**4.3 Anti-cancer activity**

According to the world health organization, cancer is considered the second leading cause of death globally an estimated 9.6 million deaths or one in six deaths, in 2018. Cervical, thyroid, lung, colorectal, and breast cancer are common cancer diseases in women whereas stomach, liver, prostate, lung, and liver cancer are common cancer in men. Cancer can be defined as the growth of abnormal cells in uncontrolled conditions in almost any organ or tissue of the body, if beyond

**Figure 5.** *Ginsenoside anticancer activity.*

#### *Ginseng: Pharmacological Action and Phytochemistry Prospective DOI: http://dx.doi.org/10.5772/intechopen.99646*

their usual boundaries then goes inside adjoining parts of the body and spread to other organs. At metastasizing process, results in cancer death. Cancer can be prevented by implementing evidence-based strategies by avoiding the risk factors use of tobacco, use of alcohol, less consumption of fruits and vegetables. For the treatment of cancer, chemotherapy is the most common therapy for treatment. Administration of chemotherapeutic agents as result gives a reduction in bone density and immunosuppression.

For many years, natural products have been a good source of agents for treating cancer and plants played a huge role in anti-cancer product development. Ginseng is a universal herb that is utilized for the prevention and treatment of cancer. It has been acting as a chemopreventive and also used to improve the quality of life among patients with cancer [24, 25]. Ginseng as an herbal drug is consumed and mentioned in the Pharmacopieas formulation in various countries like United Kingdom, China, Japan, France, Austria, and Germany. In Western Europe and Asian countries, it is commonly utilized as a combinational drug to improve cancer chemotherapy. Ginseng is responsible for the inhibition of the growth of human cancer cells of prostate cancer, lung cancer, and colon cancer. **Figure 5** is showing Ginsenoside anticancer activity.

The anticancer action is by modulation of diverse signaling pathways, including regulation of cell proliferation mediators (cyclins and CDKs), growth factors (c-myc, vascular endothelial growth factor, and EGFR), tumor suppressor (p53 and p21), cell mediators (Bcl-2, caspases, Bcl-xl, death receptors), inflammatory response molecules (COX-2 and NFκB), protein kinase (JNK, Akt, and AMPactivated protein kinase) It acts on its cellular and molecular targets through various pathways by inhibiting the tumor by regulation of the cell cycle and inhibition of angiogenesis and invasion [26].

Ginseng extract can induce chemosensitization of the conventional anticancer agent through multidrug resistance (MDR-1) associated protein. Ginseng had also shown a reduction of drug-induced toxicity when used in combination with anticancer drug for example ginsenosides Rh4 and Rk3 reduces the cisplatin-induced nephrotoxicity in dose dependant level where the reason and structure–activity relationship with other ginsenosides are remained to be studied by Baek *et al.* [27, 28].

In clinical studies, Ginseng is acting as a tonic in combination with chemotherapy which concluded that ginseng with the other anticancer drug, for example navebine, Vinorelbine, enhances the short term therapeutic efficiency of lung cancer where the study was conducted by 63 patients. The result showed an improvement in the patient's quality of life. Researchers are focusing on purified ginsenosides which gives the result to a rapid specific mechanism of action rather than using ginseng extract.

Ginseng polysaccharides are also reported as an anticancer agent which includes fractions such as WGPA-1-RG, WGPA-2-RG, WGPA-1-HG, WGPA-2-HG, WGPA-3-HG, and WGPA-4-HG that acts by regulating the immune response of host organisms whereas Ginseng pectin reported inhibiting the action of proteins linked with cancer progression [24].

#### **4.4 Antimicrobial activity**

Antimicrobial activity was derived from the Greek words anti-meaning against, mikros meaning little, and bios meaning life which can be defined as the activity against the growth of microorganisms or by their killing. The microorganisms include bacterial, fungi, parasites or viruses. Antiviral activity is defined as the action of killing a virus or suppression of its ability to replicate and inhibition of the virus for multiplication and reproduction. It is used in the treatment of infectious disease caused by a virus where the virus responsible for the disease include influenza, herpes simplex type 1 and type 2, herpes zoster, viral hepatitis, encephalitis, infectious mononucleosis, HIV/AIDS, and many more. Viruses are nucleic acid i.e. DNA or RNA and a protein coat.

Novel antiviral formulation therapies and vaccines are in recent progress of research scientists which supported to prevent and shorten the duration of the extremity of viral infection. Due to the continuous growth of new infection of the Ebola virus and respiratory syndrome coronavirus, it is compulsory to develop advanced novel therapeutic approaches. The main problem in the development of novel antiviral agent is mutation process in the viral mutation that as result in drug resistance and immune evasion. Recently the development of novel antiviral formulation has the target to develop broad-spectrum antiviral and immunomodulators which improve and inhibit the host resistance to the viral infection In large population infection, vaccination is the main measure of treatment of disease [29, 30].

In vitro and in vivo antiviral activity of Panax Korean red ginseng extract was determined on respiratory syncytial virus infection (RSV) which as a result showed improved the survival of human lung epithelial cells against RSV infection and also inhibited RSV replication by suppressing the expression of RSV-induced inflammatory cytokine genes and also enhanced level of interferon-γ producing dendritic cells which are subsequent to RSV infection [30].

Antiviral activity of fermented *Panax ginseng* extracts against a broad spectrum of Influenza viruses (H1N1, H3N2, H5N1, and H7N9) in genetically diverse mouse models was investigated. Antiviral protection was observed due to more components of saponins of fermented ginseng extracts against influenza viruses than nonfermented ginseng extract. For the development of a new vaccine and new antiviral drug against influenza viruses, the Panax notoginseng root was studied where both in vitro and in vivo analysis was investigated. The Panax notoginseng root decreased influenza A virus-induced mortality by 90% and also increased the NK cell activity of mouse splenocytes [31].

