# Kochiae Fructus, the Fruit of Common PotherbKochia scoparia (L.) Schrad: A Review on Phytochemistry, Pharmacology, Toxicology, Quality Control, and Pharmacokinetics

Authors: Wei Zou; Zhong Tang; Yao Long; Zuoqi Xiao; Bo Ouyang; Menghua Liu
Journal: Evidence-Based Complementary and Alternative Medicine
 (2021)

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## Abstract

Kochiae Fructus (KF) is the fruit of an annual potherbKochia scoparia (Linn.) Schrad and has been traditionally used for the treatment of diseases in the skin, eyes, and urinary tract for thousands of years in China. Recent studies have showed its anti-inflammatory, antifungal, antiallergic, and antipruritogenic effects to clarify the mechanisms of these actions. Meanwhile, its other effects, such as anticancer, hypoglycemic, and hepatoprotective effects, also have been reported. The achievement of these therapeutic effects is contributed by its chemical constituents. A total of 153 compounds have been identified in KF, mainly including triterpenoids, flavonoids, carbohydrates, amino acids, organic acids, and essential oils. Momordin Ic is the representative triterpene glycoside compound, which is used as a phytochemical marker for the quality control of Kochiae Fructus. The research on toxicity is insufficient, and only one article reported that the LD50 was 7.15 ± 0.03 g/kg for water extract of KF after oral administration in KM mice. In addition, the pharmacokinetic study was carried out on momordin Ic with linear pharmacokinetic characteristics. Above all, this review provides comprehensive information about Kochiae Fructus and may provide the theoretic foundation of its clinical application and further development.


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## Body

## 1. Introduction

Kochia scoparia (Linn.) Schrad (shown in Figure 1(a)), also called Bassia scoparia (L.) A.J. Scott, is a large annual potherb in the family Chenopodiaceae widely distributed in Europe and Asia and naturalized in Africa, Australia, and North and South America [1]. Kochia Fructus (KF, shown in Figure 1(b)) is the fruit of Kochia scoparia, which is a spheroidal pentagram with a diameter of 1 to 3 mm [2]. It was first recorded in “Shennong Ben Cao Jing” as a “top grade” medicinal material. Up to now, KF has been used in traditional Chinese and Japanese medicine more than 2000 years for the treatment of diseases of the skin, eyes, and urinary tract [3]. With the deepening and development of pharmacology research, it has attracted attention particularly because of its antibacterial, anti-inflammatory, antiallergic, antigastric mucosal damage, hypoglycemic, and immunity enhancing effects [4]. Recently, researchers demonstrated that KF mainly contains terpenoids, flavonoids, essential oils, trace elements, and other ingredients. Although there were many researches on the chemical constituents, pharmacological activities of KF, a systematic and updated review is unavailable. Therefore, the aim of this review is to extensively summarize the phytochemistry, pharmacology, quality control, toxicology, and pharmacokinetics of KF, as well as providing novel insights for clinical uses and further researches.Figure 1
(a) The potherb ofKochia scoparia (L.) Schrad (http://www.cvh.ac.cn/spms/detail.php?id=f27a89aa) and (b) its fruit Kochiae Fructus.


