF)-κB pathway, showing a significant inhibitory effect on breast cancer growth and lung metastasis [41].

9.4 Other immune cells

Traditional Chinese medicine polysaccharide also promotes the proliferation of T and B lymphocytes and enhances the immunity of the body. Polygonatum polysaccharide increased the thymus and spleen indices of immunosuppressed mice, increased the number of white blood cells in the blood, and increased the ratio of CD4+/CD8+ T cells in the mice in a dose-dependent manner [42]. Atractylodes polysaccharide PAMK can reduce the immunosuppression caused by cyclophosphamide by promoting the proliferation of T cells and B cells and increasing the proportion of white blood cells [43].

9.5 Cytokines

Traditional Chinese medicine polysaccharides also kill tumors by promoting the release of IL-6, IL-10, IL-12, IL-13, IFN-γ, TNF-α and other cytokines by immune cells. Jia Xi et al. [44] administered different concentrations of Hedyotis diffusa polysaccharides to Lewis lung cancer mice and found that Hedyotis diffusa polysaccharides could significantly increase the levels of IL and TNF in the serum of lung cancer mice, thereby inhibiting tumor growth. Poria polysaccharide significantly up-regulates the expression of MHC class II molecules, CD40, CD80, and CD86 on the cell surface, and increases the levels of IL-6 and IL-12, while activating CD8+ T cells and promoting the production of immunoglobulin (Ig) G, IgG1 and IgG2a [45]. Cistanche  polysaccharide promotes lymphocyte proliferation in vivo, increases the levels of IL-2, IL-4, and IFN-γ in blood, and stimulates lymphocytes to secrete IL-2, IL-4, IFN-γ, and TNF-α in vitro. Dendritic cells produce IL-10 and TNF-α, showing significant immunomodulatory effects [46]. In a word, in addition to activating various immune cells, traditional Chinese medicine polysaccharides induce the secretion of various immune factors such as interleukin and tumor necrosis factor, regulate the immune environment around the tumor, and thus indirectly kill the tumor.

10 Regulating Signaling Pathways

10.1 Phosphatidylinositol 3-kinase/Protein kinase B (PI3K/Akt)

The PI3K/Akt pathway is one of the classic tumor-related signaling pathways, mainly involved in the regulation of cell proliferation, differentiation and metabolism [47]. Tumors promote the formation of microvessels by affecting the PI3K/Akt pathway, thereby changing the microenvironment to facilitate their own growth. Inhibiting this pathway can promote tumor cell autophagy, improve the tumor microenvironment, improve tumor radiosensitivity, and improve tumor drug resistance [48- 49]. TAO et al[50] used corn silk polysaccharide S1 to intervene pancreatic cancer cells in vitro and established a transplanted tumor model. Flow cytometry was used to detect cell apoptosis, PCR, Western blot and immunohistochemistry to detect related signaling pathway molecules, and found that S1 treated BxPC. After -3 cells, the expressions of phosphorylated PI3K and phosphorylated Akt were inhibited, while S1 inhibited the expression of phosphorylated EGFR and phosphorylated CREB in a dose-dependent manner. Lycium barbarum polysaccharide LBP effectively inhibits the proliferation of primary human hemangioendothelial cells by inhibiting the PI3K/Akt pathway, inhibits tumor angiogenesis, activates Caspase-3, B-cell lymphoma-2 (Bcl-2)-related X protein (Bax), thereby inducing apoptosis [51]. In addition, the combination of traditional Chinese medicine polysaccharides and chemotherapeutic drugs showed good synergistic and detoxification effects. Compared with apatinib monotherapy, astragalus polysaccharide combined with apatinib showed stronger inhibitory effect on phosphorylated (p)-Akt and MMP-9, resulting in a significant increase in the apoptosis rate of gastric cancer AGS cells [52].

