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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Mar. Sci.</journal-id>
<journal-title>Frontiers in Marine Science</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Mar. Sci.</abbrev-journal-title>
<issn pub-type="epub">2296-7745</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fmars.2021.774927</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Marine Science</subject>
<subj-group>
<subject>Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Advances in the Global Distribution, Chemical Constituents, and Pharmacology of <italic>Hippocampus</italic>, a Traditional Marine Chinese Medicine</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Cui</surname> <given-names>Xinhai</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1498425/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Zhao</surname> <given-names>Xiangfeng</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Li</surname> <given-names>Jintong</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Li</surname> <given-names>Ziwei</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Ren</surname> <given-names>Xia</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1454435/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Zhao</surname> <given-names>Yangang</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Fu</surname> <given-names>Xianjun</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1453068/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Li</surname> <given-names>Xiuxue</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="corresp" rid="c002"><sup>&#x002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1469774/overview"/>
</contrib>
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<aff id="aff1"><sup>1</sup><institution>College of Pharmacy, Shandong University of Traditional Chinese Medicine</institution>, <addr-line>Jinan</addr-line>, <country>China</country></aff>
<aff id="aff2"><sup>2</sup><institution>Marine Traditional Chinese Medicine Research Center, Qingdao Academy of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine</institution>, <addr-line>Qingdao</addr-line>, <country>China</country></aff>
<aff id="aff3"><sup>3</sup><institution>Institute of Traditional Chinese Medicine Literature and Culture, Shandong University of Traditional Chinese Medicine</institution>, <addr-line>Jinan</addr-line>, <country>China</country></aff>
<aff id="aff4"><sup>4</sup><institution>Shandong Engineering and Technology Research Center of Traditional Chinese Medicine</institution>, <addr-line>Jinan</addr-line>, <country>China</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Bin Wu, Zhejiang University, China</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Yueying Li, Texas A&#x0026;M University, United States; Caisheng Wu, Xiamen University, China; Qihao Wu, Yale University, United States</p></fn>
<corresp id="c001">&#x002A;Correspondence: Xianjun Fu, <email>xianxiu@hotmail.com</email></corresp>
<corresp id="c002">Xiuxue Li, <email>lixiuxuelixiuxue@126.com</email></corresp>
<fn fn-type="other" id="fn004"><p>This article was submitted to Marine Biotechnology, a section of the journal Frontiers in Marine Science</p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>06</day>
<month>12</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="collection">
<year>2021</year>
</pub-date>
<volume>08</volume>
<elocation-id>774927</elocation-id>
<history>
<date date-type="received">
<day>13</day>
<month>09</month>
<year>2021</year>
</date>
<date date-type="accepted">
<day>30</day>
<month>10</month>
<year>2021</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2021 Cui, Zhao, Li, Li, Ren, Zhao, Fu and Li.</copyright-statement>
<copyright-year>2021</copyright-year>
<copyright-holder>Cui, Zhao, Li, Li, Ren, Zhao, Fu and Li</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<abstract>
<p><italic>Hippocampus</italic> is an important traditional marine Chinese medicinal resource that has been used to warm and tonify kidney yang in the clinic for a long time in China. Modern pharmacological studies show that its active ingredients display a wide range of pharmacological activities associated with the kidney, such as anti-inflammation, antioxidation, antitumor, and neuroprotective effects. Herein, we systematically summarize and analyze the research progress on the resource distribution, active ingredients, pharmacological activities, and clinical application of <italic>Hippocampus</italic>. First, the species and worldwide distribution of <italic>Hippocampus</italic> were assessed to clarify the existing resources, and the results showed that 44 species of <italic>Hippocampus</italic> have been found in 159 countries and regions worldwide. Then, based on the analysis of 16 kinds of active ingredients and extraction methods, the relationship between the ingredient extraction and pharmacological activities of <italic>Hippocampus</italic> was revealed. This review may provide a foundation for further research on the potential active ingredients and mechanisms of <italic>Hippocampus</italic>. In addition, the research status of traditional prescriptions containing <italic>Hippocampus</italic> was evaluated. The results implied that research on <italic>Hippocampus</italic> is still in its infancy, and the mechanism and material basis of its efficacy have not been clarified. This paper should provide directions for further studies on <italic>Hippocampus</italic>.</p>
</abstract>
<kwd-group>
<kwd><italic>Hippocampus</italic></kwd>
<kwd>traditional marine Chinese medicine</kwd>
<kwd>resources</kwd>
<kwd>active ingredients</kwd>
<kwd>pharmacological activities</kwd>
</kwd-group>
<counts>
<fig-count count="7"/>
<table-count count="1"/>
<equation-count count="0"/>
<ref-count count="143"/>
<page-count count="18"/>
<word-count count="14872"/>
</counts>
</article-meta>
</front>
<body>
<sec sec-type="intro" id="S1">
<title>Introduction</title>
<p>The ocean is rich in biodiversity, and many organisms have evolved unique morphological and physiological characteristics to adapt to challenging environments (<xref ref-type="bibr" rid="B24">Conte et al., 2021</xref>). Marine organisms further produce marine natural products (MNPs) with chemical diversity and interesting structures, including peptides, terpenoids, steroids, polyphenols, alkaloids, etc., (<xref ref-type="bibr" rid="B91">Sable et al., 2017</xref>; <xref ref-type="bibr" rid="B76">Murray et al., 2018</xref>; <xref ref-type="bibr" rid="B117">Wu et al., 2018</xref>; <xref ref-type="bibr" rid="B5">Carroll et al., 2019</xref>; <xref ref-type="bibr" rid="B1">Althagbi et al., 2020</xref>; <xref ref-type="bibr" rid="B28">Ermolenko et al., 2020</xref>). Currently, thousands of new MNPs are being reported every year (<xref ref-type="bibr" rid="B6">Carroll et al., 2020</xref>, <xref ref-type="bibr" rid="B7">2021</xref>). These compounds appeared to be promising therapeutics for the treatment of a variety of human diseases, such as cancers and cardiocerebrovascular diseases (<xref ref-type="bibr" rid="B26">Dayanidhi et al., 2021</xref>; <xref ref-type="bibr" rid="B63">Liang et al., 2021</xref>). In addition, studies have shown that the molecular weight and clog <italic>P</italic> of MNPs isolated since 1957 were particularly similar to that of approved drugs (<xref ref-type="bibr" rid="B3">Blunt et al., 2018</xref>). MNPs have always been an important source of new medicines (<xref ref-type="bibr" rid="B55">Khalifa et al., 2019</xref>). Currently, there are seven FDA-approved medicines and more than 20 medicine candidates from 25,000 NMPS; thus, MNPs have a bright future compared with synthetic molecules (<xref ref-type="bibr" rid="B78">Newman and Cragg, 2016</xref>). Marine biodiversity may afford potential resources for new NMPS.</p>
<p>Organisms of the genus <italic>Hippocampus</italic> (Syngnathidae) are widely distributed in marine ecological systems. As a traditional Chinese medicine (TCM), <italic>Hippocampus</italic> was first recorded in a Supplement to Materia Medica (Bencao Shiyi), which has been clinically applied for thousands of years (<xref ref-type="bibr" rid="B10">Chen, 1983</xref>). There are five medicinal <italic>Hippocampus</italic> organisms recorded in the Chinese Pharmacopoeia: <italic>Hippocampus kuda</italic> Bleeker, <italic>Hippocampus trimaculatus</italic> Leach, <italic>Hippocampus kelloggi</italic> Jordan et Snyder, <italic>Hippocampus histrix</italic> Kaup, and <italic>Hippocampus japonicus</italic> Kaup (<xref ref-type="bibr" rid="B19">Chinese, 2020</xref>). In TCM, the main efficacy of <italic>Hippocampus</italic> is warming and tonifying of the kidney yang. Modern pharmacological studies have reported that <italic>Hippocampus</italic> shows various biological activities, including antifatigue, anti-inflammation, antioxidation, antitumor, and antimicrobial activities (<xref ref-type="bibr" rid="B58">Kumaravel et al., 2012</xref>). Peptides, steroids, and fatty acids are the main active ingredients of <italic>Hippocampus</italic>. In addition, nucleosides, phthalates, ketones, etc., have also been isolated and identified (<xref ref-type="bibr" rid="B14">Chen et al., 2015</xref>). These results supported the great therapeutic potential of <italic>Hippocampus</italic>.</p>
<p>In this study, the research progress on the resource distribution, active ingredients, pharmacological activities, and prescriptions of <italic>Hippocampus</italic> was systematically analyzed and summarized. According to the literature, websites, and databases, we reviewed 44 <italic>Hippocampus</italic> species and their distributions worldwide, and resources for medicinal <italic>Hippocampus</italic> were emphasized. Sixteen kinds of ingredients of <italic>Hippocampus</italic> were described, and possible <italic>Hippocampus</italic> factors were investigated, such as the species, growth stage, wild or culture, and bait. In addition to traditional efficacy, more attention has been given to modern pharmacological agents, especially neuroprotective agents. Moreover, studies on the relationship among ingredients, extraction methods, and pharmacological activities may help to identify new active ingredients to supplement the compound-constituent groups of <italic>Hippocampus</italic>, which may further provide a scientific basis for explaining its mechanism in treating diseases. In addition, the clinical application of traditional prescriptions containing <italic>Hippocampus</italic> also may provide new ideas for the development and utilization of <italic>Hippocampus</italic> in the future.</p>
</sec>
<sec id="S2">
<title>Status of <italic>Hippocampus</italic> Resources</title>
<sec id="S2.SS1">
<title><italic>Hippocampus</italic> Distribution and Species Worldwide</title>