## 2. Phytochemistry

With the advancement of analysis technologies such as liquid chromatograph-mass spectrometer (LC-MS), nuclear magnetic resonance-mass spectrometer (NMR-MS), and gas chromatography-mass spectrometer (GC-MS), identification of various components in traditional Chinese medicine has been simplified. To date, 153 compounds within KF, including 25 triterpenoids, 13 flavonoids, 22 carbohydrates (primarily mono- and disaccharides), 21 amino acids, 9 organic acid, 49 essential oils, and 14 heterocyclics, have been identified (Table1 and Figure 2). Most of investigations indicated that triterpenoids are the main active ingredient within KF. They were characterized with tetracyclic or pentacyclic rings by the polymerization of isoprene. Among them, momordin Ic is a representative triterpenoid saponin with anti-inflammatory effect [5]. Flavonoids were another major component within KF [12]. Most of them are derivatives of flavonol aglycones including quercetin and isorhamnetin. The carbohydrates of flavonoid glycosides are glucopyranose, rhamnose, and galactose. Besides, other flavonoids such as 5,7,4′-trihydroxy-6,3′-dimethoxyflavone and 5,7,4′-dihydroxy-6-methoxyflavone were characterized by LC-MS [6]. KF contains many kinds of amino acid, and current research suggests that certain functional amino acids can play a pharmacological role through the gut-microbiome-immune axis [17]. The essential oil within KF is high fatty acid ester. Yang et al. used a supercritical CO2 extraction method combined with a gas chromatography-mass spectrometer (GC-MS) method to qualify these essential oil components [14]. Eighteen compounds were isolated and identified, most of which were fatty acid esters and aromatic compounds. The level of the higher fatty acid ester is high, and the relative amount of 9,12-octadecadienoic acid is the highest in oil, followed by 9-octadecenoic acid. Wen et al. used the GC-MS method to qualitatively analyze the essential oil within KF [15]. Compared with the standard mass spectrum, 36 components were identified. Among them, the relative level of high fatty acid esters is the highest, and the amount of terpenoids is small.Table 1
Chemical compounds identified in Kochiae Fructus.
No.CompoundsFormulaRef.Triterpenoids120-HydroxyecdysoneC27H44O7[5]2β-SitosterolC29H50O[6]3Momordin IcC41H64O13[7]4Oleanic-acid-3-O-β-D-xylopyranosly(1⟶3)-β-D-glucopyranosideC41H65O12[7]5Momordin IC41H64O13[7]6Oleanolic acidC30H48O3[7]7Oleanolic acid 3-O-glucuronideC36H56O9[7]8Oleanolic acid 3-O-β-D-glucopyranosideC36H56O8[7]928-O-Deglucosyl-chikusetsusaponin VC42H66O14[7]102′-O-Glucopyranosyl-momordin IcC48H76O19[7]11Chikusetsusaponin VC48H76O19[7]12Momordin IIcC47H74O18[7]13Kochianoside IC36H56O10[8]14Kochianoside IIC47H74O18[8]15Kochianoside IIIC41H64O14[8]16Kochianoside IVC41H64O13[8]17DaucosterolC35H60O6[6]18Oleanolic acid 3-O-β-D-xylopyranosyl(1⟶3)-β-D-glucopyranosiduronic acid 6-methyl esterC42H66O13[6]193-O-β-D-Glucuronopyranosy-28-O-β-D-glucuronopyranosyl-oleanic-acidC42H66O14[6]20Oleanolic acid 3-β-D-glucopyranosiduronic acid 6-methyl esterC37H58O9[9]21Stigmasterol-3-O-β-D-glucopyranosideC35H58O6[8]22Oleanic-acid-3-O-[β-D-glucopyranosyl(1⟶2)-β-D-xylopyranosly(1⟶3)]-β-D-glucopyranosiduronic acidC47H74O18[10]236′-Methyl ester of momordin IcC42H66O13[11]242′-O-β-D-Glucopyranosyl momordin IcC47H74O18[11]252′-O-β-D-Glucopyranosyl momordin IIcC53H84O23[11]Flavonoids26Quercetin 3-O-β-D-apiofuranosyl-(1⟶2)-β-D-galactopyranosyl-7-O-β-D-glucopyranosideC32H38O21[12]27Quercetin 3-O-α-L-rhamnopyranosyl-(1⟶6)-β-D-galactopyranosyl-7-O- β-D-sophorosideC39H50O26[12]28Quercetin 7-O-β-D-glucopyranosideC21H20O12[12]29Quercetin 3-O-β-D-sophorosideC27H30O17[12]30Quercetin 3-O-β-D-galactopyranosyl-7-O-β-D-glucopyranosideC27H30O17[12]31Quercetin 3-O-β-D-apiofuranosyl-(1⟶2)- β-D-galactopyranosideC26H28O16[12]32IsorhamnetinC16H12O7[6]33QuercetinC15H10O7[6]34RutinC27H30O16[6]35Isorhamnetin-3-O-glucosideC22H22O12[6]365,7,4′-Trihydroxy-6,3′-dimethoxyflavoneC17H14O7[6]375,7,4′-Dihydroxy-6-methoxyflavoneC16H12O6[6]38HyperosideC21H20O12[10]Carbohydrates39SorbitolC6H14O6[13]40GlucoseC6H12O6[13]41GalactopyranoseC6H12O6[13]42FructoseC6H12O6[13]43Inositol-scyllo[13]44TrehaloseC12H22O11[13]45SucroseC12H22O11[13]46N-Acetyl glucosamineC8H15NO6[13]47MannitolC6H14O6[13]48MannoseC6H12O6[13]49GlucosamineC6H13NO5[13]50Glycerophosphoric acidC3H9O6P[13]51RhamnoseC6H12O5[13]52RibitolC5H12O5[13]53XyluloseC5H10O5[13]54ErythritolC4H10O4[13]552-O-Glycerol-α-D-galactopyranosideC9H18O8[13]56MaltitolC12H24O11[13]57MelibioseC12H22O11[13]58XyloseC5H10O5[13]59RiboseC5H10O5[13]60ArabinoseC5H10O5[13]Amino acids61TryptophanC11H12N2O2[13]62TyrosineC9H11NO3[13]63PhenylalanineC9H11NO2[13]64MethionineC9H11NO2[13]65Glutamic acidC5H9NO4[13]66LysineC6H14N2O2[13]67GlutamineC5H10N2O3[13]68Aspartic acidC4H7NO4[13]69AsparagineC4H8N2O3[13]70LeucineC6H13NO2[13]71IsoleucineC6H13NO2[13]72Pyroglutamic acidC5H7NO3[13]73ThreonineC4H9NO3[13]74ValineC5H11NO2[13]75ProlineC5H9NO2[13]76SerineC3H7NO3[13]77AlanineC3H7NO2[13]78GlycineC2H5NO2[13]79OrnithineC5H12N2O2[13]80CysteineC3H7NO2S[13]81β-AlanineC3H7NO2[13]Organic acid82Glucaric acidC6H10O8[13]83Gluconic acidC6H12O7[13]84Glucuronic acidC6H10O7[13]85Citric acidC6H8O7[13]86Gluconic acid-1,5-lactoneC6H10O6[13]87Threonic acidC4H8O5[13]88Malic acidC4H6O5[13]89Malonic acidC3H4O4[13]90Oxalic acidC2H2O4[13]Essential oils91α-PineneC10H16[14]922-CampheneC10H16[14]939-Hexadecenoic acidC16H30O2[14]94Hexadecenoic acidC16H30O2[14]95Ethyl hexadecenoic acidC18H34O2[14]969,12-Octadecadienoic acidC18H32O2[14]97Ethyl 9,12-octadecadienoic acidC20H36O2[14]989-Ethyl octadecanoateC20H38O2[14]99Stearic acidC18H36O2[14]100Methyl hexadecanoateC17H34O2[14]101Methyl hexadecenoic acidC17H32O2[14]102Octadeca-9,12,15-trienoic acidC18H30O2[14]103Methyl 9-octadecenoic acidC19H36O2[14]104Methyl 10-octadecenoic acidC19H36O2[14]105Octadecenoic acidC19H34O2[14]106Methyl 11-eicosenoic acidC21H40O2[14]107Methyl eicosenoic acidC21H42O2[14]108Benzene, 1-methyl-2-propyl-C10H14[15]109Cyclohexene, 1-methyl-4-(1-methylethenyl)-C10H10[15]110(E)-3,7-Dimethyl-2,6-octadienalC10H16O[15]111Methyl 2-methyl-octanateC10H20O2[15]112Benzene, 1-methoxy-4-(1-propenyl)-C10H12O[15]113Methyl nonanoateC10H20O[15]1141-UndecyneC11H20[15]115Ethyl nonanoateC11H22O2[15]116NaphthaleneC11H10[15]117Bicyclo(4,3,1)decan-10-oneC10H16O[15]1185-Ethyl-2-nonanolC11H24O[15]1194,8-Dimethyl-1-nonanolC11H24O[15]120(Z)-β-FarneseneC15H24[15]121trans-β-FarneseneC15H24[15]1222,6-Di-T-butyl-1,4-benzoquinoneC14H20O[15]123β-IononeC13H20O[15]124Naphthalene, 1,2,3,5,6,7,8a-octahydro-1,8a-demethyl-7-(1-methyethyl)-[1R-(1α,7β,8aα)]-C15H24[15]125β-ChamigreneC15H24[15]126Ethyl dodecanoateC14H28O2[15]127HexadecaneC16H34[15]128Methyl tetradecanoateC15H30O2[15]129Benzene, 1,1’-(1,2-ethynediyl)bis-C14H10[15]130OctadecaneC18H38[15]1312-Pentadecanone, 6,10,14-trimethyl-C18H36O[15]132Ethyl pentadecanoateC17H34O2[15]133Ethyl hexadecanoateC18H36O2[15]134EicosaneC20H42[15]135Methyl octadecadienoateC19H34O2[15]136HeneicosaneC21H44[15]137Ethyl-octadecadienoateC20H36O2[15]138Ethyl octadecanoateC20H40O2[15]139DocosaneC22H46[15]Heterocyclics140OleamideC18H35NO[13]141EthanolamineC2H7NO[13]142UridineC9H12N2O6[13]143Uric acidC5H4N4O3[13]144GuanineC5H5N5O[13]145AdenineC5H5N5[13]146SpermidineC7H19N3[13]147PutrescineC4H12N2[13]148Ethylene glycolC2H6O2[13]149UreaCH4N2O[13]150AllantoinC4H6N4O3[13]151ThymineC5H6N2O2[13]1522-(4-Hydroxy-3-methoxyphenyl)-ethanolC9H12O3[13]153DopamineC8H11NO2[16]Figure 2
Chemical structures of substances within Kochiae Fructus.
(a)(b)(c)(d)


