International Journal of Molecular Medical Science, 2024, Vol.14, No.6, 324-341 http://medscipublisher.com/index.php/ijmms 334 release and targeted delivery to the tumor site (Li et al., 2023). This targeted approach not only maximizes the therapeutic effects but also minimizes systemic toxicity. Figure 7 Anti-tumor mechanism of natural polysaccharides (Adopted from Ying and Hao, 2023) Image caption: Polysaccharides not only induce apoptosis by directly acting on tumor cells, but also inhibit the occurrence and development of tumors by acting on tumor microenvironment (TME); Among them, (A) indicates that natural polysaccharides promote the expression of cytokines such as IL-2, IFN-γ and IL-12, inhibit the expression of cytokines such as IL-4, IL-5, IL-10 and IL-13, resluting in promoting the differentiation of Th0 cells into Th1 cells, which have anti-tumor effect. What’s more, natural polysaccharides activate DC cells, allowing them to function normally in antigen presentation; (B) indicates that polysaccharide reduces the concentration of cytokines such as IL-6, IL-10, COX-2 and TGF-β in TME, so as to promote the differentiation of M1 macrophages,which play an anti-tumor role; (C) indicates that polysaccharides down regulate the expression of VEGF and so inhibit tumor related angiogenesis; (D) shows the direct anti-tumor effect of natural polysaccharides: cell cycle arrest and inducing apoptosis (Adopted from Ying and Hao, 2023) Chemical modifications of polysaccharides, such as sulfation, phosphorylation, and selenylation, have been shown to further enhance their antitumor activities and improve their physicochemical properties, such as water solubility and molecular weight (Xie et al., 2020; Li et al., 2021). These modifications can lead to more effective interactions with conventional chemotherapy drugs, resulting in a more robust antitumor response. 6.3 Clinical prospects of combined therapy The clinical prospects of combining Sanghuangporus polysaccharides with conventional antitumor drugs are highly promising. The synergistic effects observed in preclinical studies suggest that such combinations could lead to more effective and less toxic cancer treatments. Polysaccharides' ability to enhance the efficacy of chemotherapy drugs while reducing their side effects makes them attractive candidates for adjuvant therapy in clinical settings (Chen and Huang, 2018; Yang et al., 2021). Moreover, the use of polysaccharides in combination with other therapeutic modalities, such as immunotherapy, photodynamic therapy, and photothermal therapy, has shown potential in preclinical studies. These combination
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