# The Potential Role of Timosaponin-AIII in Cancer Prevention and Treatment
## 1 Introduction  
Cancer, which is characterized by the dysregulated growth and proliferation of cells, has become one of the main causes of death worldwide. It is estimated that the number of new cancer cases increased by 19.3 million in 2020 and may continue to increase to 30.2 million by 2040 [1]. The World Health Organization (WHO) has reported that there will be 27 million new cancer cases and 17.1 million deaths by 2050 [2]. Extensive investigations and understanding of the pathogenesis of cancers have been advanced. Treatment options, such as surgery, chemotherapy, and radiotherapy, have been widely used in clinics. However, current strategies for cancer treatment are unsatisfactory due to their limited safety and effectiveness [1]. Developing efficient and safe chemotherapy agents for cancer treatment is still needed. The anticancer effects of chemotherapy agents could be associated with the disruption of the cell cycle, the induction of apoptosis, the regulation of autophagy, suppression of angiogenesis, the inhibition of migration and invasion, and the improvement of multidrug resistance [3, 4].  
Natural products display a role in the prevention and treatment of cancers, and these can be further developed as novel candidates or anticancer agents. Bioactive compounds derived from natural products and primarily traditional medicinal plants are commonly used worldwide [5]. _Anemarrhena asphodeloides_ Bunge (Figure 1), also known as Zhimu in Chinese, has been frequently used in traditional medicine in China, Japan, and Korea to treat various diseases, such as diabetes, hematochezia, arthralgia, coughs, and hemoptysis [6]. A phytochemical investigation into Zhimu has revealed that steroid saponins,phenylpropanoids, flavonoids, alkaloids, anthraquinones, and organic acids are its main constituents [6]. In addition, steroid saponin constituents, such as Timosaponin-AIII (TSAIII, Figure 1), Timosaponin-BII (TSBII), sarsasaponin, xanthones, and anemarsaponin, are one of the natural compound classes. Steroid saponins structurally consist of a lipophilicsteroidal derivative and a hydrophilic glycoside moiety. Due to different sugar moiety substituents and sapogenins, saponins have diverse compounds [7].  
Pharmacological assays for screening bioactive ingredients in Zhimu show that TSAIII is one of the natural steroidal saponins with multiple biological activities, such as antipyretics, anti-inflammation, antioxidation, antiplatelet aggregation, and antidepression [8]. Importantly, TSAIII has become one of the markers for the quality control of various _A. asphalodeloides_ Bunge-containing formulae, including Guizhi/Shaoyang/Zhimu formula, Zhimu/Bihre formula, TongGuan Wan, and _Rhizoma anemarhenae/Phellodendron_ formula [6; 9; 10; 11; 12]. Natural saponins have been demonstrated to have anticancer effects [13], and TSAIII has shown efficacy in different diseases, including Alzheimer's disease (AD), diabetes, colitis, and cancer [8; 14; 15; 16]. TSAIII has been proposed as a potent anticancer agent [8; 9]. Recently, research on anticancer drugs has entered the fast lane. Informative data on the pharmacological activities of TSAIII are explosive. In this article, the anticancer effects of TSAIII are comprehensively updated.