## 3. Pharmacology

Traditionally, according to records of “Shennong Ben Cao Jing,” KF was used with the therapeutic effects of diuresis and benefiting pneuma. Compendium of Materia Medica described that the KF could be used in the treatment of red eyes, hemntodiarrhoea, pregnancy combined with gonorrhea, and urinary stoppage [18]. Many other books also depicted the traditional use of KF, which are summarized in Table 2. Modern investigations have proved that KF has anti-inflammatory, hypoglycemic, anticancer, antifungal, antipruritogenic, and antinociceptive effects, as well as antiallergic, antiedema, and hepatoprotective activities. We have enlisted an overview of the pharmacological studies in the following sections (Table 3).Table 2
Traditional uses of Kochiae Fructus (KF) referring to database “https://www.yaozh.com.”
Traditional usesReferenceKF is used to treat frequent urination, urinary incontinence, and abnormal leucorrhea and has an effect of strengthening earsBen Cao Qiu YuanKF is used to treat frequent urination and urinary incontinence and has an effect of strengthening earsBen Cao Qiu ZhenKF has an effect of heat-clearingBen Cao ShuKF is used to treat skin itching and eczema and has effects of reducing swelling and improving eyesight and earsYao JianKF is good for urinating and has effects of improving eyesight and ears and antiagingBen JingKF is used to treat eczemaBie LuKF has an effect for urinatingBen Cao Zheng YiKF is used to treat male impotenceYao Xing LunKF has an effect of reducing swellingRi Hua Zi Ben CaoKF is used to improve urination problems, treat rubella, and abnormal vaginal dischargeDian Nan Ben CaoKF is used to treat itchy skinBen Cao Yuan ShiKF can help urinationBen Cao Bei YaoKF is used to treat swelling and pain of the head and eyes, back pain, blood in the stool, and malignant soresYu Qiu Yao JieTable 3
Pharmacological effects of Kochiae Fructus (KF).
Pharmacological effectModelAdministrationMinimal active concentrationReferenceAnti-inflammatory effectThe ddY mice in an acetic acid-induced vascular permeabilityTested drug: 70% ethanol extract of KF at the doses of 50, 200, and 500 mg/kg, p.o.Positive control: indomethacin at 10 mg/kg200 mg/kg[19]The ddY mice in a carrageenin-induced edemaTested drug: 70% ethanol extract of KF at the doses of 50, 200, and 500 mg/kg, p.o.Positive control: indomethacin at 10 mg/kg200 mg/kg[19]The ddY mice in a compound 48/80-induced edemaTested drug: 70% ethanol extract of KF at the doses of 50, 200, and 500 mg/kg, p.o.Positive control: diphenhydramine at 50 mg/kg500 mg/kg[19]The ddY mice in a chemical mediator-induced edemaTested drug: 70% ethanol extract of KF at the doses of 50, 200, and 500 mg/kg, p.o.Positive control: cyproheptadine at 2 mg/kg; diphenhydramine at 50 mg/kg200 mg/kg[19]The isolated ileum of guinea pig in a histamine-induced contractionTested drug: 70% ethanol extract of KF at the doses of 10, 50, 100, and 300μg/mL220μg/mL[19]The ddY mice in an arachidonic acid-induced edemaTested drug: 70% ethanol extract of KF at the doses of 50, 200, and 500 mg/kg, p.o.Positive control: phenidone at 20 mg/kg, i.v.500 mg/kg[19]A picryl chloride-induced ear inflammatory model in ICR miceTested drug: 70% ethanol extract of KF at the doses of 100, 200, and 500 mg/kg, i.g.Positive control: prednisone at 50 mg/kg500 mg/kg[20]A dinitrochlorobenzene-induced allergic contact dermatitis model in ratsTested drug: total flavonoids of KF at the doses of 100 and 200 mg/kg. p.o.Positive control: sodium prednisolone acetate at 2.5 μg/mL100 mg/kg[21]A DNFB-induced contact dermatitis model in miceTested drug: methanol extract of KF at the doses of 30, 100, and 300μg/ear for external usePositive control: dexamethasone at 75 μg/ear100μg/ear[22]The ddY mice in a carrageenin-induced edemaTested drug: momordin Ic at the doses of 20, 50, and 100 mg/kg, p.o.Positive control: indomethacin at 10 mg/kg20 mg/kg[19]LPS-stimulated RAW 264.7 cell lineTested drug: 20-hydroxyecdysone, momordin Ic, and oleanolic acid with various concentrations (6.25, 12.5, or 25μM)Positive control: indomethacin at 2.5 ng/mL6.25μM[5]Hypoglycemic effectNormal, alloxan-induced hyperglycemic and insulin-induced hypoglycemic miceTested drug:n-butanol extract of KF at the doses of 25 and 50 mg/kg, p.o.25 mg/kg[23]Examining the activity ofα-glucosidase in rat intestine in vitroTested drug:n-butanol extract of KF at the doses of 62.5, 125, 250, and 500 μg/mLPositive control: acarbose at 2 μg/mL125μg/mL[23]Examining the ability of glucose absorption in rat intestine in vitroTested drug:n-butanol extract of KF at the doses of 0, 100, 200, 400, and 800 μg/mL100μg/mL[23]Testing the propulsive function of small intestine in normal, fenfluramine-treated, dopamine-treated, acetic acid-treated, and Nω-nitro-L-arginine-treated ratsTested drug:n-butanol extract of KF at the doses of 25 and 50 mg/kg, p.o.50 mg/kg[24]Testing the gastric emptying in ratsTested drug: oleanolic acid 3-O-glucuronide and momordin Ic at the doses of 12.5, 