Safflower flavonoids positively impact cardiovascular treatment. According to pharmacological studies, its main effects are the following four aspects: (1) Impact of intervention on myocardial ischemia/reperfusion (I/R) and myocardial infarction (MI); (2) Impact of intervention on middle cerebral artery occlusion and reperfusion (MCAO/R) and stroke; (3) Anticoagulant effect; (4) Protective effect on vascular cells.

Oxidative stress significantly contributes to the progression of various diseases. Safflower flavonoids possess significant antioxidant effects, this effect is mainly achieved through the following ways: (1) Inhibition of ROS and malondialdehyde (MDA), increase antioxidant enzyme activity; (2) Activation of silent information regulator 1 (SIRT1) signaling pathway; (3) Increased the expression of antioxidant factor Nrf2; (4) Regulates Bcl-2 associated X protein (BAX)/B-cell lymphoma-2 (Bcl-2) Expression, Akt/phosphatase and tensin homolog (PTEN) signaling pathway, and NF-κB; (5) Regulates glutathione (GSH) content and GSH/glutathione oxidized (GSSG).

Oxidative stress is crucial in OGD/R and ischemia/reperfusion injury, and safflower flavonoids mitigate this by enhancing antioxidant enzyme activity, reducing ROS, and modulating relevant signaling pathways. A study employing PC12 cells subjected to OGD/R as an in vitro oxidative stress model revealed that both HSYA and AHSYB effectively counteract cell death triggered by oxidative stress. These compounds work by enhancing the activity of the cystine/glutamate antiporter system xc and boosting glutathione peroxidase 4 (GPX4) expression. Additionally, they help rebalance the GSH/GSSG ratio, ROS, and normalize iron ion concentrations (24). SIRT1, highly expressed in the hippocampus, influences oxidative stress and apoptosis at the cellular level. Fangma et al. (23) crafted a model for cerebral ischemia/reperfusion injury, both in vitro and in vivo experiments have demonstrated that HSYA and AHSYB can exert antioxidant and anti-apoptotic effects by activating the SIRT1 signaling pathway. In vivo, HSYA and AHSYB boosted levels of glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD), effectively mitigating oxidative stress within hippocampal neurons. In vitro, they discovered that HSYA and AHSYB curbed ROS and MDA output in a way that depended on the dose, while simultaneously increasing GSH-Px and SOD production. They also saw a considerable rise in mRNA and protein markers associated with the SIRT1 pathway.

Safflower flavonoids reduce high glucose-related oxidative stress by suppressing c-Jun N-terminal kinase (JNK)/c-Jun and NOX4 pathways. Zhao et al. (33) established a high glucose-induced insulinoma cell model in rats. Elevated glucose markedly raises MDA while lowering SOD, GSH-Px, and catalase (CAT), triggering JNK/c-Jun activation. The HSYA therapy effectively eases oxidative stress, bolsters antioxidant defenses, and diminishes oxidative harm and cell death in the pancreas’ beta cells. It does this by quelling the phosphorylation of JNK/c-Jun, subsequently stifling the JNK/c-Jun signaling cascade and curbing the excess production of reactive oxygen species triggered by high glucose levels. NOX4 is crucial in high glucose-induced ROS generation and apoptosis. HSYA reduces ROS levels in HUVECs via the NOX4 pathway, decreasing H₂O₂ and ROS production, NOX4 activation, adhesion molecules, and monocyte endothelial cell (EC) adhesion, providing an effective therapeutic effect on high glucose-induced EC injury (30).

Safflower flavonoids enhance antioxidant enzyme activity, elevate Nrf2 levels, and decrease MDA content, thereby mitigating oxidative stress associated with obesity-related diseases. Nrf2 controls cellular redox homeostasis and detoxification enzyme activation (34). Wang et al. (35) established ethanol-induced liver injury models in vivo and in vitro. Treatment with HSYA effectively reduced MDA levels, enhanced SOD and GSH levels, decreased intracellular ROS accumulation, and activated the Nrf2 pathway, demonstrating significant antioxidant effects. In a study involving rats with diabetic nephropathy, which was triggered by a high-fat diet and streptozotocin, the HSYA treatment markedly boosted SOD levels while lowering MDA levels in both the serum and kidney tissue. This suggests that HSYA has the potential to safeguard the kidneys by mitigating oxidative stress (36, 37).

Safflower flavonoids could mitigate oxidative stress through the regulation of BAX/Bcl-2 ratios, the Akt/PTEN signaling cascade, and NF-κB activation. The HUVEC oxidative damage model demonstrates that oxidative damage can lead to apoptosis. HSYA therapy boosts GSH/GSSG intracellular balance and SOD levels, reduces ROS, increases Akt and Bcl-2 protein, and diminishes BAX and PTEN protein (38). In a study involving rats with spinal cord injuries, HSYA treatment alleviated spinal cord edema, inhibited elevated MDA levels and reduced SOD activity, and significantly decreased myeloperoxidase (MPO) and nitro tyrosine levels. The underlying mechanism may involve NF-κB inhibition, which mitigates oxidative stress and prevents the release of pro-inflammatory molecules (39).

Safflower flavonoids have the ability to significantly enhance antioxidant enzyme activity and scavenging of MDA and ROS. Xu et al. (40) established a traumatic brain injury (TBI) model, demonstrating oxidative stress and a reduction in antioxidant enzymes post-injury. HSYA significantly increased the activity of SOD, CAT, and GSH, as well as the GSH/GSSG ratio within the damaged cortex. Luo et al. (41) established a polycystic ovary syndrome (PCOS) animal model by administering dehydroepiandrosterone. The study revealed that HSYA boosted the function of key antioxidant enzymes: SOD, GSH-Px, and CAT. Additionally, HSYA lowered MDA concentrations while increasing both GSH levels and the GSH/GSSG ratio in ovarian tissue affected by PCOS. Furthermore, HSYA and SYA significantly prolonged LDL oxidation delay time and mitigated copper-induced LDL lipid peroxidation. HSYA and SYA reduce oxidative stress in tert-butyl hydroperoxide (t-BOOH) exposed HuDe cells, mitigating ROS generation (42). Figure 3 illustrates the antioxidant mechanism of safflower flavonoids.