<p>At present, 44 species of <italic>Hippocampus</italic> have been found in 159 countries and regions worldwide (<xref ref-type="fig" rid="F1">Figure 1</xref> and <xref ref-type="supplementary-material" rid="DS1">Supplementary Table 1</xref>; <xref ref-type="bibr" rid="B22">CITES, 2021b</xref>; <xref ref-type="bibr" rid="B32">FishBase, 2021</xref>), with the highest diversity of species observed in Australia (<xref ref-type="fig" rid="F2">Figure 2A</xref>). Oceania has the largest number of species on the continent, followed by Asia and Africa (<xref ref-type="fig" rid="F2">Figure 2B</xref>). <italic>Hippocampus</italic> is primarily found in the Indo-Pacific Ocean and distributed in shallow waters with a depth of less than 30 m in temperate, subtropical, and tropical regions (<xref ref-type="bibr" rid="B33">Foster and Vincent, 2004</xref>). On the west coast of peninsular Malaysia, <italic>Hippocampus kelloggi</italic> Jordan et Snyder was collected by trawlers in deepwater below 65 m (<xref ref-type="bibr" rid="B21">Choo and Liew, 2003</xref>). The habitat of <italic>Hippocampus</italic> includes seagrass, coral reefs, mangroves, and seaweeds, with coral reefs representing the main habitat constituents of tropical <italic>Hippocampus</italic> (<xref ref-type="bibr" rid="B33">Foster and Vincent, 2004</xref>). <italic>Hippocampus coronatus</italic> Temminck and Schlegel and <italic>Hippocampus mohnikei</italic> Bleeker generally inhabit seagrass in the southern coastal waters of Korea. Temperate <italic>Hippocampus</italic> tends to inhabit seagrass beds, which provide food for a variety of flora and fauna (<xref ref-type="bibr" rid="B20">Choi et al., 2012</xref>). Among the five medicinal <italic>Hippocampus</italic> in China, only <italic>Hippocampus japonicus</italic> Kaup is mainly distributed in northern China. The other four species were mainly found in the tropical and subtropical regions of China, such as the East China Sea and South China Sea (<xref ref-type="bibr" rid="B65">Lin et al., 2008</xref>; <xref ref-type="bibr" rid="B38">Han, 2013</xref>).</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption><p>The number of <italic>Hippocampus</italic> species in different countries and regions.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmars-08-774927-g001.tif"/>
</fig>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption><p><bold>(A)</bold> The top 10 countries of <italic>Hippocampus</italic> species; <bold>(B)</bold> The species of <italic>Hippocampus</italic> in each continent.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmars-08-774927-g002.tif"/>
</fig>
<p>The ease of identification of a <italic>Hippocampus</italic> specimen varies from species to species. <italic>Hippocampus</italic> specimens were generally identified using preparation tools (ruler, magnifying glass, calculator, etc.) by identifying characteristics, using measured and recorded data about an unidentified specimen, and using standards (<xref ref-type="supplementary-material" rid="DS1">Supplementary Tables 1</xref>&#x2013;<xref ref-type="supplementary-material" rid="DS1">6</xref> from a guide of <italic>Hippocampus</italic> identification) to determine possible species and identify specimens. The data mainly included the head length (HL) and snout length (SnL), length of the snout in relation to the length of the head (HL/SnL), number of tail rings (TaR), trunk rings (TrR), etc., (<xref ref-type="bibr" rid="B69">Lourie et al., 2004</xref>). The characteristics and morphological identification based on distinguishing characteristics are appropriate when performed by investigators who are experienced with <italic>Hippocampus</italic> identification. However, some <italic>Hippocampus</italic> specimens are particularly similar, and new species may be encountered; thus, deoxyribonucleic acid (DNA) barcoding technology may need to be applied for <italic>Hippocampus</italic> identification. The species phylogenetic tree is constructed based on the alignment results of the complete mitochondrial genome or mitochondrial cytochrome b gene from different species (<xref ref-type="bibr" rid="B8">Casey et al., 2004</xref>; <xref ref-type="bibr" rid="B34">Ge et al., 2018</xref>). The phylogenetic tree with the Cytochrome Oxidase I (COI) gene as a primer showed that different species of <italic>Hippocampus</italic> were in different branches with reasonable distances between them, and the accuracy was higher than that of other mitochondrial genes (<xref ref-type="bibr" rid="B42">Hou et al., 2016</xref>). <xref ref-type="bibr" rid="B66">Liu et al. (2018)</xref> used a multiplex polymerase chain reaction (PCR) method to simultaneously identify five medicinal <italic>Hippocampus</italic> species by judging the absence and size of DNA bands on the gel map in a single assay. DNA barcoding provides an accurate technique for the identification of <italic>Hippocampus</italic> specimens. A rapid detection kit should be developed in the future to reduce the complicated and time-consuming aspects of this technology. Fast and effective identification methods can be used to protect endangered <italic>Hippocampus</italic> species and monitor the <italic>Hippocampus</italic> trade (<xref ref-type="bibr" rid="B71">Luo et al., 2013</xref>). In TCM, metabolomics technology has been used to study differences in metabolites for various species and find metabolic markers, and such work has provided references for the identification of multisource medicinal materials (<xref ref-type="bibr" rid="B30">Fan, 2012</xref>). This may provide new ideas for the identification of <italic>Hippocampus</italic>.</p>
</sec>
<sec id="S2.SS2">
<title>Global Trade Volume of <italic>Hippocampus</italic></title>
<p>Recent studies have revealed that the number of <italic>Hippocampus</italic> individuals has continuously declined over the past 20 years. The trade demand for <italic>Hippocampus</italic> has increased significantly because of its value for medicine, aquarium displays, and collectibles (<xref ref-type="bibr" rid="B108">Vincent et al., 2011</xref>). The export volume of medicinal <italic>Hippocampus</italic> is concentrated in Southeast Asian countries, with Thailand being the largest exporter (<xref ref-type="fig" rid="F3">Figure 3A</xref> and <xref ref-type="supplementary-material" rid="DS1">Supplementary Table 2</xref>; <xref ref-type="bibr" rid="B23">CITES, 2021a</xref>). The export volume of <italic>Hippocampus kuda</italic> Bleeker, <italic>Hippocampus trimaculatus</italic> Leach, and <italic>Hippocampus kelloggi</italic> Jordan et Snyder accounted for 88% of the global export of dried <italic>Hippocampus</italic> (<xref ref-type="bibr" rid="B68">Loh et al., 2016</xref>). Regarding importing countries, China and its affiliated Hong Kong Special Administrative Region and Taiwan were the main importers of dried <italic>Hippocampus</italic> due to the influence of TCM (<xref ref-type="fig" rid="F3">Figure 3B</xref> and <xref ref-type="supplementary-material" rid="DS1">Supplementary Table 3</xref>; <xref ref-type="bibr" rid="B23">CITES, 2021a</xref>). Exports of other <italic>Hippocampus</italic> species were mainly concentrated in Australia and some countries in the Americas (<xref ref-type="bibr" rid="B25">Convention on International Trade in Endangered Species of Wild Fauna and Flora, 2020</xref>). A large global trade volume is mainly associated with wild <italic>Hippocampus</italic> caught by trawl by catch. Huge fishing pressure has made <italic>Hippocampus</italic> populations unsustainable (<xref ref-type="bibr" rid="B108">Vincent et al., 2011</xref>). Moreover, the <italic>Hippocampus</italic> population is also threatened by habitat reduction and environmental pollution (<xref ref-type="bibr" rid="B88">Rosa et al., 2005</xref>). The International Union for Conservation of Nature (IUCN) listed <italic>Hippocampus</italic> on the red list, with five medicinal <italic>Hippocampus</italic> species listed as vulnerable species (<xref ref-type="bibr" rid="B47">IUCN, 2021</xref>). In addition, breeding techniques for <italic>Hippocampus</italic> similar to wild medicinal species are required. With the gradual solution to problems associated with rearing and bacterial infection in the breed, an increasing number of countries have tried to breed <italic>Hippocampus</italic>, such as Australia, Brazil, China, Sri Lanka, the United Kingdom, the United States, and Vietnam (<xref ref-type="bibr" rid="B57">Koldewey and Martin-Smith, 2010</xref>). The amount of wild Hippocampus cannot meet market needs, and artificial breeding is an important way to meet market demand and protect wild Hippocampus resources. In addition, we may seek alternative species. The phylogenetic tree of <italic>Hippocampus</italic> listed eight species of <italic>Hippocampus</italic> that were similar to the medicinal <italic>Hippocampus</italic> (<xref ref-type="fig" rid="F4">Figure 4</xref> and <xref ref-type="supplementary-material" rid="DS1">Supplementary Table 4</xref>; <xref ref-type="bibr" rid="B77">NCBI, 2020</xref>). As a next step, we may identify <italic>Hippocampus</italic> species with a large trade volume to study their ingredients and pharmacological activities and strive to find supplemental medical <italic>Hippocampus</italic> species.</p>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption><p><bold>(A)</bold> In five medicinal <italic>Hippocampus</italic>, the export volume of the top five countries and regions accounted for proportion of total export volume in 2000&#x2013;2020. <bold>(B)</bold> In five medicinal <italic>Hippocampus</italic>, the import volume of the top five countries and regions accounted for proportion of total import volume in 2000&#x2013;2020. TH, Thailand; CN, China; HK, Hong Kong (China); MY, Malaysia; PH, Philippines; VN, Vietnam; ID, Indonesia; SG, Singapore; US, United States of America; TW, Taiwan Province of China; CA, Canada; JP, Japan; IT, Italy; DE, Germany; Others, other countries and regions.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmars-08-774927-g003.tif"/>
</fig>
<fig id="F4" position="float">
<label>FIGURE 4</label>
<caption><p>The phylogenetic tree of 33 species of <italic>Hippocampus</italic>. Yellow fonts represent the medicinal <italic>Hippocampus</italic>.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmars-08-774927-g004.tif"/>
</fig>
</sec>
</sec>
<sec id="S3">
<title>Traditional Medicinal Use</title>