25, and 50 mg/kg, p.o.Positive control: atropine sulfate at 10 mg/kg25 and 12.5 mg/kg, respectively[25]Testing the glucose uptake in rat small intestine in vitroTested drug: oleanolic acid 3-O-glucuronide and momordin Ic at the doses of 0, 5, 50, and 500μMPositive control: phlorizin at 1 μM50 and 5μM, respectively[25]Gastric emptying test on 1.5% carboxymethyl cellulose sodium salt test meal-loaded mice, 40% glucose test meal-loaded mice, milk test meal-loaded mice, and 60% ethanol test meal-loaded miceTested drug: momordin Ic in the dose range of 12.5–50 mg/kg, p.o.50 mg/kg[3]Anticancer effectsAntiliver cancerInducing apoptosis of human hepatocyte carcinoma HepG2 cellsTested drug: momordin Ic in the concentration range of 10–30μM15μM[26]Inducing autophagy of human hepatocyte carcinoma HepG2 cellsTested drug: momordin Ic in the dose range of 5–20μM10μM[27]Inducing apoptosis of human hepatocyte carcinoma HepG2 cellsTested drug: momordin Ic in the dose range of 5, 10, and 15μM5μM[28]Suppressing invasion of human hepatocyte carcinoma HepG2 cellsTested drug: momordin Ic at the dose of 10μM10μM[29]Inhibiting migration and invasion of human hepatocyte carcinoma HepG2 cellsTested drug: momordin Ic in the dose range of 1–10μM5μM[30]Antiprostate cancerVEGF-induced angiogenesis in human umbilical vein endothelial cells and proliferation in prostate cancer cellsTested drug: methanol extract ofKF in the dose range of 10–20 μg/mL and 10–250 μg/mL, respectively20μg/mL and 100 μg/mL, respectively[31]Testing the SUMO-specific protease 1 in prostate cancer cells and a xenograft PC3 tumor mouse modelTested drug: momordin Ic at the dose of 6.25, 12.5, and 25μM and 10 mg/kg/day, i.p. For 20 days, respectivelyIC50 was 15.37 μM and 10 mg/kg/day[32]Antifungal effectIn vitro for Trichophyton mentagrophytes, Trichophyton rubrum, Microsporum canis, Trichophyton violaceum, and Trichophyton schoenleiniiTested drug: water extract of KF in the concentration range of 0.04%–25%3.12%[33]Inhibiting the growing ofFusarium graminearum, Fusarium oxysporum, Monilia cinerea, Physalos porapiricola, Alternaria alternata, and Valsa maliTested drug: water, petroleum ether, chloroform, ethylacetate, and methanol extract ofKF with the concentration of dose 1 mg/15 mL1 mg/15 mL[34]In vitro for Microsporum ferrugineum, Microsporum gypseum, Trichophyton schoenleini, Trichophyton mentagrophytes, Trichophyton violaceum, Trichophyton rubrum, Epidermophyton floccosum, Aspergillus fumigatus, Candida albicans, Cryptococcus neoformansTested drug: the saponin extract, flavone extract I (40% alcohol eluent), flavone extract II (80% alcohol eluent), and lipid extract with no concentration mentionedAll samples have the antifungal effect onMicrosporum ferrugineum and Trichophyton rubrum, but the concentration was not mentioned[35]Antipruritogenic effectA compound 48/80-induced pruritogenic model in male ddY miceTested drug: 70% ethanol extract of KF at the dose of 200 and 500 mg/kg, p.o.200 mg/kg[36]Tested drug: methanol extract of KF at the dose of 50, 200, and 500 mg/kg, p.o.500 mg/kgTested drug: momordin Ic at the dose of 20, 50, and 100 mg/kg, p.o.Positive control: diphenhydramine at 20 mg/kg50 mg/kgItching guinea pig model caused by histamine itching mice modelTested drug: water extract of KF at the concentration of 0.15 g/mL, 0.3 g/mL, and 0.6 g/mL for external usePositive control: cyproheptadine0.15 g/mL[33]Antinociceptive effectThe ddY mice in an acetic acid-induced writhing testTested drug: 70% ethanol extract of KF at the dose of 50, 200, and 500 mg/kg, p.o.500 mg/kg[19]Tested drug: momordin Ic at the dose of 20, 50, and 100 mg/kg, p.o.Positive control: aspirin at 200 mg/kg20 mg/kgInhibition effect on hypersensitivityDTH models upon challenge with SRBC or PCTested drug: 70% ethanol extract of KF at the dose of 100, 200, and 500 mg/kg.Positive control: prednisone at 50 mg/kg100 mg/kg[20]Tested drug: total saponins extract of KF at the dose of 50, 100, and 200μg/mLPositive control: cyproheptadine at 20 mg/kg200 mg/kgMyocardial protectionA furazolidone-induced dilated cardiomyopathy model in Wistar ratsTested drug: water extract of KF at the dose of 5 and 20 mg/g, p.o.Negative model: water20 mg/g[37]Hepatoprotective effectCarbon tetrachloride-induced liver damage in ratsTested drug: momordin Ic and oleanolic acid at the dose of 30 mg/kg/day for 14 days, p.o.Negative control: saline30 mg/kg/day for 14 days[38]Protecting gastric mucosal lesionsEthanol-induced gastric mucosal lesions in rats and indomethacin-induced gastric mucosal lesions in ratsTested drug: momordin Ic in the dose range of 2.5–50 mg/kg, p.o.Positive control: omeprazole at 20 or 5 mg/kg, respectively5 mg/kg[39]Suppressing osteoclastogenesisA cocultured system and a RANKL-induced osteoclast precursor systemTested drug: momordin Ic in the dose range of 0.1–5μM0.5μM[40]Antibacteria effectMinimum inhibitory concentration (MIC) test onEscherichia coliTested drug: oleanolic acid in the dose range of 15.6–4000μg/mL31.3μg/mL[41]


