Recent Advances in Astragaloside IV Modulate Immune Response and Skin Cells Promoting Wound Healing

Skin wound healing remains a major clinical challenge. Natural plant extracts have attracted increasing attention due to their high biocompatibility and biosafety, offering effective wound healing while avoiding antibiotic resistance and the development of resistant bacterial strains. Astragaloside IV (AS), a naturally active compound primarily extracted from Astragalus mongholicus Bunge, has demonstrated significant efficacy in promoting skin wound healing. AS is capable of modulating all phases of wound healing, including the inflammatory phase, proliferative phase, and remodeling phase. These effects contribute to reduced inflammation, accelerated tissue regeneration, and controlled scar formation by regulating immune responses and acting on various tissue cells. The potential of AS for clinical application in promoting skin wound healing has been confirmed by numerous in vivo and in vitro studies; however, no comprehensive review has yet been published. This article provides the first systematic overview of the mechanisms by which AS and AS-loaded wound dressings promote wound healing, including the modulation of immune responses in wound healing through antimicrobial, antioxidative stress, and anti-inflammatory activities, and the regulation of endothelial cells, endothelial progenitor cells, fibroblasts, and keratinocytes to promote angiogenesis, collagen deposition, granulation tissue formation, and re-epithelialization. This article also summarizes the common types and advantages of AS-loaded wound dressings. These dressings enhance the bioavailability of AS and enable controlled release, while the incorporation of AS improves their physicochemical properties, thereby markedly enhancing therapeutic efficacy. Finally, the article points out existing research limitations, such as insufficient mechanistic exploration, a limited variety of AS-loaded dressing types, and the absence of clinical trials, and proposes future directions to advance the application.Impact StatementThe potential of AS for clinical application in promoting skin wound healing has been confirmed by numerous in vivo and in vitro studies; however, no comprehensive review has yet been published. This article provides the first systematic overview of the mechanisms by which AS and AS-loaded wound dressings promote wound healing.