Antifungal is an agent for the treatment and prevention of fungal infections which selectively eliminates fungal pathogen from a host with minimal toxicity to the host. Fungi examples are yeast, *Candida albicans, molds, Xanthoriaparietina, Amanita phalloides, Polyphagus euglena, Gigaspora gigantean* and many more. Korean red ginseng containing saponin as ginsenosides were reported as having antifungal effects against *Candida albicans*. The result was concluded that ginsenosides antifungal activity by disrupting the structure of cell membrane were awaited for further clinical investigation [32].

The root of ginseng, Notoginseng was investigated antifungal activities against *Epidermophyton floccosum, Trichophyton rubrum*, and *Trichophyton mentagrophytes*. The mechanism of antifungal activity was to find out which was due to interaction with the fungal cell membrane and damages the integrity of the membrane. The result concluded that notoginseng saponin can used for the treatment of ringworm [33].

Antibacterial and antifungal effect of ginseng powder on gram-positive, gram-negative, and *Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Enterococcus faecalis* and *Candida albicans* as fungus was investigated by disc diffusion method showed significant zone inhibition [34].

#### **4.5 Antioxidant activity**

Antioxidant activity is the limitation and inhibition of nutrient oxidation by restraining oxidative chain reactions. Herbal antioxidants prevent destructive

*Ginseng: Pharmacological Action and Phytochemistry Prospective DOI: http://dx.doi.org/10.5772/intechopen.99646*

processes caused by oxidative stress by stabilizing or deactivate free radicals before they attack targets in a biological cell. Cancer, diabetes, inflammation, senile dementia, asthma, liver damage, and many other diseases are closely related to free radicals. Free radicals are originated from various sources such as pollution, alcohol, tobacco, smoking, pesticides, phagocytic cells etc. In vitro and in vivo antioxidant effect of *Panax ginseng* showed higher free radical scavenging activity power than white and red ginseng which was due to the presence of higher content of total saponin, phenolic, and flavonoids. The antioxidant activity analyzes by free radical scavenging activity assay and reducing power assay method, lipid peroxidation, antioxidant enzyme activity models [35].

The antioxidant effect of *Panax Ginseng* was studied on healthy volunteers of 82 participants of which 21 men and 61 women were investigated where Serum level of reactive oxygen species (ROS), malondialdehyde (MDA), total antioxidant capacity (TAC), the activities of catalase, superoxide dismutase (SOD), glutathione reductase (GSH-Rd), and peroxidase (GSH-Px), and total glutathione content were determined. The healthy volunteers confirmed the antioxidant potential of *P. ginseng*. *P. quinquefolius* containing ginsenosides analyzed affinity DPPH-stable free radical, metal chelation, and hydroxyl free radicals for characterization of antioxidant effect [36].

## **5. Novel formulation development**

Ginseng as a supertonic herbal drug should be in novel approaches that get rid of the limitation of the conventional drug. Novel approaches will help in increase of bioavailability, minimize drug physical and chemical degradation and loss, prevention of harmful side-effects, protecting toxicity and enhancement stability. This will help to overcome problems associated with herbal medicine. Herbal Novel drug delivery includes nanoparticles, liposomes, phytosomes, nanoemulsion, microsphere, transferosomes, nanocapsules and ethosomes are reported using extract and marker Nanoparticles and nanocomposite technology of ginseng had reported previously [37, 38].

A novel multifunctional liposome system was developed in a combination of three ginsenosides with paclitaxel using the thin-film hydration method. Antitumor activity was analyzed by GC, MTT, cell cycle, and apoptosis assays method. The result concluded that ginseng liposome was acting as tumor-targeting therapy with dual effect as chemotherapy adjuvant and functional membrane material [39]. Nanoginseng showed better antitumor activity and high drug load efficiency and capacity, excellent biocompatibility with reduced damage to normal tissues [40]. Nanocapsulated red ginseng extract using bioactive coating materials chitosan enhanced antithrombotic activities by both in-vitro and ex vivo platelet aggregation assay method [41]. Phytosome *Panax ginseng* containing ginsenosides acting as nutraceutical and immunomodulator elevated superoxide dismutase, glutathione peroxidase, and glutathione reductase activities. Commercial product of phytosome as Ginseng PhytosomeTM is in market.

### **6. Conclusion**

The traditional system of medicine including the Chinese system of medicine and Ayurvedic system of medicine already mentioned ginseng as man herb acting as a supertonic which is used for the treatment of all type of disease cancer, cardiovascular disorder, impotence, diabetes, palpitation, insomnia, hyperdynamic, anorexia, and many more. Unique cultivation and collection techniques are

## *Ginseng - Modern Aspects of the Famed Traditional Medicine*

discussed. More than 200 phytochemical are reported where main classes include saponins glycosides, carbohydrates, polyacetylenes, phytosterols, nitrogenous substances, amino acids, peptides, vitamins, volatile oil, minerals, and enzymes. The miracle ginseng consist of anti-inflammatory, anticancer, antifungal, antibacterial, antiviral, immune- booster, antidiabetic, and antioxidant activities pharmacological actions of which latest anticancer, anti-inflammatory, antimicrobial, and antioxidant pharmacological activities is discussed where not only in vivo and in vitro studies is discussed but also clinical trial is highlighted. Novel formulation phytosome, nanocapsulated, nanoparticles for cancer, inflammation, and neurological disorder developed to enhance bioavailability and target delivery of drug. It can be concluded that focusing the herb in research and development of the pharmaceutical industry in private and government agencies in future development would be beneficial and helpful to eliminate the toxic effect of supertonic ginseng.