### 3.1. Anti-Inflammatory Effect

Pharmacological studies showed that anti-inflammatory is a very significant pharmacological activity of KF. In six different animal models (the ddY mice in an acetic acid-induced vascular permeability, the ddY mice in a carrageenin-induced edema, the ddY mice in a compound 48/80-induced edema, the ddY mice in a chemical mediator-induced edema, the ddY mice in an arachidonic acid-induced edema, a picryl chloride-induced ear inflammatory model in ICR mice), the 70% alcohol extract of KF has been proved with obvious inhibition effect on the development of inflammation [19, 20]. The methanol extract of KF was used as a candidate drug for the treatment of inflammatory skin diseases due to its eutherapeutic effect on 1-fluoro-2,4-dinitrofluorobenzene-induced contact dermatitis mice model. The mechanism might be involved in inhibiting the skewing reaction of T helper cell type 1 [22]. The total flavonoids of the KF have shown an anti-inflammatory effect on the dinitrochlorobenzene-induced allergic contact dermatitis rats, and the most likely mechanism of this action involves regulating pERK1/2/TLR4-NF-κB pathway activation [42]. The anti-inflammatory effect of KF was coincident with its traditional use for inflammations in vagina and skin.Three triterpenoid saponins, namely, 20-hydroxyecdysone, momordin Ic, and oleanolic acid from KF have also been investigated on LPS-stimulated murine macrophage RAW 264.7 cell line. 20-Hydroxyecdysone performed significant inhibitory action on prostaglandin E2 (PGE2) generation at the dose of 12.5 μM, while momordin Ic and oleanolic acid showed the anti-inflammatory effect at the dose of 6.25 μM. In addition, momordin Ic significantly reduced productions of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) at the concentration of 12.5 μM [5].


### 3.2. Hypoglycemic Effect

KF has shown a potential hypoglycemic effect. Dai et al. illustrated thatn-butanol fraction of KF could markedly inhibit gastric emptying in normal mice and could more potently inhibit gastric emptying in hyperglycemic and hypoglycemic mice at the dose of 25 mg/kg. The hypoglycemic mechanism is probably related to transportation and transformation of sugar in the digestive tract and absorption of glucose via the membrane of the small intestine [23]. Subsequently, a research on the function of small intestine was implemented and it found that the n-butanol fraction with a dose of 50 mg/kg could improve the propulsive function of small intestine, and the mechanism of this action probably involves cholinergic nerve and nitric oxide [24].Matsuda et al. found that momordin Ic inhibited gastric emptying in rats and inhibited glucose uptake in the small intestinein vitro, which contributed to the hypoglycemic action of momordin Ic [25]. Further study showed that momordin Ic inhibits gastric emptying in normal mice, hyperglycemic (including diabetic) and hypoglycemic mice, nonnutrient meal-loaded mice, and nutrient meal-loaded mice [3]. When gastric emptying is slow, the postprandial absorption of food will prolong. Hence, the inhibition of gastric emptying induced by momordin Ic may be useful for the prevention and treatment of diabetes and the morbid obesity with accelerated gastric emptying.


### 3.3. Anticancer Effect

#### 3.3.1. Antiliver Cancer Effect

Momordin Ic was the main triterpenoid saponins within KF and has showed an antiliver cancer effect. Wang et al. have carried out a series of researches and found that HepG2 cells were sensitive to the cytotoxic effect of momordin Ic. Momordin Ic could induce apoptosis through oxidative stress-regulated mitochondrial dysfunction involving MAPK and PI3K-mediated iNOS and HO-1 pathways [26]. Based on these results, Wang et al. investigated the MAPK and PI3K pathways and their downstream proteins, such as PPARg and COX-2. Then, they provided the evidence that momordin Ic-induced HepG2 cell apoptosis was associated with PI3K and MAPK pathway-mediated PPARg activation [28]. In addition, Mi et al. showed that the underlying mechanisms of the cross-talk between apoptosis and autophagy involved ROS-related PI3K/Akt, MAPK, and NF-κB signaling pathways, and momordin Ic simultaneously induced apoptosis and autophagy by activating these intersecting signaling pathways [27]. The summarized signal pathway is presented in Figure 3. On the contrary, momordin Ic showed a good anti-invasive activity by altering E-cadherin, VCAM-1, ICAM-1, and MMP-9, and the underlying mechanism involved PPARγ activation and COX-2 inhibition [30].Figure 3
The signal pathways of antiliver cancer effect of momordin Ic.


#### 3.3.2. Antiprostate Cancer Effect

The MeOH extract of KF has shown inhibition effects on human umbilical vein endothelial cell angiogenesis and human prostate cancer cell proliferation [31]. As a member of the de-SUMOylation protease family, SUMO-specific protease 1 (SENP1) is elevated in prostate cancer (PCa) cells and is involved in PCa pathogenesis [43–46]. Momordin Ic as a novel SENP1 inhibitor could inhibit proliferation of prostate cancer cells in vitro and in vivo by inducing cell cycle arrest and apoptosis [32]. The possible mechanism is that momordin Ic could increase the sub-G1 phase cell population, increase numbers of annexin-V positive cells, increase active caspase-3, caspase-8, and PARP1 cleavage, and reduce cyclin B and CDK1 levels. Thus, it was considered that SENP1 may play an important role in momordin Ic-induced cell death in prostate cancer cells, even though the downstream effectors of SENP1 that mediate momordin Ic-induced apoptosis are currently unknown.


### 3.4. Antifungal Effect

In vitro, the water extract of KF showed a strong inhibition on common dermatophytes. Its minimum inhibitory concentration (MIC) on Trichophyton mentagrophytes was 3.12% and on Trichophyton rubrum, Microsporum canis, Trichophyton violaceum, and Trichophyton schoenleinii were 0.78% [33]. Wu et al. tested six KF extracts against Fusarium graminearum, Fusarium oxysporum, Monilia cinerea, Physalos porapiricola, Alternaria alternata, and Valsa mali. As a result, the water extract had the strongest inhibition effect on all six plant pathogenic bacteria with antifungal activities of more than 74.34%, and the water, petroleum ether, chloroform, ethylacetate, and methanol extracts showed stronger antifungal activities against Monilia cinerea and Valsa mali than the others [34]. In addition, the saponin extract, flavone extract I (40% alcohol eluent), flavone extract II (80% alcohol eluent), and lipid extract from KF were tested against Microsporum ferrugineum, Microsporum gypseum, Trichophyton schoenleini, Trichophyton mentagrophytes, Trichophyton violaceum, Trichophyton rubrum, Epidermophyton floccosum, Aspergillus fumigatus, Candida albicans, and Cryptococcus neoformans. The lipid extract showed a good antifungal effect on Microsporum ferrugineum, Microsporum gypseum, Trichophyton mentagrophytes, and Trichophyton rubrum; the saponin extract gave inhibition effects on Microsporum ferrugineum, Microsporum gypseum, Trichophyton schoenleini, Trichophyton mentagrophytes, and Trichophyton rubrum; the flavone extract I (40% alcohol eluent) exerted inhibition effects on Microsporum ferrugineum, Trichophyton rubrum, and Epidermophyton floccosum, whereas the flavone extract II (80% alcohol eluent) play an inhibitory role on Microsporum ferrugineum, Microsporum gypseum, and Trichophyton rubrum. Unfortunately, the MIC was not mentioned in this article [35]. Above all, this effect of KF supports its traditional use in gynecological infection.