10.2 TLR4

TLRs are a class of pattern recognition receptors. Human TLRs are mainly divided into two types: TLR1, 2, 5, 6, and 10 are located on the extracellular side of the cell surface, and TLR3, 7, 8, and 9 are located in intracellular organelles. 53]. Among them, TLR4 can specifically recognize and bind polysaccharides, promote cytokines

It is involved in innate immune response and inflammatory response [54]. The treatment of HeLa cells with purslane polysaccharide POL-P3b increases the expression of TLR4 in cells and inhibits the downstream signaling pathway of TLR4, eventually up-regulating Bax and down-regulating the level of Bcl-2 [55]. Salvia miltiorrhiza polysaccharide promotes the expression of TLR1, TLR2, TLR4 and the formation of TLR-MyD88 complex by binding to TLR receptors on the surface of T cells, thereby activating the proliferation of T lymphocytes in the peripheral blood of tumor patients and enhancing their killing effect on tumors [56] ].

10.3 Mitogen-activated protein kinase/NF-κB (MAPK/NF-κB) The MAPK/NF-κB pathway is often involved in tumor suppression as a downstream signal of TLR4 expression. Among them, traditional Chinese medicine polysaccharides mainly induce early autophagy of tumors by regulating MAPK [57] ], NF-κB is involved in the regulation of cytokine production and plays an important role in regulating inflammation, immune response and apoptosis [58]. Lotus leaf polysaccharide LLWP activates MAPK/NF-κB signaling pathway by inducing ERK, JNK, p38 phosphorylation, activates macrophages and produces NO, IL-6 and TNF-α

[59]. Polygonatum polysaccharide PSP improves the spleen index and thymus index of tumor-bearing mice by mediating the MAPK/NF-κB pathway, increases the ratio of CD4+/CD8+ T cells, and promotes IL-1β, IL-6, IL-12p70, TNF-α secretion, resulting in anti-tumor effect [60]. In addition, traditional Chinese medicine polysaccharides also promote the proliferation of mononuclear cells (PBMC) by regulating the MAPK/NF-κB pathway [61], enhance the phagocytic activity of macrophages [62], and increase the levels of IL-2, IL-17A, and IFN-γ. [63].

10.4 Vascular aging Adenosine monophosphate-activated protein kinase/rapamycin (AMPK/mTOR) The AMPK/mTOR pathway is closely related to autophagy. When tumor cells are starved, hypoxia or receive other specific stimuli, AMPK acts as a Energy sensors are activated to promote metabolic reprogramming and alter cellular metabolic pathways to maintain energy balance [64]. At the same time, the activation of AMPK induces the dephosphorylation of mTOR, thereby regulating cell proliferation and metabolism [65]. Studies have shown that Dendrobium officinale polysaccharide DOP can increase ROS and reduce mitochondrial membrane potential, thereby activating the AMPK/mTOR pathway, inhibiting the proliferation of colon cancer cells CT26 and promoting autophagy [27].

10.5 EGFR/ERK EGFR, a member of the ErbB receptor family, is the first tumor-associated tyrosine kinase, and its overexpression and activation are often associated with tumor metastasis, drug resistance, and poor prognosis [66]. The polysaccharide HDP of A. chinensis at 25, 50, 100 mg·L-1

It can effectively inhibit the EGFR/ERK signaling pathway in A549, down-regulate the expressions of cyclooxygenase-2 (COX-2), MMP-2, MMP-9 and EMT markers vimentin and N-cadherin, and up-regulate the expression of EMT. -cadherin, thereby inhibiting the metastatic ability of A549 [67].

10.6 p53

p53 is a tumor suppressor gene, and about 50% of human tumors are associated with mutations in TP53 [68]. The p53 pathway is a mTOR-independent autophagy-related pathway. When TP53 is mutated, it further leads to the inactivation of p53 and regulates the expression of genes related to tumor cell metabolism, proliferation, and aging [69]. Wang et al. [70] intervened in tumor cells by ginger polysaccharide GP in vitro, and found that GP not only regulates Bax, Fas, FasL, and Caspase-3 through thiazolyl blue (MTT) colorimetry, reactive oxygen species (ROS) detection, and flow cytometry. , Bcl-2 expression, in addition to the apoptosis of HepG2 through the death receptor pathway, GP also up-regulates the expression of intracellular p21 and p53, so that the cell cycle of HepG2 is arrested in the G0/G1 phase.

