Icariside II: natural occurrence, biotransformation, pharmacological activity, synthetic modification, pharmacokinetics, and bioavailability

ICS-II is a characteristic metabolite of various Epimedum plants, and it can be obtained by enzymatic hydrolysis of other flavonoids. It is a promising compound with multiple in vitro and in vivo pharmacological potentials. The studied flavone showed cancer-related biological activity via cell cycle arrest, proliferation inhibition, autophagy, and apoptosis and inhibited cytokines in anti-inflammatory actions. Significantly, the health benefits were accompanied by its role in antidiabetics, sexual reproduction, and protection against harmful effects on the heart, brain, bones, lungs, kidneys, livers, and eyes. Molecular mechanisms of action were deduced from various signaling pathways, such as Akt/NOS/NF-κB, JAK/STAT3/MAPK, and PI3K/Akt/mTOR. Pharmacokinetic evidence involved sugar and methyl removals, hydroxylation, glucuronidation, and glycosylation.