<p>The traditional usage of <italic>Hippocampus</italic> was recorded in the Chinese Materia Medica (Zhonghua Bencao), and it indicates that <italic>Hippocampus</italic> was extracted with water to make a decoction, in which the dosage of <italic>Hippocampus</italic> was 3&#x2013;9 g. The decoction was taken for its ability to warm and tonify kidney yang and reduce swelling. In addition, <italic>Hippocampus</italic> was further processed into a powder for external use to treat furunculosis (<xref ref-type="bibr" rid="B100">Song, 1999</xref>). The Chinese Pharmacopoeia also included this traditional extraction method and dosage (<xref ref-type="bibr" rid="B19">Chinese, 2020</xref>). At present, relevant reports have not indicated that <italic>Hippocampus</italic> is harmful to the human body. However, few studies have performed safety assessments of <italic>Hippocampus</italic> (<xref ref-type="bibr" rid="B142">Zhu, 2004</xref>).</p>
<p>In the Ming dynasty, &#x201C;warming kidney, tonifying yang, eliminating lumps, and curing carbuncle&#x201D; were the efficacies of <italic>Hippocampus</italic> recorded in The Compendium of Materia Medica (Bencao Gangmu; <xref ref-type="bibr" rid="B61">Li, 1982</xref>). The traditional efficacy of warming and tonifying kidney yang is not only reflected in its ability to improve reproductive function but also in its ability to regulate organs related to the kidney (<xref ref-type="bibr" rid="B137">Zhao et al., 2021</xref>). Kidney and yang have unique meanings in terms of TCM theory. The kidney may be understood from two aspects. First, in addition to referring to the organ in Western medicine, the kidney is also associated with a series of internal organs, namely, the kidney, bladder, bone, brain, ear, etc. Second, e kidney has effects on reproduction and operates in conjunction with other organs to complete the metabolism of the body (<xref ref-type="bibr" rid="B109">Wang et al., 2012</xref>). Yin and yang theory has been used to explain diseases that occur in the body (<xref ref-type="bibr" rid="B49">Ji and Yu, 2020</xref>). Yang has effects of warming, exciting, pushing, dispersing, and lifting in the human body (<xref ref-type="bibr" rid="B131">Zhang, 2021</xref>). Therefore, kidney yang deficiency causes the human body to have symptoms that include sperm deficiency, soreness and weakness of the waist and knees, dizziness, and tinnitus. These symptoms correspond to kidney disease and reproductive, immune, nervous, and other diseases in modern medicine (<xref ref-type="bibr" rid="B84">Qi et al., 2012</xref>; <xref ref-type="bibr" rid="B87">Reheman et al., 2019</xref>; <xref ref-type="bibr" rid="B107">Tian et al., 2021</xref>). In modern studies, the pharmacological activities of <italic>Hippocampus</italic>, such as its antihypertensive, antifatigue, and neuroprotection activities, have been reported and are consistent with traditional theory (<xref ref-type="bibr" rid="B14">Chen et al., 2015</xref>).</p>
<p>Traditional prescriptions containing <italic>Hippocampus</italic> were commonly made into pills, capsules, plasters, and wines for medicinal usage. The main clinical efficacies of the pill and capsule forms were warming and tonifying kidney yang, such as <italic>Haimabushen pill</italic>, <italic>Haimaduobian pill</italic>, and <italic>Hippocampus capsule</italic> (<xref ref-type="supplementary-material" rid="DS1">Supplementary Table 5</xref>). In TCM, pills have delayed release in the gastrointestinal tract to achieve stable and long-lasting efficacy and reduce toxicity and adverse reactions (<xref ref-type="bibr" rid="B136">Zhang et al., 2017</xref>). Pills containing <italic>Hippocampus</italic> might be suitable for chronic diseases of kidney deficiency. <italic>Haimabushen pill</italic> enriches Yin and tonifies the kidney and improves fatigue, soreness, and weakness in the waist and knees. <xref ref-type="bibr" rid="B140">Zhi et al. (2019a)</xref> found that <italic>Haimabushen pill</italic> improved the testosterone content level and had androgen-like effects in castrated or young mice by regulating the hypothalamus-pituitary-gonad axis. Additionally, <italic>Haima Zhuangyang soft capsule</italic> significantly shortened the incubation period for the erection of the penis and increased the prostate and semen sac coefficients of kidney yang-deficient mice (<xref ref-type="bibr" rid="B70">Lu et al., 2001</xref>). Capsules with controllable quality have been made by modern advanced preparation technology. Compared with traditional pills, the reproductive organ index of ovariectomized mice treated with low-dose <italic>Haima</italic> capsules (0.045 g/kg) was significantly higher than that of ovariectomized mice treated with middle-dose <italic>Haimabushen pill</italic> (0.28 g/kg) (<xref ref-type="bibr" rid="B74">Mei et al., 2005</xref>). In addition to the traditional effect of warming and tonifying kidney yang, <italic>Hippocampus</italic> in the plaster form was often compatible with medicines for dispelling wind and drying dampness. In particular, plasters are preferred formulations to treat local symptoms and quickly relieve the pain to improve the treatment comfort of the patient (<xref ref-type="bibr" rid="B50">Jia et al., 2003</xref>). For example, <italic>Shexiang Haima Zhuifeng Gao</italic> has been used to treat wind and dampness impediments and lumbago and leg pain (<xref ref-type="bibr" rid="B67">Liu and Lin, 2006</xref>). Medicinal wine may exert the biological effects identified in the trace elements in <italic>Hippocampus</italic> better than a decoction. Research has shown that <italic>seahorse</italic> medicinal liquor contains amino acids and mineral elements, has antifatigue effects, and improves immunity (<xref ref-type="bibr" rid="B44">Huang et al., 1997</xref>).</p>
<p>Traditional prescriptions containing <italic>Hippocampus</italic> are widely used in the clinic, and their pharmacological effects have gradually attracted more attention. Traditional prescriptions containing <italic>Hippocampus</italic> have been further explored using animal experiments to identify other effects, such as in learning, memory, and tumors. In a mouse model of memory impairment induced by scopolamine and sodium nitrite, <italic>Haimabushen pill</italic> effectively reduced the impairment of learning and memory ability of mice through its acetylcholinesterase inhibitory ability (<xref ref-type="bibr" rid="B141">Zhi et al., 2019b</xref>). <italic>Haimashengshui pill</italic> was also found to inhibit S180 tumor-bearing mice and promote tumor cell apoptosis (<xref ref-type="bibr" rid="B37">Han, 2002</xref>). The formulation of traditional prescriptions containing <italic>Hippocampus</italic> has become an urgent issue. New formulations are another main method of expanding the clinical application of traditional prescriptions containing <italic>Hippocampus</italic>. For example, nanotechnology has the ability to cross various biological barriers (<xref ref-type="bibr" rid="B27">De Jong and Borm, 2008</xref>). The nanoparticle formulation of <italic>Haimabushen pill</italic> may play a greater role in crossing the blood&#x2013;brain barrier and entering the brain. In addition, the <italic>Hippocampus</italic> species used in traditional prescriptions are not fully understood, which may have a certain impact on clinical efficacy.</p>
</sec>
<sec id="S4">
<title>Active Ingredients of <italic>Hippocampus</italic></title>
<p>Many <italic>Hippocampus</italic> species in China have been chemically investigated. Peptides were identified from <italic>Hippocampus</italic> located in Indonesia, South Korea, and China. Steroids were mainly obtained from species in China and Australia. Although the main source of fatty acids is China, these ingredients were also found in Mexico and Spain (<xref ref-type="fig" rid="F5">Figure 5</xref>). To date, a total of 329 ingredients in 16 categories have been identified, including acids, steroids, amino acids, mineral elements, nucleosides, phospholipids, phthalates, peptides, glycoproteins, volatile ingredients (hydrocarbons, alcohols, aldehydes, ketones, esters, amines), and others (<xref ref-type="supplementary-material" rid="DS1">Supplementary Figure 1</xref> and <xref ref-type="supplementary-material" rid="DS1">Supplementary Table 6</xref>).</p>
<fig id="F5" position="float">
<label>FIGURE 5</label>
<caption><p>Global distribution of main chemical ingredients in <italic>Hippocampus.</italic></p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmars-08-774927-g005.tif"/>
</fig>
<sec id="S4.SS1">
<title>Amino Acids and Peptides</title>
<p>Amino acids play vital roles in regulating metabolism, growth, and development. Among the 20 types of amino acids constituting human proteins, essential amino acids cannot be synthesized by humans (<xref ref-type="bibr" rid="B75">Mitsuhashi, 2014</xref>). Twenty-three types of amino acids have been found in <italic>Hippocampus</italic> (<xref ref-type="supplementary-material" rid="DS1">Supplementary Table 6</xref>). <xref ref-type="bibr" rid="B65">Lin et al. (2008)</xref> found that the total amount of amino acids was as high as 50&#x2013;60% (based on a comparison of their retention times with those of amino acid standards) in six species of <italic>Hippocampus</italic>, and eight types of essential amino acids accounted for 17&#x2013;20% of the total amino acid content, which indicated that the <italic>Hippocampus</italic> is a high-quality protein source. The content of glycine was the highest (83.98 mg/g) among the 15 types of amino acids in <italic>Hippocampus kuda</italic> Bleeker and <italic>Hippocampus trimaculatus</italic> Leach (<xref ref-type="bibr" rid="B105">Sun et al., 2020</xref>). In addition, <italic>Hippocampus</italic> is also rich in glutamic acid, aspartic acid, alanine, and arginine (<xref ref-type="bibr" rid="B64">Lin et al., 2009</xref>). <xref ref-type="bibr" rid="B51">Jia and Yao (1990)</xref> reported 22 types of amino acids in <italic>Hippocampus kuda</italic> Bleeker and <italic>Hippocampus japonicus</italic> Kaup, including taurine, a special amino acid with high medicinal value. The type and the content of amino acids in <italic>Hippocampus erectus</italic> Perry were similar to those in medicinal <italic>Hippocampus</italic>, and even the content of essential amino acids in <italic>Hippocampus erectus</italic> Perry was higher than that in medicinal <italic>Hippocampus</italic> (<xref ref-type="bibr" rid="B126">Yan Z. Z., 2019</xref>). Peptides are important marine natural products that widely exist in vast marine organisms. Most peptides extracted from <italic>Hippocampus</italic> have various pharmacological activities and can be classified as angiotensin-converting enzyme (ACE) inhibitory peptides, anti-inflammatory peptides, neuroprotective peptides, and antimicrobial peptides. <xref ref-type="bibr" rid="B98">Shi et al. (2020)</xref> isolated ACE inhibitory peptides with the amino acid sequence Pro-Ala-Gly-Pro-Arg-Gly-Pro-Ala from the enzymatic hydrolysate of <italic>Hippocampus