### 3.5. Antipruritogenic Effect

The 70% ethanol extract (200 mg/kg) and methanol extract of KF (500 mg/kg) have been proved to inhibit the scratching behavior on a compound 48/80-induced pruritogenic model in male ddY mice [36]. Momordin Ic isolated from KF also exhibited an inhibition effect at a dose of 50 mg/kg. Meanwhile, in an itching guinea pig model and an itching mice model, the water extract of KF at the concentration of 0.15 g/mL could significantly decrease the number of itching and total time of itching within 30 minutes, indicating that KF could be used as an antipruritogenic agent [33]. These results agree with the traditional use of KF for itch.


### 3.6. Others

The inhibition effect of hypersensitivity of 70% ethanol and total saponin extracts from KF has been tested on DTH models upon challenge with SRBC or PC. As a result, the 70% ethanol extract produced a concentration-dependent reduction on immediate and delayed-type hypersensitivity, while total saponins extract showed an inhibitory tendency at 200 mg/kg [20]. This effect might have a close relationship with its stabilization of mast cell membrane, reduction of release of anaphylactic mediators, and anti-inflammatory activities [20]. The water extract of KF at the dose of 20 mg/g could reverse the imbalance of Th1/Th2 cell in rat model with dilated cardiomyopathy, which reduced the damage of immune response to myocardium and protected the heart function. Momordin Ic gave a protective effect on gastric mucosal lesions [37]. Kim et al. discovered that momordin Ic has a hepatoprotective effect against CCl4-induced liver damage because it could enhance the hepatic antioxidant defense system [38]. Meanwhile, as an AP-1 inhibitor, momordin Ic could downregulate NF-κB activation as well as AP-1 activation, which plays a key role in osteoclast differentiation, by inhibiting IκB degradation and c-Fos expression, respectively. Therefore, momordin Ic has high potential to be a good candidate for controlling bone disorders in the future [40]. In addition, the extracts of KF, including total flavonoid, saponin, and phenolic, were proved to have a good antioxidant activity by measuring free radical scavenging activities with ABTS, DPPH, or FARP assay [47–50]. Scavenging free radicals play a key role in aging and inflammation [51]. Therefore, its antioxidant effects need to be further studied on these aspects.The studies on toxicity of KF are scarce. Although KF is almost nontoxic in traditional use, the animal death was found when a large dosage is used. According to a toxicological study, when KM mice were orally administrated with water extract of KF in a dose range from 4.5 mg/kg to 9.4 mg/kg, the median lethal dose (LD50) was 7.15 ± 0.03 g/kg [35]. Therefore, the toxic and side effects of KF should be paid more attention in its clinical application.


## 3.1. Anti-Inflammatory Effect

Pharmacological studies showed that anti-inflammatory is a very significant pharmacological activity of KF. In six different animal models (the ddY mice in an acetic acid-induced vascular permeability, the ddY mice in a carrageenin-induced edema, the ddY mice in a compound 48/80-induced edema, the ddY mice in a chemical mediator-induced edema, the ddY mice in an arachidonic acid-induced edema, a picryl chloride-induced ear inflammatory model in ICR mice), the 70% alcohol extract of KF has been proved with obvious inhibition effect on the development of inflammation [19, 20]. The methanol extract of KF was used as a candidate drug for the treatment of inflammatory skin diseases due to its eutherapeutic effect on 1-fluoro-2,4-dinitrofluorobenzene-induced contact dermatitis mice model. The mechanism might be involved in inhibiting the skewing reaction of T helper cell type 1 [22]. The total flavonoids of the KF have shown an anti-inflammatory effect on the dinitrochlorobenzene-induced allergic contact dermatitis rats, and the most likely mechanism of this action involves regulating pERK1/2/TLR4-NF-κB pathway activation [42]. The anti-inflammatory effect of KF was coincident with its traditional use for inflammations in vagina and skin.Three triterpenoid saponins, namely, 20-hydroxyecdysone, momordin Ic, and oleanolic acid from KF have also been investigated on LPS-stimulated murine macrophage RAW 264.7 cell line. 20-Hydroxyecdysone performed significant inhibitory action on prostaglandin E2 (PGE2) generation at the dose of 12.5 μM, while momordin Ic and oleanolic acid showed the anti-inflammatory effect at the dose of 6.25 μM. In addition, momordin Ic significantly reduced productions of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) at the concentration of 12.5 μM [5].


## 3.2. Hypoglycemic Effect

KF has shown a potential hypoglycemic effect. Dai et al. illustrated thatn-butanol fraction of KF could markedly inhibit gastric emptying in normal mice and could more potently inhibit gastric emptying in hyperglycemic and hypoglycemic mice at the dose of 25 mg/kg. The hypoglycemic mechanism is probably related to transportation and transformation of sugar in the digestive tract and absorption of glucose via the membrane of the small intestine [23]. Subsequently, a research on the function of small intestine was implemented and it found that the n-butanol fraction with a dose of 50 mg/kg could improve the propulsive function of small intestine, and the mechanism of this action probably involves cholinergic nerve and nitric oxide [24].Matsuda et al. found that momordin Ic inhibited gastric emptying in rats and inhibited glucose uptake in the small intestinein vitro, which contributed to the hypoglycemic action of momordin Ic [25]. Further study showed that momordin Ic inhibits gastric emptying in normal mice, hyperglycemic (including diabetic) and hypoglycemic mice, nonnutrient meal-loaded mice, and nutrient meal-loaded mice [3]. When gastric emptying is slow, the postprandial absorption of food will prolong. Hence, the inhibition of gastric emptying induced by momordin Ic may be useful for the prevention and treatment of diabetes and the morbid obesity with accelerated gastric emptying.


