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Astragalus polysaccharide (APS) is a bioactive, water-soluble heteropolysaccharide extracted from the roots of *Astragalus membranaceus*, a staple of traditional Chinese medicine. It is primarily recognized as an immunomodulator and anti-tumor agent. The most well-characterized commercial formulation is PG2, an injectable biologic developed by PhytoHealth Corporation, which is approved in Taiwan for the treatment of cancer-related fatigue in patients with advanced malignancy. APS exerts its effects through multiple molecular mechanisms, including the activation of pattern recognition receptors like Toll-like receptor 4 (TLR4), the mannose receptor, and Dectin-1, as well as the modulation of key signaling pathways such as NF-κB, PI3K/Akt/mTOR, and STAT5. It has also been shown to downregulate PD-L1 expression, enhance the persistence of CAR-T cells by increasing CD122 expression, and inhibit muscle atrophy (cachexia) by targeting the ubiquitin-proteasome pathway and Atrogin-1. Clinical research, supported by institutions like Guang'anmen Hospital and companies like Jiangsu Hengrui Medicine, explores its use in lung cancer, idiopathic thrombocytopenic purpura, and as an adjunct to chemotherapy and immunotherapy.
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