trimaculatus</italic> Leach. Circular dichroism analysis showed that the secondary structure was mainly composed of a random coil. Three ACE inhibitory peptides were also isolated from cultured <italic>Hippocampus abdominalis</italic> Lesson. The amino acid sequence of Cys-ASN-Val-Pro-Leu-Ser-Pro was more stable in molecular docking with ACE, which may become the preferred candidate for antihypertensive peptides (<xref ref-type="bibr" rid="B48">Je et al., 2020</xref>). <xref ref-type="bibr" rid="B90">Ryu et al. (2010)</xref> isolated an anti-inflammatory peptide composed of 15 types of amino acids (including five aspartic acids) from <italic>Hippocampus</italic>. Recently, a novel neuroprotective peptide (HTP-1) rich in hydrophobic amino acids and a molecular weight of less than 1 kDa have been isolated from <italic>Hippocampus trimaculatus</italic> Leach. The N-terminal amino acid sequence of HTP-1 is similar to that of insulin-like growth factor-1 (IGF-1) and may have neuroprotective effects (<xref ref-type="bibr" rid="B82">Pangestuti et al., 2013</xref>). <xref ref-type="bibr" rid="B103">Sun et al. (2012)</xref> identified an antimicrobial peptide (HKPLP) from the brooding pouch of male <italic>Hippocampus Kuda</italic> Bleeker. Bioinformatics analyses of available genomic and transcriptomic data allowed us to find the distribution of antimicrobial peptides closely related to the male brooding pouch (<xref ref-type="bibr" rid="B18">Chen et al., 2019</xref>). In conclusion, the activity of low molecular weight peptides is affected by the composition and sequence of amino acids. In terms of favorable structure-activity relationships for high ACE-inhibitory activity, aromatic amino acids at the C-terminus end and hydrophobic amino acids at the N-terminus end were most potent (<xref ref-type="bibr" rid="B120">Xu, 2015</xref>). 2,2-Diphenyl-1-picrylhydrazyl (DPPH) radical scavenging results indicated that low molecular weight (43&#x2013;278 kDa) peptides from <italic>Hippocampus erectus</italic> Perry showed higher activity than peptides over 278 kDa (<xref ref-type="bibr" rid="B11">Chen et al., 2018</xref>). Elucidating the structure-activity relationships of these peptides may help develop peptides with enhanced bioactivity.</p>
</sec>
<sec id="S4.SS2">
<title>Steroids</title>
<p>Steroids are among the major ingredients of <italic>Hippocampus</italic>, and 38 types of steroids have been isolated and identified to date (<xref ref-type="supplementary-material" rid="DS1">Supplementary Table 6</xref>). Gas chromatography&#x2013;mass spectrometry (GC&#x2013;MS) analysis identified 16 types of steroids from seven species of <italic>Hippocampus</italic>. Cholesterol and cholest-4-en-3-one were the major ingredients in the total steroids (<xref ref-type="bibr" rid="B13">Chen, 2015</xref>). <xref ref-type="bibr" rid="B105">Sun et al. (2020)</xref> reported that the average content of steroids in <italic>Hippocampus kuda</italic> Bleeker was 6.16 mg/g, and cholesterol accounted for 0.55 mg/g. The average ratios of cholest-4-en-3-one and cholest-3,6-dione in <italic>Hippocampus trimaculatus</italic> Leach, <italic>Hippocampus histrix</italic> Kaup, and <italic>Hippocampus japonicus</italic> Kaup were 0.0301 and 0.0096%, respectively (<xref ref-type="bibr" rid="B135">Zhang et al., 1998</xref>). In addition, <xref ref-type="bibr" rid="B114">Wu et al. (2017b)</xref> extracted 3&#x03B2;-hydroxycholest-5-en-7-one and cholest-5-en-3&#x03B2;,7&#x03B2;(7&#x03B1;)-diol from <italic>Hippocampus trimaculatus</italic> Leach. Cholesterol stearate and cholest-5-en-3&#x03B2;,7&#x03B1;-diol were also extracted from <italic>Hippocampus histrix</italic> Kaup (<xref ref-type="bibr" rid="B110">Wang et al., 1998</xref>). <xref ref-type="bibr" rid="B127">Yang et al. (2014)</xref> supplemented steroids of <italic>Hippocampus erinaceus</italic> Gunther, and six ingredients were identified: cholesterol, cholest-4-en-3-one, (22E,24R)-3&#x03B2;,5&#x03B1;,9&#x03B1;-trihydroxyergosta-7,22-dien-6-one, 24-methyl-cholesta-7,22-diene-3&#x03B2;,5&#x03B1;,6&#x03B2;-triol, 3&#x03B2;-hydroxy-7-methoxy-cholesta-5-en, and 3&#x03B2;-hydroxycholest-5-en-7-one. In addition, brassicasterol, which has antitumor activity, has been recently obtained from <italic>Hippocampus abdominalis</italic> Lesson (<xref ref-type="bibr" rid="B123">Xu et al., 2020</xref>). Although a large number of steroids have been isolated, marker ingredients have not been identified from <italic>Hippocampus</italic> quality evaluation standards. It is urgent to establish a stable and controllable method to scientifically evaluate and control the quality of <italic>Hippocampus</italic>.</p>
</sec>
<sec id="S4.SS3">
<title>Fatty Acids</title>
<p><italic>Hippocampus</italic> contains 82 types of fatty acids, including 35 types of saturated fatty acids and 47 types of unsaturated fatty acids (<xref ref-type="supplementary-material" rid="DS1">Supplementary Table 6</xref>). <xref ref-type="bibr" rid="B65">Lin et al. (2008)</xref> found that there were 12 types of fatty acids distributed widely among six species of <italic>Hippocampus</italic>, and hexadecanoic acid, octadecanoic acid, oleic acid, 5,8,11,14,17-eicosapentaenoic acid (EPA), and 4,7,10,13,16,19-docosahexaenoic acid (DHA) were the main ingredients. The ratios of unsaturated fatty acids and EPA and DHA to total fatty acids were 48&#x2013;59% and 14&#x2013;35%, respectively. Studies have shown that EPA and DHA not only reduce the risk of cardiovascular diseases, such as atherosclerosis, arrhythmia, and hyperlipidemia (<xref ref-type="bibr" rid="B112">Watanabe and Tatsuno, 2017</xref>), but also improve sperm quality and sperm motility when used as food supplements (<xref ref-type="bibr" rid="B41">Hosseini et al., 2019</xref>). <xref ref-type="bibr" rid="B13">Chen (2015)</xref> identified 26 types of fatty acids from seven species of <italic>Hippocampus</italic>; among benzenepropanoic acids, 3,5-bis(1,1-dimethylethyl)-4-hydroxy was found for the first time. Tetradecanoic acid, hexadecanoic acid, octadecanoic acid, 9(Z)-octadecenoic acid, 5,8,11,14-eicosatetraenoic acid, and DHA were the main fatty acids in the five medicinal <italic>Hippocampus</italic> species. <xref ref-type="bibr" rid="B132">Zhang and Wang (1996)</xref> isolated 42 fatty acid peaks of <italic>Hippocampus japonicus</italic> Kaup by a rapid fat extraction method, among which EPA and DHA accounted for 14.1%. Amazingly, there were many other types of fatty acids in <italic>Hippocampus erectus</italic> Perry, such as heptadecanoic acid, tetracosenoic acid, 11-octadecenoic acid, 15-tetracosenic acid, and 7,10,13,16-docosatetraenoic acid (<xref ref-type="bibr" rid="B79">Nicol&#x00E1;s et al., 2014</xref>).</p>
</sec>
<sec id="S4.SS4">
<title>Mineral Elements</title>
<p>Mineral elements play an important role in growth because they help to improve immunity and anti-fatigue (<xref ref-type="bibr" rid="B97">Sherman, 1992</xref>). Twenty-four types of mineral elements were found in five <italic>Hippocampus</italic> medicinal species. The contents of P, K, Na, and Mg were all above 100 mg/g, while the contents of mineral elements, including Al, Fe, Mn, Sr, Zn, etc., were at the level of a microgram. <xref ref-type="bibr" rid="B64">Lin et al. (2009)</xref> reported that the contents of Mn and Zn in <italic>Hippocampus trimaculatus</italic> Leach were 21.73 and 31.44 &#x03BC;g/g, respectively. The total contents of mineral elements in <italic>Hippocampus Kuda</italic> Bleeker were 84,873 &#x03BC;g/g, which also contained Cr, Co, Se, and Pb (<xref ref-type="bibr" rid="B51">Jia and Yao, 1990</xref>). The effect of <italic>Hippocampus</italic> on warming and tonifying kidney yang also benefited from mineral elements (<xref ref-type="bibr" rid="B134">Zhang et al., 1997</xref>). Clinical studies have shown that higher levels of mineral elements may reduce the likelihood of declines in cognitive function over 5 years (<xref ref-type="bibr" rid="B35">Gerardo et al., 2020</xref>). In the brain, various nervous activities require the participation of essential mineral elements, such as Fe and Zn. Some neurodegenerative diseases are related to an imbalance in the homeostasis of these cations (<xref ref-type="bibr" rid="B4">Bohic et al., 2011</xref>), which indicates that <italic>Hippocampus</italic> may have a therapeutic effect on neurodegenerative diseases.</p>
</sec>
<sec id="S4.SS5">
<title>Phospholipids and Nucleosides</title>
<p>Studies on <italic>Hippocampus</italic> mainly focus on amino acids, mineral elements, and fatty acids, while relatively few reports have focused on the analysis technologies and ingredient activities, such as that of phospholipids and nucleosides. Phospholipids are the main component of biomembranes. A study of the contents and types of phospholipids in five medicinal <italic>Hippocampus</italic> was carried out using molybdenum blue colorimetry and thin layer chromatography (TLC) scanning. The results showed that the total contents ranged from 3.28 to 7.82 mg/g, including LPC, SM, PC, and PE (<xref ref-type="bibr" rid="B122">Xu et al., 1994</xref>). <xref ref-type="bibr" rid="B95">Shen et al. (2016)</xref> identified 50 phospholipid molecules by hydrophilic interaction chromatography-quadrupole time of flight-mass spectrometry (HILIC-QTOF/MS). In addition to PC and PE, there were 12 PIs and 9 PSs. PC and PE accounted for most of the total phospholipids at 1.91&#x2013;4.89 mg/g and 1.52&#x2013;2.64 mg/g, respectively. Marine nucleosides were found to have antiviral, anticancer, and hypertensive activities (<xref ref-type="bibr" rid="B46">Huang et al., 2014</xref>). <xref ref-type="bibr" rid="B139">Zheng et al. (2012)</xref> reported that the contents of hypoxanthine extracted from <italic>Hippocampus Kuda</italic> Bleeker and <italic>Hippocampus japonicus</italic> Kaup were 0.73 and 0.52 mg/g, respectively. The average contents of nucleosides and nucleotides in the <italic>Hippocampus japonicus</italic> Kaup were 1.974 and 0.79 mg/g, respectively. However, uridine, cytosine nucleotides, and guanine nucleotides were not found in <italic>Hippocampus japonicus</italic> Kaup (<xref ref-type="bibr" rid="B113">Wei et al., 2015</xref>). <xref ref-type="bibr" rid="B126">Yan Z. Z., (2019)</xref> found six nucleosides in <italic>Hippocampus erectus</italic> Perry, more types and contents than those in <italic>Hippocampus japonicus</italic> Kaup.</p>
</sec>
<sec id="S4.SS6">
<title>Other Ingredients</title>