## 3.3. Anticancer Effect

### 3.3.1. Antiliver Cancer Effect

Momordin Ic was the main triterpenoid saponins within KF and has showed an antiliver cancer effect. Wang et al. have carried out a series of researches and found that HepG2 cells were sensitive to the cytotoxic effect of momordin Ic. Momordin Ic could induce apoptosis through oxidative stress-regulated mitochondrial dysfunction involving MAPK and PI3K-mediated iNOS and HO-1 pathways [26]. Based on these results, Wang et al. investigated the MAPK and PI3K pathways and their downstream proteins, such as PPARg and COX-2. Then, they provided the evidence that momordin Ic-induced HepG2 cell apoptosis was associated with PI3K and MAPK pathway-mediated PPARg activation [28]. In addition, Mi et al. showed that the underlying mechanisms of the cross-talk between apoptosis and autophagy involved ROS-related PI3K/Akt, MAPK, and NF-κB signaling pathways, and momordin Ic simultaneously induced apoptosis and autophagy by activating these intersecting signaling pathways [27]. The summarized signal pathway is presented in Figure 3. On the contrary, momordin Ic showed a good anti-invasive activity by altering E-cadherin, VCAM-1, ICAM-1, and MMP-9, and the underlying mechanism involved PPARγ activation and COX-2 inhibition [30].Figure 3
The signal pathways of antiliver cancer effect of momordin Ic.


### 3.3.2. Antiprostate Cancer Effect

The MeOH extract of KF has shown inhibition effects on human umbilical vein endothelial cell angiogenesis and human prostate cancer cell proliferation [31]. As a member of the de-SUMOylation protease family, SUMO-specific protease 1 (SENP1) is elevated in prostate cancer (PCa) cells and is involved in PCa pathogenesis [43–46]. Momordin Ic as a novel SENP1 inhibitor could inhibit proliferation of prostate cancer cells in vitro and in vivo by inducing cell cycle arrest and apoptosis [32]. The possible mechanism is that momordin Ic could increase the sub-G1 phase cell population, increase numbers of annexin-V positive cells, increase active caspase-3, caspase-8, and PARP1 cleavage, and reduce cyclin B and CDK1 levels. Thus, it was considered that SENP1 may play an important role in momordin Ic-induced cell death in prostate cancer cells, even though the downstream effectors of SENP1 that mediate momordin Ic-induced apoptosis are currently unknown.


## 3.3.1. Antiliver Cancer Effect

Momordin Ic was the main triterpenoid saponins within KF and has showed an antiliver cancer effect. Wang et al. have carried out a series of researches and found that HepG2 cells were sensitive to the cytotoxic effect of momordin Ic. Momordin Ic could induce apoptosis through oxidative stress-regulated mitochondrial dysfunction involving MAPK and PI3K-mediated iNOS and HO-1 pathways [26]. Based on these results, Wang et al. investigated the MAPK and PI3K pathways and their downstream proteins, such as PPARg and COX-2. Then, they provided the evidence that momordin Ic-induced HepG2 cell apoptosis was associated with PI3K and MAPK pathway-mediated PPARg activation [28]. In addition, Mi et al. showed that the underlying mechanisms of the cross-talk between apoptosis and autophagy involved ROS-related PI3K/Akt, MAPK, and NF-κB signaling pathways, and momordin Ic simultaneously induced apoptosis and autophagy by activating these intersecting signaling pathways [27]. The summarized signal pathway is presented in Figure 3. On the contrary, momordin Ic showed a good anti-invasive activity by altering E-cadherin, VCAM-1, ICAM-1, and MMP-9, and the underlying mechanism involved PPARγ activation and COX-2 inhibition [30].Figure 3
The signal pathways of antiliver cancer effect of momordin Ic.


## 3.3.2. Antiprostate Cancer Effect

The MeOH extract of KF has shown inhibition effects on human umbilical vein endothelial cell angiogenesis and human prostate cancer cell proliferation [31]. As a member of the de-SUMOylation protease family, SUMO-specific protease 1 (SENP1) is elevated in prostate cancer (PCa) cells and is involved in PCa pathogenesis [43–46]. Momordin Ic as a novel SENP1 inhibitor could inhibit proliferation of prostate cancer cells in vitro and in vivo by inducing cell cycle arrest and apoptosis [32]. The possible mechanism is that momordin Ic could increase the sub-G1 phase cell population, increase numbers of annexin-V positive cells, increase active caspase-3, caspase-8, and PARP1 cleavage, and reduce cyclin B and CDK1 levels. Thus, it was considered that SENP1 may play an important role in momordin Ic-induced cell death in prostate cancer cells, even though the downstream effectors of SENP1 that mediate momordin Ic-induced apoptosis are currently unknown.


## 3.4. Antifungal Effect

In vitro, the water extract of KF showed a strong inhibition on common dermatophytes. Its minimum inhibitory concentration (MIC) on Trichophyton mentagrophytes was 3.12% and on Trichophyton rubrum, Microsporum canis, Trichophyton violaceum, and Trichophyton schoenleinii were 0.78% [33]. Wu et al. tested six KF extracts against Fusarium graminearum, Fusarium oxysporum, Monilia cinerea, Physalos porapiricola, Alternaria alternata, and Valsa mali. As a result, the water extract had the strongest inhibition effect on all six plant pathogenic bacteria with antifungal activities of more than 74.34%, and the water, petroleum ether, chloroform, ethylacetate, and methanol extracts showed stronger antifungal activities against Monilia cinerea and Valsa mali than the others [34]. In addition, the saponin extract, flavone extract I (40% alcohol eluent), flavone extract II (80% alcohol eluent), and lipid extract from KF were tested against Microsporum ferrugineum, Microsporum gypseum, Trichophyton schoenleini, Trichophyton mentagrophytes, Trichophyton violaceum, Trichophyton rubrum, Epidermophyton floccosum, Aspergillus fumigatus, Candida albicans, and Cryptococcus neoformans. The lipid extract showed a good antifungal effect on Microsporum ferrugineum, Microsporum gypseum, Trichophyton mentagrophytes, and Trichophyton rubrum; the saponin extract gave inhibition effects on Microsporum ferrugineum, Microsporum gypseum, Trichophyton schoenleini, Trichophyton mentagrophytes, and Trichophyton rubrum; the flavone extract I (40% alcohol eluent) exerted inhibition effects on Microsporum ferrugineum, Trichophyton rubrum, and Epidermophyton floccosum, whereas the flavone extract II (80% alcohol eluent) play an inhibitory role on Microsporum ferrugineum, Microsporum gypseum, and Trichophyton rubrum. Unfortunately, the MIC was not mentioned in this article [35]. Above all, this effect of KF supports its traditional use in gynecological infection.