10.7 Wnt/β-catenin (Wnt/β-catenin)

The Wnt/β-catenin pathway induces epithelial-mesenchymal transition and inhibits downstream gene expression to promote tumor growth and metastasis. Among them, β-catenin, as a key target protein regulating the Wnt pathway, forms a complex, which leads to the phosphorylation of β-catenin and activates the Wnt/β-catenin pathway [71]. Elimination of Acanthopanax senticosus polysaccharide down-regulates MMP-2, MMP-9, FN1, vimentin, on

In addition to regulating E-cadherin and inhibiting the epithelial-mesenchymal transition of NCl-H520 cells, it can also inhibit the invasion and metastasis of non-small cell lung cancer [24].

In summary, the anti-tumor mechanism of traditional Chinese medicine polysaccharides involves multiple signaling pathways, and many pathways work synergistically and influence each other to form a complex molecular mechanism network. achieve the purpose of suppressing tumors. At the same time, there are still many signaling pathways related to the anti-tumor effect of traditional Chinese medicine polysaccharides that need further research and discovery. For the anti-tumor effects of traditional Chinese medicine polysaccharides and their mechanisms, see Enhanced Publishing Additional Materials.

11 Summary and Outlook

In recent years, the number of patients with tumors has been increasing. Although new treatment methods are used in clinical treatment, their prices are high and it is difficult for tumor patients to afford them. Conventional therapies such as radiotherapy and chemotherapy have large adverse reactions and are prone to drug resistance, which is not conducive to long-term treatment. The anti-tumor effect of traditional Chinese medicine is remarkable. As one of the main natural active components of traditional Chinese medicine, polysaccharide has a simple preparation method. It can inhibit tumor cell proliferation, promote apoptosis, induce tumor autophagy, affect cell cycle, and inhibit tumor angiogenesis.

It can directly kill tumors by regulating EMT, pro-oxidative stress, etc. It also improves the tumor microenvironment and regulates the body's anti-tumor immunity by regulating the production of various tumor-related immune cells and immune factors. In addition, traditional Chinese medicine polysaccharides can regulate PI3K/Akt, TLR4, MAPK/NF-κB,

AMPK/mTOR, EGFR/ERK, p53 and Wnt/β-catenin and other related signaling pathways play an anti-tumor effect.

The above studies have shown that traditional Chinese medicine polysaccharides have significant anti-tumor effects and are new anti-tumor drugs worthy of further research and development. This paper summarizes the molecular mechanism and related signaling pathways of Chinese medicine polysaccharides in anti-tumor in recent years, which strengthens researchers' understanding of Chinese medicine polysaccharides in anti-tumor to a certain extent. However, the current research methods on the anti-tumor of traditional Chinese medicine polysaccharides are limited, lack of various experimental verifications, and the molecular mechanism is not completely clear; the research on the molecular mechanism mostly focuses on conventional anti-tumor targets, and for genes with good tumor suppressor effects There are few studies on the targets and mechanisms; the research objects are mainly concentrated on common Chinese medicinal materials, and most of them are tonic Chinese medicines, and there are still many anti-tumor effects of traditional Chinese medicine polysaccharides.

Clinical anti-tumor drugs are often used in combination, and it is still unclear how effective the combination of traditional Chinese medicine polysaccharides and other drugs is, and whether it can reduce toxicity and enhance efficacy. Therefore, more anti-tumor effects of traditional Chinese medicine polysaccharides can be explored in the future, and their molecular mechanisms can be clarified through in vitro and in vivo experiments and clinical trials. With the in-depth development of research, the value of traditional Chinese medicine polysaccharides in tumor treatment will gradually be reflected, and it is expected to become a commonly used clinical anti-tumor drug.

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