<p>Apart from the abovementioned ingredients, other ingredients have also been reported. Six phthalate derivatives have been isolated from ethanol extracts of <italic>Hippocampus Kuda</italic> Bleeker and <italic>Hippocampus trimaculatus</italic> Leach, including dibutyl phthalate, bis(2-ethylhexyl)phthalate (<xref ref-type="bibr" rid="B114">Wu et al., 2017b</xref>), bis(2-ethylheptyl)phthalate, bis(2-ethyldodecyl) phthalate, 2-ethyldecyl 2-ethylundecyl phthalate, and 2,12-diethyl-11-methylhexadecyl 2-ethyl-11-methylhexadecylphthalate (<xref ref-type="bibr" rid="B62">Li et al., 2008</xref>). As a part of ongoing research on extraction and isolation, paeonol was incidentally isolated from <italic>Hippocampus Kuda</italic> Bleeker (<xref ref-type="bibr" rid="B40">Himaya et al., 2012</xref>). The flavor profile was identified based on a set of volatile ingredients that rendered the characteristic taste and smell of <italic>Hippocampus</italic>. Based on headspace solid-phase microextraction combined with GC&#x2013;MS, 84 potential volatile ingredients were identified, including acids, hydrocarbons, alcohols, aldehydes, ketones, esters, and amines. The main flavor ingredients with contributions over 70% were (E,E)-3,5-octadiene-2-one, trimethylamine, hexanoic acid, 2-nonone, etc., (<xref ref-type="bibr" rid="B99">Si et al., 2018</xref>). Glycoproteins of <italic>Hippocampus</italic> have rarely been reported because of their relatively complex composition. Box-Behnken and ultrasonic extraction technology were applied to separate glycoproteins HG-11 and HG-21 (<xref ref-type="bibr" rid="B101">Su and Xu, 2015a</xref>). Glycoproteins included in marine organisms are the main active ingredients and deserve additional attention in future research. In addition, the nuclear magnetic resonance (NMR) and GC&#x2013;MS metabonomics methods (<xref ref-type="bibr" rid="B138">Zhao, 2018</xref>) and the Traditional Chinese Medicines Integrated Database (TCMID) (<xref ref-type="bibr" rid="B106">TCMID, 2020</xref>) have provided a large amount of information regarding the chemical ingredients of <italic>Hippocampus</italic>.</p>
</sec>
</sec>
<sec id="S5">
<title>Influencing Factors of Different Ingredient Constituents</title>
<p>The ingredient constituents of <italic>Hippocampus</italic> are affected by multiple factors. Different species of <italic>Hippocampus</italic> have significant differences in ingredient constituents (<xref ref-type="bibr" rid="B65">Lin et al., 2008</xref>). Studies on the influence of sex and wild and cultured growth stages on <italic>Hippocampus</italic> ingredients provided a basis for medicinal research and breeding technology (<xref ref-type="bibr" rid="B102">Su and Xu, 2015b</xref>). Based on the connection of factors and constituents, <italic>Hippocampus</italic> species may be chosen according to the needs of the research. We may adjust the proportion of baits in breeding according to the difference in ingredient constituents. In contrast, such studies have also provided references for species identification. The ingredient constituents in the samples may also provide information on the <italic>Hippocampus</italic> species, genders, growth stage, etc.</p>
<sec id="S5.SS1">
<title>Species and Genders</title>
<p><xref ref-type="bibr" rid="B65">Lin et al. (2008)</xref> compared different ingredient constituents of six species of <italic>Hippocampus</italic>. The crude protein content was the most abundant in <italic>Hippocampus kelloggi</italic> Jordan et Snyder, while, in <italic>Hippocampus histrix</italic> Kaup, was the lowest. Notably, more than half of the fatty acids in <italic>Hippocampus comes</italic> Cantor were unsaturated fatty acids, resulting in approximately 1.25&#x2013;1.8 times as much EPA and DHA in <italic>Hippocampus comes</italic> Cantor compared to those in medicinal <italic>Hippocampus</italic> species. Mg was the most abundant mineral element in <italic>Hippocampus trimaculatus</italic> Leach and <italic>Hippocampus histrix</italic> Kaup, and the contents were 1125.44 and 1076.57 &#x03BC;g/g, respectively. <xref ref-type="bibr" rid="B13">Chen (2015)</xref> compared steroids in seven species of <italic>Hippocampus</italic>. The most abundant steroids content was found in <italic>Hippocampus japonicus</italic> Kaup, and the least abundant steroid content was found in <italic>Hippocampus histrix</italic> Kaup and <italic>Hippocampus comes</italic> Canter. <xref ref-type="bibr" rid="B122">Xu et al. (1994)</xref> reported the total phospholipid contents of five medicinal <italic>Hippocampus</italic> species. The highest phospholipids content was observed in <italic>Hippocampus japonicus</italic> Kaup (7.82 mg/g), but PEs were hardly detected compared with that of any other <italic>Hippocampus</italic> species. <sup>1</sup>H-NMR metabonomics studies showed that the contents of glutamic acid, aspartic acid, glycerol, taurine, and acetic acid in <italic>Hippocampus trimaculatus</italic> Leach and <italic>Hippocampus kelloggi</italic> Jordan et Snyder were significantly higher than those in <italic>Hippocampus kuda</italic> Bleeker, while the contents of isoleucine and leucine were significantly low (<xref ref-type="bibr" rid="B138">Zhao, 2018</xref>). TCM theory about medicinal <italic>Hippocampus</italic> emphasizes that both male and female <italic>Hippocampus</italic> should be used together (<xref ref-type="bibr" rid="B121">Xu et al., 2002</xref>). Whether there was a difference in medicinal value between males and females was not clear. At the age of 6 months, female <italic>Hippocampus</italic> had a slightly higher proportion of steroids and unsaturated fatty acids than males (<xref ref-type="bibr" rid="B105">Sun et al., 2020</xref>). The fatty acid extraction rate of male <italic>Hippocampus</italic> was slightly higher than that of females (<xref ref-type="bibr" rid="B102">Su and Xu, 2015b</xref>). There was no significant difference in ingredient constituents between male and female <italic>Hippocampus erectus</italic> Perry and <italic>Hippocampus trimaculatus</italic> Leach, although the contents of cholesterol and hypoxanthine in female <italic>Hippocampus</italic> were significantly higher than that in males, and the content of uridine in female <italic>Hippocampus erectus</italic> Perry was significantly lower than that in males (<xref ref-type="bibr" rid="B126">Yan Z. Z., 2019</xref>). Such findings may explain why male and female <italic>Hippocampus</italic> would be used together. In conclusion, gender had a limited effect on the ingredient constitutions.</p>
</sec>
<sec id="S5.SS2">
<title>Growth Stage</title>
<p>Eggs of <italic>Hippocampus guttulatus</italic> Cuvier are round and transparent, and the yolk sac provides nutrition for embryo development. Eggs and newborn <italic>Hippocampus</italic> represent different growth stages, and their ingredient constituents are different. Taking fatty acids as an example, the fatty acid contents in newborn <italic>Hippocampus</italic> were much lower than those in eggs. The content of unsaturated fatty acids in eggs was more than four times higher than that in newborn <italic>Hippocampus</italic>, and DHA and EPA were rich in eggs. Omega-3 unsaturated fatty acids were consumed during embryonic development, which explained the difference in fatty acid contents between newborn <italic>Hippocampus</italic> and eggs (<xref ref-type="bibr" rid="B29">Faleiro and Narciso, 2010</xref>). <xref ref-type="bibr" rid="B105">Sun et al. (2020)</xref> analyzed the ingredients of wild <italic>Hippocampus</italic> at the ages of 6 month, 1 year, and 2 years. It was obvious that crude protein content was higher in the ration of 1-year-old <italic>Hippocampus</italic> compared with the ration of 6- and 2-year-old. The Fe, Cu, and Zn contents increased with age, whereas unsaturated fatty acid contents decreased significantly. Contents of proteins and fatty acids were more abundant in 1-year-old <italic>Hippocampus</italic>; therefore, <italic>Hippocampus</italic> in this stage is proper for TCM applications.</p>
</sec>
<sec id="S5.SS3">
<title>Wild Types and Cultured Types</title>
<p>The qualities of wild and cultured <italic>Hippocampus</italic> differed due to the different growth environments. The contents of essential amino acids and unsaturated fatty acids were much higher in cultured <italic>Hippocampus kuda</italic> Bleeker than in wild <italic>Hippocampus</italic>. In terms of mineral elements, Se, Fe, Cu, and Ca were much more abundant in wild <italic>Hippocampus</italic> (<xref ref-type="bibr" rid="B105">Sun et al., 2020</xref>). <xref ref-type="bibr" rid="B64">Lin et al. (2009)</xref> showed that the contents of DHA and EPA in cultured <italic>Hippocampus trimaculatus</italic> Leach were nearly two times as high as those in wild <italic>Hippocampus</italic>, and the proportions of polyunsaturated fatty acids in total fatty acids were 31.89 and 21.39%, respectively. The cultured <italic>Hippocampus</italic> was rich in polyunsaturated fatty acids, but there were some deficiencies in protein. In addition to Pb, the contents of Cd, Cr, Zn, and Mn in cultured <italic>Hippocampus</italic> were higher than those in wild <italic>Hippocampus</italic>. Additional nutritional supplements were added to the bait as required. Understanding the difference in nutritional characteristics between wild and cultured <italic>Hippocampus</italic> is helpful for optimizing the breeding technology and supplementing wild <italic>Hippocampus</italic>.</p>
</sec>
<sec id="S5.SS4">
<title>Baits</title>
<p>For cultured <italic>Hippocampus</italic>, different baits had a great influence on the ingredient constituents of <italic>Hippocampus</italic>. Hexadecanoic acid, octadecenoic acid, octadecatrienoic acid, eicosapentaenoic acid, etc., are rich in <italic>Artemia</italic> and rotifers. Several differences in fatty acid types have been observed for different baits, and obvious variations have been observed for EPA and DHA. <xref ref-type="bibr" rid="B80">Otero-Ferrer et al. (2010)</xref> fed <italic>Hippocampus hippocampus</italic> Linnaeus <italic>Artemia</italic> and rotifers, and, after 5 days of feeding, the rotifer group showed a higher level of omega-3 unsaturated fatty acids, and the fatty acid types were more abundant than those in the <italic>Artemia</italic> group. The contents of 9,12-octadecadienoic acid and 9,12,15-octadecatrienoic acid in the <italic>Artemia</italic> group were more prominent. After 34 days of feeding, fatty acids in the <italic>Artemia</italic> group were gradually enriched, and the contents of DHA and EPA in the <italic>Artemia</italic> group were higher than those in the rotifer group. In addition, the <italic>Artemia</italic> group also showed lower mortality and a higher growth rate. <xref ref-type="bibr" rid="B93">Segade et al. (2016)</xref> further compared the differences among <italic>Hippocampus</italic>-fed <italic>Artemia</italic>, frozen <italic>Artemia</italic>, and Mysis. The results showed that the crude protein content of the frozen <italic>Artemia</italic> group was the lowest among the three groups. The content of polyunsaturated fatty acids in the <italic>Artemia</italic> group was the highest, while that in the Mysis group was the lowest. Frozen bait may not fully meet the nutritional needs of <italic>Hippocampus</italic>. In addition, the Mysis group had the most abundant nucleosides, and thymine was not detected in the frozen Mysis group or the <italic>Artemia</italic> group (<xref ref-type="bibr" rid="B126">Yan Z. Z., 2019</xref>). In the selection of baits, mixing of different baits may meet different nutritional needs.</p>