## 3.5. Antipruritogenic Effect

The 70% ethanol extract (200 mg/kg) and methanol extract of KF (500 mg/kg) have been proved to inhibit the scratching behavior on a compound 48/80-induced pruritogenic model in male ddY mice [36]. Momordin Ic isolated from KF also exhibited an inhibition effect at a dose of 50 mg/kg. Meanwhile, in an itching guinea pig model and an itching mice model, the water extract of KF at the concentration of 0.15 g/mL could significantly decrease the number of itching and total time of itching within 30 minutes, indicating that KF could be used as an antipruritogenic agent [33]. These results agree with the traditional use of KF for itch.


## 3.6. Others

The inhibition effect of hypersensitivity of 70% ethanol and total saponin extracts from KF has been tested on DTH models upon challenge with SRBC or PC. As a result, the 70% ethanol extract produced a concentration-dependent reduction on immediate and delayed-type hypersensitivity, while total saponins extract showed an inhibitory tendency at 200 mg/kg [20]. This effect might have a close relationship with its stabilization of mast cell membrane, reduction of release of anaphylactic mediators, and anti-inflammatory activities [20]. The water extract of KF at the dose of 20 mg/g could reverse the imbalance of Th1/Th2 cell in rat model with dilated cardiomyopathy, which reduced the damage of immune response to myocardium and protected the heart function. Momordin Ic gave a protective effect on gastric mucosal lesions [37]. Kim et al. discovered that momordin Ic has a hepatoprotective effect against CCl4-induced liver damage because it could enhance the hepatic antioxidant defense system [38]. Meanwhile, as an AP-1 inhibitor, momordin Ic could downregulate NF-κB activation as well as AP-1 activation, which plays a key role in osteoclast differentiation, by inhibiting IκB degradation and c-Fos expression, respectively. Therefore, momordin Ic has high potential to be a good candidate for controlling bone disorders in the future [40]. In addition, the extracts of KF, including total flavonoid, saponin, and phenolic, were proved to have a good antioxidant activity by measuring free radical scavenging activities with ABTS, DPPH, or FARP assay [47–50]. Scavenging free radicals play a key role in aging and inflammation [51]. Therefore, its antioxidant effects need to be further studied on these aspects.The studies on toxicity of KF are scarce. Although KF is almost nontoxic in traditional use, the animal death was found when a large dosage is used. According to a toxicological study, when KM mice were orally administrated with water extract of KF in a dose range from 4.5 mg/kg to 9.4 mg/kg, the median lethal dose (LD50) was 7.15 ± 0.03 g/kg [35]. Therefore, the toxic and side effects of KF should be paid more attention in its clinical application.


## 4. Quality Control

The quality of herbal medicines is the key for its clinical efficacy and safety, and hence, establishing a quality control system is the premise of its clinical application. The quality control of KF was focused on quantitative analysis of components by a series of analytical methods, such as ultraviolet-visible detector (UV), gas chromatography-mass spectrometry (GC-MS), and high-performance liquid chromatography-evaporative light scattering detector (HPLC-ELSD). Since the main component of KF is triterpenoid saponin, whose UV absorption is poor, researchers incline to use ELSD. Xia et al. developed a method to determine the content of momordin Ic in KF and the content of momordin Ic was 0.83%–0.21% in four kinds of marketed KF [52]. Moreover, they used HPLC-ELSD and colorimetric methods to determine the content of momordin Ic and total saponins, respectively, in KF at different collecting times or from eleven places in China [53, 54]. Except for saponin, there also established an HPLC method with good stability and reproducibility to simultaneously determine the content of rutin and quercetin in KF [55]. Currently, the fingerprint derived from HPLC has been an acknowledged method to control the quality of traditional Chinese medicine and botanical medicine. An HPLC fingerprint method was applied to 10 batches of KF purchased from Shandong, China. According to the cluster analysis, 19 common peaks of fingerprint were found, and 10 batches could be divided into 3 groups related to their origins [56]. The results showed that this method could differentiate samples from different geographical origins or processing methods. Nevertheless, there were few compounds quantified as mark compounds for the quality control of KF, and it is in urgent need of a comprehensive quantification method to further ensure the quality control.


## 5. Pharmacokinetics

Momordin Ic is a representative pharmacologically active ingredient and quality control marker of KF, and its pharmacokinetic property has attracted attentions. Yan et al. developed and validated a highly selective and sensitive method based on ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) for routine analysis of momordin Ic in rat plasma. After intravenous administration of momordin Ic at 0.52, 1.56, and 4.67 mg/kg in rats, the AUClast (area under the concentration-time curve from time 0 to t hours postodose) values were 1864.17 ± 431.01, 5466.00 ± 889.86, and 16890.45 ± 3028.64 ng h/mL, respectively, which was consistent with linear pharmacokinetic characteristics. The elimination half-life (t1/2) values were 1.22 ± 0.39, 1.14 ± 0.10, and 1.83 ± 0.39 h, respectively [4]. However, there are few studies on the pharmacokinetic of other substances within KF and on the interaction between substances during their ADME in vivo.


## 6. Conclusion and Perspectives

Recent pharmacology studies showed anti-inflammatory, antifungal, antiallergic, and antipruritogenic effects of KF, which supports the traditional clinical applications including the treatment of diseases in the skin, eye, and urinary tract in China, Korea, and Japan. Interestingly, the anticancer, hypoglycemic, and hepatoprotective effects of KF were also tested. Besides, the potential mechanisms of some effects were also elucidated. However, there are few toxicology studies on KF, which may be necessary for its better application as a medicine or a food. A total of 25 triterpenoids, 13 flavonoids, 22 carbohydrates, 21 amino acids, 9 organic acid, 49 essential oils, and 14 heterocyclics within KF have been reported. Momordin Ic is a main substance, and it is usually used as a phytochemical marker for the quality control of KF. The pharmacological effects were achieved by the chemical constituents within KF. Hence, the interrelationship between compounds and pharmacological activities should be further studied. The pharmacokinetics of KF was lack, and a range of pharmacokinetic studies on its active compounds are needed to provide comprehensive data for clinical application. Altogether, this review extensively summarized phytochemistry, pharmacology, toxicity, quality control, and pharmacokinetic studies on KF to provide information for its further research and clinical applications.



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*Source: 5382684-2021-01-31.xml*