</sec>
</sec>
<sec id="S6">
<title>Extraction Strategies of <italic>Hippocampus</italic></title>
<p>Extraction is a method of obtaining effective ingredients from medicinal materials through chemical processes, such as solvent treatment, or by mechanical processes, such as supercritical fluid extraction and microwave-assisted extraction (<xref ref-type="bibr" rid="B9">Chaves et al., 2020</xref>). Extraction of <italic>Hippocampus</italic> active ingredients is the basis for the study of its pharmacological activity. The potential targets and mechanisms of action of <italic>Hippocampus</italic> in disease treatment must be clarified. Extraction methods for different ingredients should be further researched to find a high-efficiency method that presents a shorter extraction time.</p>
<sec id="S6.SS1">
<title>Extraction Strategies of Hydrophilic Ingredients</title>
<p>The hydrophilic ingredients of <italic>Hippocampus</italic> are mainly amino acids, peptides, glycoproteins, nucleosides, etc., <xref ref-type="bibr" rid="B17">Chen et al. (1997)</xref> compared amino acids in water and ethanol extracts of <italic>Hippocampus</italic>. The results showed that the <italic>Hippocampus</italic> water extract contained 17 types of amino acids, while the ethanol extract contained only 10 types of amino acids. The essential amino acid content of the <italic>Hippocampus</italic> water extract was also higher than that of the ethanol extract. <italic>Hippocampus</italic> peptides were obtained by enzyme hydrolysis and chromatography technologies. For bioactive peptides from marine organisms, the first step was the trituration of the tissues, followed by initial treatment (organic extraction, concentration, and/or partitioning). Under the guidance of activity assays, chromatographic technology was used for prepurification, and purified peptides were finally obtained by high-performance liquid chromatography using reversed-phase (RP-HPLC). Alternatively, after tissue separation, enzymatic hydrolysis could be employed to identify bioactive peptides (<xref ref-type="bibr" rid="B72">Macedo et al., 2021</xref>). Enzymatic hydrolysis is a commonly used method to extract <italic>Hippocampus</italic> peptides. Commonly selected enzymes include pronase E, alcalase, protamex, trypsin, papain, and pepsin (<xref ref-type="table" rid="T1">Table 1</xref>). Enzymes and substrates at a ratio of 1:100 (w/w) were mixed under certain conditions, and then the mixture was inactivated at 100&#x00B0;C for 10 min and stored at &#x2212;80&#x00B0;C (<xref ref-type="bibr" rid="B82">Pangestuti et al., 2013</xref>). In addition, <italic>Hippocampus</italic> was defatted with ethyl acetate or CO<sub>2</sub> supercritical fluid extraction technology and then mixed with enzyme (<xref ref-type="bibr" rid="B53">Jiang et al., 2014</xref>). <xref ref-type="bibr" rid="B53">Jiang et al. (2014)</xref> studied the condition of compound enzyme hydrolysis and found that the hydrolysis rate of alcalase and trypsin was 2&#x2013;3% higher than that of single enzyme hydrolysis. We summarized the enzyme reaction under different conditions to obtain optimized reaction conditions (<xref ref-type="table" rid="T1">Table 1</xref>). Enzymes were selected according to the different needs of research. For example, <italic>Hippocampus trimaculatus</italic> Leach protein was hydrolyzed by four different proteases (trypsin, pepsin, papain, and alcalase) to prepare peptides, and, compared with other hydrolysates, alcalase hydrolysates exhibited the highest ACE inhibitory activity (<xref ref-type="bibr" rid="B120">Xu, 2015</xref>). Nucleosides of <italic>Hippocampus</italic> are generally extracted with 50% ethanol or water, followed by HPLC analysis (<xref ref-type="bibr" rid="B113">Wei et al., 2015</xref>; <xref ref-type="bibr" rid="B126">Yan Z. Z., 2019</xref>). <xref ref-type="bibr" rid="B12">Chen et al. (2010)</xref> developed an online rapid method for the identification of hypoxanthine, and the antioxidant hypoxanthine was identified from a water extract of <italic>Hippocampus japonicus</italic> Kaup by HPLC-ESI-TOF/MS combined with an ABTS free radical scavenging online detection system. <xref ref-type="bibr" rid="B139">Zheng et al. (2012)</xref> used different antioxidant evaluation experiments for DPPH free radical scavenging, and an online detection system also identified hypoxanthine from water extracts of <italic>Hippocampus kuda</italic> Bleeker and <italic>Hippocampus japonicus</italic> Kaup. The online detection system combines biological activity and chemical separation, and the target ingredient may be quickly separated.</p>
<table-wrap position="float" id="T1">
<label>TABLE 1</label>
<caption><p>The optimized enzyme hydrolysis conditions.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"><bold>Enzyme</bold></td>
<td valign="top" align="center"><bold>Temperature (&#x00B0;C)</bold></td>
<td valign="top" align="center"><bold>Hydrolysis time (h)</bold></td>
<td valign="top" align="center"><bold>pH</bold></td>
<td valign="top" align="center"><bold>Enzyme to substrate (E/S) ratio (%)</bold></td>
<td valign="top" align="left"><bold>References</bold></td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">pronase E</td>
<td valign="top" align="center">36.7</td>
<td valign="top" align="center">20.0</td>
<td valign="top" align="center">7.3</td>
<td valign="top" align="center">2.0</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B82">Pangestuti et al., 2013</xref></td>
</tr>
<tr>
<td valign="top" align="left">Protamex</td>
<td valign="top" align="center">40.0</td>
<td valign="top" align="center">NA&#x002A;</td>
<td valign="top" align="center">6.0</td>
<td valign="top" align="center">1.0</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B48">Je et al., 2020</xref></td>
</tr>
<tr>
<td valign="top" align="left">Alcalase</td>
<td valign="top" align="center">54.7</td>
<td valign="top" align="center">6.0</td>
<td valign="top" align="center">9.0</td>
<td valign="top" align="center">4.0</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B53">Jiang et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left">Trypsin</td>
<td valign="top" align="center">45.0</td>
<td valign="top" align="center">4.0</td>
<td valign="top" align="center">8.8</td>
<td valign="top" align="center">4.0</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B53">Jiang et al., 2014</xref></td>
</tr>
<tr>
<td valign="top" align="left">Papain</td>
<td valign="top" align="center">59.0</td>
<td valign="top" align="center">7.5</td>
<td valign="top" align="center">7.7</td>
<td valign="top" align="center">5.0</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B36">Gu and Xu, 2016</xref></td>
</tr>
<tr>
<td valign="top" align="left">Pepsin</td>
<td valign="top" align="center">50.0</td>
<td valign="top" align="center">6.0</td>
<td valign="top" align="center">2.6</td>
<td valign="top" align="center">1.0</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B130">Yuan et al., 2011</xref></td>
</tr>
<tr>
<td valign="top" align="left">Alcalase + Trypsin</td>
<td valign="top" align="center">45.0&#x2013;54.7</td>
<td valign="top" align="center">4.0&#x2013;6.0</td>
<td valign="top" align="center">8.8&#x2013;9.0</td>
<td valign="top" align="center">4.0</td>
<td valign="top" align="left"><xref ref-type="bibr" rid="B53">Jiang et al., 2014</xref></td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn1"><p><italic>The optimized enzyme hydrolysis conditions. &#x002A;NA: Not Available.</italic></p></fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="S6.SS2">
<title>Extraction Strategies of Hydrophobic Ingredients</title>
<p>More reports have focused on <italic>Hippocampus</italic> hydrophobic ingredients than other types, and these hydrophobic ingredients include fatty acids, steroids, and phospholipids. The extraction of fatty acids in <italic>Hippocampus</italic> is performed by the traditional solvent extraction method. <xref ref-type="bibr" rid="B79">Nicol&#x00E1;s et al. (2014)</xref> directly soaked <italic>Hippocampus</italic> powder in chloroform:methanol (2:1) for 24 h to extract total lipids. The extraction solvent of chloroform:methanol (2:1) was also used for ultrasonic extraction (<xref ref-type="bibr" rid="B122">Xu et al., 1994</xref>). The results showed that there were more types of fatty acids in the ultrasonic extraction. Extraction methods using ether as the extraction solvent include Soxhlet extraction (<xref ref-type="bibr" rid="B134">Zhang et al., 1997</xref>), rapid fat extraction (<xref ref-type="bibr" rid="B132">Zhang and Wang, 1996</xref>), and ultrasonic extraction (<xref ref-type="bibr" rid="B13">Chen, 2015</xref>). Among them, the rapid fat extraction method greatly shortened the extraction period and effectively reduced the oxidation of <italic>Hippocampus</italic> unsaturated fatty acids (<xref ref-type="bibr" rid="B132">Zhang and Wang, 1996</xref>). In summary, ultrasonic extraction and rapid fat extraction are generally used in the extraction of fatty acids. Compared with traditional solvent extraction methods with the problems of solvent residue and heating damage to fatty acids, CO<sub>2</sub> supercritical fluid extraction can extract total lipids at low temperatures and without organic solvents (<xref ref-type="bibr" rid="B52">Jiang et al., 2013</xref>). <xref ref-type="bibr" rid="B45">Huang and Xu (2016)</xref> compared the effects of chloroform-methanol extraction, absolute ethanol extraction, petroleum ether Soxhlet extraction, and CO<sub>2</sub> supercritical fluid extraction on the lipid and fatty acid constituents of <italic>Hippocampus</italic>. The results showed that the types of fatty acids by the four methods were almost the same while the contents of unsaturated fatty acids in chloroform-methanol extraction and absolute ethanol extraction were the highest, with saturated fatty acids in CO<sub>2</sub> supercritical fluid extraction the highest. The extraction of <italic>Hippocampus</italic> steroids has generally been performed by ethanol extraction followed by organic solvent (n-butanol, ethyl acetate, and petroleum ether) extraction. The fractions were then repeatedly chromatographed with silica gel column chromatography using a stepwise gradient elution of different solvents (<xref ref-type="bibr" rid="B114">Wu et al., 2017b</xref>). The total lipids of the <italic>Hippocampus</italic> were extracted by chloroform-methanol (2:1), 75% ethanol, and water, and the content of total phospholipids was identified by molybdenum blue colorimetry. Studies have shown that the chloroform-methanol (2:1) extraction method has the highest content of total phospholipids (<xref ref-type="bibr" rid="B122">Xu et al., 1994</xref>; <xref ref-type="bibr" rid="B96">Sheng et al., 2011</xref>).</p>
</sec>
</sec>
<sec id="S7">
<title>Pharmacological Activities of <italic>Hippocampus</italic></title>
<p>The pharmacological activities of <italic>Hippocampus</italic> were sorted according to the different extraction methods (enzymolysis, alcohol extraction, water extraction, and other extraction methods). Modern pharmacological studies have revealed that <italic>Hippocampus</italic> shows various biological activities, such as sex hormone-like effects and antioxidation, anti-inflammation, antitumor effects, neuroprotection, and antimicrobial activities. Different extraction portions of <italic>Hippocampus</italic> exhibited particular pharmacological activities, which may be related to the ingredient types. For example, the antihypertensive and neuroprotective activities of enzymolysis portions were based on the peptides extracted. The alcohol extraction portions mainly showed sex hormone-like effects and anti-inflammation, which were closely related to steroids, ketones, etc. In <xref ref-type="fig" rid="F6">Figure 6</xref>, the extraction methods, ingredients, and pharmacological activities are summarized.</p>
<fig id="F6" position="float">
<label>FIGURE 6</label>
<caption><p>Pharmacological activities of <italic>Hippocampus</italic> extractions.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmars-08-774927-g006.tif"/>
</fig>
<sec id="S7.SS1">
<title>Enzymolysis</title>
<p>The pharmacological activities of <italic>Hippocampus</italic> peptides include antihypertensive, antioxidation, and anti-inflammation activities (<xref ref-type="fig" rid="F6">Figure 6</xref>). The ACE inhibitory peptide obtained from <italic>Hippocampus abdominalis</italic> Lesson induced an increase in NO content in blood vessels through the expression of phosphor-endothelial nitric oxide synthase (p-eNOS) to promote vasodilation and lower blood pressure (<xref ref-type="bibr" rid="B48">Je et al., 2020</xref>). ACE is part of the renin-angiotensin system and plays a vital role in regulating blood pressure, and ACE inhibitors are effective in the treatment of hypertension (<xref ref-type="bibr" rid="B59">Li et al., 2014</xref>). In addition, free radicals are in a special state of balance in the human body, and when this balance is disrupted, they may cause oxidative stress, which can lead to the damage of blood vessels and cardiovascular diseases. Interestingly, <xref ref-type="bibr" rid="B36">Gu and Xu (2016)</xref> found that <italic>Hippocampus</italic> ACE inhibitory peptide showed DPPH radical scavenging activity. One of the medicinal candidates for the treatment of hypertension may be bifunctional peptides with both ACE inhibitory and antioxidant activity. The therapeutic effects of peptide SHP-1 isolated from <italic>Hippocampus kuda</italic> Bleeker on arthritis were observed with human chondrocyte-like SW-1353 and human osteoblast-like MG-63 cells. The inhibition rates of SHP-1 on collagen release in SW-1353 and MG-63 cells were 40.35&#x2013;59.96% and 60.82&#x2013;85.82%, respectively. SHP-1 inhibited the expression of collagenase 1,13 and NO induced by the proinflammatory cytokine 12-O-tetradecanoylphorbol-13-acetate (TPA) and blocked NF-KB/p38 kinase (<xref ref-type="bibr" rid="B90">Ryu et al., 2010</xref>). <xref ref-type="bibr" rid="B89">Ryu (2010)</xref> further isolated a <italic>Hippocampus</italic> peptide with alkaline phosphatase activity and showed that it not only promoted the differentiation of MG-63 osteoblasts and SW-1353 chondrocytes but also inhibited the expression of the inflammatory factors cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS). A peptide showed remarkable anti-inflammatory activity by regulating the NF-&#x03BA;B and MAPK signaling pathways. Patients with arthritis have persistent joint swelling and restricted movement due to pain (<xref ref-type="bibr" rid="B73">Mandl, 2019</xref>). The anti-inflammatory effect of peptides may be associated with the traditional efficacy of <italic>Hippocampus</italic> in reducing swelling.</p>
<p><italic>Hippocampus</italic> also presents an anti-fatigue effect (<xref ref-type="bibr" rid="B43">Hu et al., 2000</xref>). <xref ref-type="bibr" rid="B54">Kang et al. (2017)</xref> found that enzymatic hydrolysates of <italic>Hippocampus abdominalis</italic> Lesson promoted the proliferation of C2C12 myoblasts and increased the contents of physical activity markers, such as ATP and glycogen. <italic>Hippocampus</italic> enzymatic hydrolysates not only promoted the elimination of lactic acid and urea nitrogen during exercise but also strengthened the antifatigue activity with increasing exercise intensity. Compared with the antifatigue effect of the one-time fatigue model, the incremental exercise fatigue model was more effective. For normal mice, <italic>Hippocampus</italic> enzymatic hydrolysates improved the survival time under hypoxia and cold conditions (<xref ref-type="bibr" rid="B83">Peng and Chen, 2005</xref>). Accordingly, supplementation with <italic>Hippocampus</italic> enzymatic hydrolysates may be a natural health product that has an improved effect on the human body. For nervous diseases, <italic>Hippocampus</italic> enzymatic hydrolysates promoted the recovery of neurological function and reduced the volume of cerebral infarction and brain edema in animal models of ischemia-reperfusion brain damage (<xref ref-type="bibr" rid="B31">Feng et al., 2005</xref>). The peptide HTP-1 had a protective effect on A&#x03B2;<sub>42</sub>-induced PC12 cells and may be an active ingredient of <italic>Hippocampus</italic> for the treatment of neurodegenerative disease (<xref ref-type="bibr" rid="B82">Pangestuti et al., 2013</xref>). However, the neuroprotective mechanisms of <italic>Hippocampus</italic> require further investigation. In a coculture system with PC12 cells and BV-2 cells induced by A&#x03B2;<sub>42</sub>, HTP-1-protected PC12 cells were not subjected to the neurotoxicity of BV-2 cells. HTP-1 attenuated the neurotoxic mediators released by BV-2 cells and activated PI3K/Akt by inducing transforming growth factor-&#x03B2; (TGF-&#x03B2;), which is the main signaling pathway of neuronal survival (<xref ref-type="bibr" rid="B81">Pangestuti and Kim, 2015</xref>).</p>
</sec>
<sec id="S7.SS2">
<title>Alcohol Extraction</title>
<p>The <italic>Hippocampus</italic> activity of warming and tonifying kidney yang was closely related to the alcohol extract of <italic>Hippocampus</italic>. <xref ref-type="bibr" rid="B15">Chen et al. (2009)</xref> studied the effect of the n-butanol extract from <italic>Hippocampus</italic> on a mouse model of kidney yang deficiency. After 15 days of continuous administration, the results showed that the n-butanol group improved the rectal temperature, grip strength, testis index, and seminal vesicle index of the model mouse. The ethanol extract of <italic>Hippocampus</italic> was orally administered to normal and cyclophosphamide model mice, and it was found to increase the overall sperm number and viability. From the perspective of modern science, <italic>Hippocampus</italic> improves the symptoms of kidney deficiency, such as weakness at the waist and knees, frigidity, chilliness, and cold limbs (<xref ref-type="bibr" rid="B133">Zhang et al., 1995</xref>). The total sterol content in <italic>Hippocampus kuda</italic> Bleeker not only increased the content of testosterone <italic>in vivo</italic> but also changed the structure of the seminiferous duct and promoted the formation of sperm. However, long-term high-dose intake of total sterols might change the shape of the kidney and testis (<xref ref-type="bibr" rid="B104">Sun, 2015</xref>). Over thousands of years, traditional Chinese clinical practices have supported the effect of <italic>Hippocampus</italic> on improving sexual function, although the material basis and concrete mechanism of efficacy were not clear. The enzymatic hydrolysate of <italic>Hippocampus</italic> had a certain therapeutic effect on arthritis, while the alcohol extract was more effective in the treatment of neuroinflammation. <xref ref-type="bibr" rid="B39">Himaya et al. (2011</xref>, <xref ref-type="bibr" rid="B40">2012)</xref> isolated 1-(5-bromo-2-hydroxy-4-methoxyphenyl)ethanone (SE1) and paeonol from <italic>Hippocampus kuda</italic> Bleeker and showed that it inhibited the expression of proinflammatory cytokines in BV-2 microglial cells induced by lipopolysaccharide (LPS). This compound played an anti-inflammatory role by inhibiting the phosphorylation of JNK and p38 in the MAPK pathway and nuclear heterotrophs in the NF-kB pathway (<xref ref-type="fig" rid="F7">Figure 7</xref>). <xref ref-type="bibr" rid="B125">Yan et al. (2019)</xref> further found that SE1 and paeonol improved the morphology of activated microglia with enlarged cell bodies and shorter synapses. Recent studies have shown that neurodegenerative diseases are closely related to neuroinflammation caused by activated microglia (<xref ref-type="bibr" rid="B92">Sarlus and Heneka, 2017</xref>). SE1 and paeonol extracted from <italic>Hippocampus</italic>-modulated neuroinflammation and may be potential candidates for treating neurodegenerative diseases, such as Alzheimer&#x2019;s disease (AD). To verify the effects and mechanisms of SE1 and paeonol on AD, <italic>in vitro</italic> or <italic>in vivo</italic> experiments with pharmacological approaches are needed in the future. Recently, patients with schizophrenia have been shown to have an increased inflammatory response, and autophagy dysfunction caused by inflammation might continue to increase the inflammatory response. Studies have shown that the alcohol extract of <italic>Hippocampus kelloggi</italic> Jordan et Snyder exerts anti-inflammatory effects by improving autophagy, thus revealing a new possible target for <italic>Hippocampus</italic>-based therapeutics to combat schizophrenia (<xref ref-type="bibr" rid="B124">Yan L., 2019</xref>). In addition, the methanol extract of <italic>Hippocampus</italic> increased the concentration of neurotransmitters and the expression of brain-derived neurotransmitters by inhibiting the secretion of proinflammatory factor interleukin-1&#x03B2; (1L-1&#x03B2;), which improved depressive behavior in mice and restored normal neurotransmitter function (<xref ref-type="bibr" rid="B60">Li et al., 2020</xref>). The <italic>Hippocampus</italic> anti-inflammatory effect is associated with the regulation of the MAPK and NF-&#x03BA;B pathways, which are primarily associated with inflammation (<xref ref-type="bibr" rid="B116">Wu et al., 2017a</xref>). <xref ref-type="bibr" rid="B115">Wu et al. (2020)</xref> identified miR-98-5p from the cellular RNA library, and 3&#x03B2;-hydroxycholest-5-en-7-one isolated from <italic>Hippocampus</italic> regulated the expression of the miR-98-5p target gene TNFAIP3 to inhibit the excessive secretion of proinflammatory factors and produce an anti-inflammatory effect. The screening of antitumor active ingredients from TCM has become a hot field. Studies have shown that the alcohol extract of <italic>Hippocampus</italic> has an inhibitory effect on tumor cells. In a study of dihydrotestosterone-induced LNCaP cells of prostate cancer, dual-targeting AKT and AR signaling showed that brassicasterol from <italic>Hippocampus abdominalis</italic> Lesson exerted an anticancer effect (<xref ref-type="bibr" rid="B123">Xu et al., 2020</xref>). Sphingoid bases were purified from <italic>Hippocampus</italic> using lipid extraction, saponification, and acid hydrolysis (<xref ref-type="bibr" rid="B129">Yu, 2018</xref>). The IC<sub>50</sub> of human chronic myeloid leukemia cells treated with sphingoid bases for 24 h was 37.17 &#x03BC;g/ml. Further investigation of the mechanisms by Western blot and RT&#x2013;PCR analysis revealed that sphingoid bases exerted their antitumor activity by inducing apoptosis <italic>via</italic> both the mitochondrial apoptosis pathway and the death receptor pathway. In addition, sphingoid bases also inhibited the formation of neovascularization and promoted cell apoptosis by inhibiting the expression of COX-2. The antitumor activity of <italic>Hippocampus</italic> is mainly caused by low- and medium-polarity ingredients and has great research prospects in cancer therapy.</p>
<fig id="F7" position="float">
<label>FIGURE 7</label>
<caption><p>Paeonol and 1-(5-bromo-2-hydroxy-4-methoxyphenyl)ethanone(SE1) from <italic>Hippocampus Kuda</italic> Bleeker blocked the LPS-stimulated inflammatory responses in BV-2 microglial cell <italic>via</italic> modulating MAPK and NF-&#x03BA;B-signaling pathways.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmars-08-774927-g007.tif"/>
</fig>
<p>The antioxidant activity of <italic>Hippocampus</italic> was also explored. Three phthalic acid derivatives isolated by <xref ref-type="bibr" rid="B85">Qian et al. (2012)</xref> from the methanol extract of <italic>Hippocampus kuda</italic> Bleeker had antioxidant activity, among which 2,12-diethyl-11-methylhexadecyl 2-ethyl-11-methylhexadecylphthalate had the strongest antioxidant activity and exhibited dose-dependent effects; moreover, it is a safe and effective antioxidant that inhibited reactive oxygen in mouse macrophages (RAW264.7) and had no toxic effect on cells. The ethanol extract of <italic>Hippocampus</italic> had a certain immunomodulatory effect. On the one hand, it increased the spleen weight of mice and promoted lymphocyte proliferation and phagocyte function (<xref ref-type="bibr" rid="B16">Chen et al., 1995</xref>). On the other hand, it inhibited the delayed-type hypersensitivity induced by dinitrochlorobenzene in mice (<xref ref-type="bibr" rid="B143">Zhu, 2005</xref>). Brain monoamine oxidase B (MAO-B) increases during aging, which is considered a sign of aging. The alcohol extract of <italic>Hippocampus Kuda</italic> Bleeker had a significant inhibitory effect on MAO-B activity in the mouse brain, suggesting that the <italic>Hippocampus</italic> delayed aging (<xref ref-type="bibr" rid="B94">She et al., 1995</xref>). The methanol extract of <italic>Hippocampus</italic> had an obvious inhibitory effect on the experimental common carotid artery and cerebral thrombosis in mice. The inhibition rate of 200 mg/kg extract on cerebral thrombosis was 46.8%. The main active ingredients were unsaturated fatty acids, and the content of 9,12-octadecadienoic acid accounted for 18.5% (<xref ref-type="bibr" rid="B118">Xu and Xu, 1997</xref>). In addition, the ethanol extracts from five species of <italic>Hippocampus</italic> promoted the differentiation of osteoblasts and the formation of bone nodules and had a certain therapeutic effect on osteoporosis (<xref ref-type="bibr" rid="B111">Wang, 2015</xref>).</p>
</sec>
<sec id="S7.SS3">
<title>Water Extraction</title>
<p>Antioxidant activity was found in both the water extracts of <italic>Hippocampus japonicus</italic> Kaup and <italic>Hippocampus Kuda</italic> Bleeker (<xref ref-type="bibr" rid="B12">Chen et al., 2010</xref>; <xref ref-type="bibr" rid="B139">Zheng et al., 2012</xref>), suggesting that the water extract of <italic>Hippocampus</italic> had antioxidant activities. The most important key factor affecting the degree of pharmacological activity was the extraction time, followed by the extraction temperature (<xref ref-type="bibr" rid="B128">Yi et al., 2006</xref>). <xref ref-type="bibr" rid="B86">Qian et al. (2008)</xref> compared the antioxidant activities of the methanol extract, ethanol extract, and water extract. The antioxidant activity degree of the methanol extract was higher than that of the other two extracts, and its activity degree was between that of &#x03B1;-tocopherol and vitamin C. In general, moderately and less hydrophilic ingredients showed strong antioxidant activity. The warming and tonifying kidney yang effect has been associated with the alcohol extract of <italic>Hippocampus</italic>. However, the water extract of <italic>Hippocampus</italic> also improved the ability of the testicles in the mice model with kidney yang deficiency, and the testis index was higher than that observed for the petroleum ether extract at the same dose (<xref ref-type="bibr" rid="B15">Chen et al., 2009</xref>).</p>
</sec>
<sec id="S7.SS4">
<title>Other Extraction Methods</title>
<p><xref ref-type="bibr" rid="B103">Sun et al. (2012)</xref> synthesized the antimicrobial peptide HKPLP from the brooding pouch cDNA library of <italic>Hippocampus kuda</italic> Bleeker. The results indicated that the most sensitive bacterium of HKPLP was <italic>Staphylococcus aureus</italic>. In addition, HKPLP appeared to have a minor inhibitory effect on fungi. <xref ref-type="bibr" rid="B56">Ko et al. (2016)</xref> identified a goose-type lysozyme (ShLysG) from <italic>Hippocampus abdominalis</italic> Lesson that had a certain inhibitory effect against gram-positive/negative bacteria and a potential immune-protecting effect against pathogens. Bacterial pathogen factors are one of the important factors affecting the survival of marine organisms. Isolation of marine microorganisms with antimicrobial activity from the intestinal contents and skin mucus of <italic>Hippocampus guttulatus</italic> Cuvier promoted the development of breeding and rearing of <italic>Hippocampus</italic> (<xref ref-type="bibr" rid="B2">Balcazar et al., 2010</xref>). In addition, the ethyl acetate extract from <italic>Hippocampus</italic> significantly improved benign prostatic hyperplasia in castration and testosterone mouse models (<xref ref-type="bibr" rid="B119">Xu et al., 2014</xref>).</p>
</sec>
</sec>
<sec sec-type="conclusion" id="S8">
<title>Conclusion</title>
<p>The increasing demand for safe and effective medicines has led to increased attention on marine natural products. This review mainly focused on the ingredients, extraction methods, pharmacological activities, and traditional prescriptions containing different species of <italic>Hippocampus</italic>. <italic>Hippocampus</italic> is mainly distributed in the Pacific region, with the largest species number in Australia. <italic>Hippocampus</italic> trade in China and surrounding Southeast Asian countries is high. The active ingredients of <italic>Hippocampus</italic> include hydrophobic ingredients, such as steroids and fatty acids, and hydrophilic ingredients, such as peptides and glycoproteins. Studies have shown that anti-inflammation, antioxidation, antitumor, and neuroprotective effects are the important key functions of <italic>Hippocampus</italic>. The alcohol extract of <italic>Hippocampus</italic> not only warms and tonifies kidney yang but also blocks neuroinflammation by regulating the MAPK and NF-&#x03BA;B pathways. In particular, <italic>Hippocampus</italic> peptides reduce the toxicity of A&#x03B2;<sub>42</sub> to nerve cells. The neuroprotective activity of <italic>Hippocampus</italic> indicates its ability to treat nervous system diseases. In addition, an animal experiment involving traditional prescriptions containing <italic>Hippocampus</italic> also showed its antitumor value and treatment of benign prostatic hyperplasia. In the future, quality evaluation standards for <italic>Hippocampus</italic> should be established, and the targets and mechanisms of the pharmacological activity, active ingredients, and pharmacological activities of <italic>Hippocampus</italic> need to be further studied. The kidney-brain axis may be the key point at which <italic>Hippocampus</italic> impacts neurodegenerative diseases, and <italic>Hippocampus</italic> peptides may have broader application prospects.</p>
</sec>
<sec id="S9">
<title>Author Contributions</title>
<p>XL, XF, and XC conceived and proposed the idea, designed the study, and prepared the manuscript. XZ contributed to <xref ref-type="supplementary-material" rid="DS1">Supplementary Table 6</xref>. JL contributed to <xref ref-type="fig" rid="F4">Figure 4</xref>. XF was the project organization leader. XL and XF guided the manuscript writing. All authors contributed to the article and approved the submitted version.</p>
</sec>
<sec sec-type="COI-statement" id="conf1">
<title>Conflict of Interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="pudiscl1">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
</body>
<back>
<sec sec-type="funding-information" id="S10">
<title>Funding</title>
<p>This work was supported by the National High Technology Research and Development Program of China (863 Program) (No. 2013AA093001).</p>
</sec>
<sec id="S11" sec-type="supplementary material"><title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fmars.2021.774927/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fmars.2021.774927/full#supplementary-material</ext-link></p>
<supplementary-material xlink:href="Data_Sheet_1.docx" id="DS1" mimetype="application/vnd.openxmlformats-officedocument.wordprocessingml.document" xmlns:xlink="http://www.w3.org/1999/xlink"/>
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