The neuroprotective effects of safflower flavonoids are demonstrated in the following neurological diseases: (1) Suppress inflammation and safeguard against spinal cord injury; (2) Improve dopamine (DA) metabolism in the substantia nigra striata pathway to protect against Parkinson’s disease (PD) neurotoxicity; (3) Control inflammation and oxidative stress, critical contributors to brain damage from ischemia-reperfusion; (4) Eliminate beta-amyloid protein deposits to slow Alzheimer’s disease (AD) progression.

Spinal cord injury (SCI) is a severe disorder with significant global health and economic consequences. Uncontrolled traumatic spinal cord injury exacerbates pathological events including increased blood-spinal cord barrier (BSCB) permeability, tissue edema, lipid peroxidation, inflammatory cytokine release, and neuronal apoptosis (43). Pei et al. (39) suggest that HSYA demonstrates therapeutic potential in animal studies modeling human spinal injuries, including fracture dislocations and burst compression fractures. Its protective effects appear to stem from reducing oxidative stress through free radical neutralization while simultaneously suppressing key inflammatory pathways, particularly by downregulating tumor necrosis factor-α (TNF-α) and blocking the expression of inflammatory enzymes like iNOS and cyclooxygenase-2 (COX-2). This dual action mechanism shows promise for mitigating neural damage in both traumatic and ischemia-related spinal cord injuries.

PD is one of the most common neurodegenerative diseases worldwide, and an increasing number of studies are focusing on the development of drugs that can effectively prevent dopaminergic cell death (44, 45). In a study employing a 6-hydroxydopamine (6-OHDA)-induced PD animal model, scientists observed notable improvements following a three-week treatment with different safflower flavonoid extract (SAFE) doses. The results showed a marked rise in spontaneous movement crossings among PD rats, alongside encouraging upward trends in tyrosine hydroxylase (TH) expression and DA metabolic activity. The nigrostriatal pathway DA is a key clinical marker for PD diagnosis. SAFE demonstrated a significant decrease in astrocyte reactivity within the substantia nigra of Parkinson’s disease model rats. It also markedly lowered ionized calcium-binding adapter molecule 1 (IBA1) protein concentrations in the striatum while effectively inhibiting the activation of the NLRP3 inflammasome pathway. Within the co-culture context, kaempferol 3-o-retinoid and AHSYB bolstered neural viability, mitigated cell death, and decreased interleukin (IL)-1β and IL-10 concentrations (46).

The NF-κB pathway drives inflammation by boosting inflammatory factor synthesis. Du et al. (47) showed that SYB significantly lowered neurological impairment metrics and infarct sizes in a dosage-related fashion within cerebral ischemia/reperfusion treatment. Furthermore, SYB suppressed the elevation of pro-inflammatory markers TNF-α, IL-6, and IL-1. However, the reoxygenation from restored blood flow can worsen tissue damage and lead to excessive ROS production, which subsequently impairs mitochondrial function. Leads to neurological damage. Studies indicate that SYB detection is facilitated by increasing intracellular cAMP levels, down-regulating long non-coding ribonucleic acids (lncRNAs) like AK046177, overexpressing microRNAs (miRNAs) such as miR-134, and triggering the CAMP-response element binding protein (CREB)/Nrf2 signaling pathway to safeguard against ischemia-reperfusion damage (48).

AD involves severe spatial memory impairment, driven largely by Amyloid β-protein (Aβ) accumulation (49). Fluctuations in the synthesis and removal of Aβ, often triggered by inflammatory factors, result in an excessive build-up of Aβ, particularly Aβ1-42, outside the neurons. This buildup then causes harmful effects on the neurons (50). Consequently, AD patients exhibit symptoms of neurodegeneration and cognitive impairment. The formation of Aβ peptides stems from the amyloid precursor protein (APP), which typically undergoes cleavage by α-secretase and γ-secretase enzymes. This standard processing pathway not only prevents the accumulation of harmful Aβ fragments but also yields the beneficial soluble amyloid protein precursor α (sAPPα) as a byproduct. Under healthy physiological circumstances, this mechanism maintains a delicate balance that safeguards against neurotoxic buildup. Alternatively, β-secretase and γ-secretase produce neurotoxic Aβ (51). In the APP/presenilins 1 (PS1) mouse model, treatment with SY promoted APP catabolism towards sAPPα secretion in the hippocampus. Du et al. (52) shows that blocking the beta-secretase 1 (BACE1) enzyme can help clear the Aβ plaques, as thorough studies indicate that a high dosage of SY can also reduce BACE1 activity in Alzheimer’s disease mouse models. SY exhibits strong therapeutic effects by regulating secretory enzymes to suppress Aβ accumulation, providing neuroprotection against AD in APP/PS1 mice. Mevalonate pyrophosphate decarboxylase (MVD) and apolipoprotein E (APOE) regulate cholesterol synthesis, secretion, and metabolism in neurons. It has been shown that when both are expressed abnormally, it will increase the probability of AD. After administering SY orally at a dose of 30 mg/kg daily for 4 weeks to both 12-month-old APP/PS1 transgenic mice and wild-type mice exhibiting AD markers, scientists observed a marked decrease in the intensity and spread of fluorescent amyloid plaques within the cortical and hippocampal regions of the transgenic subjects. Moreover, there was a significant reduction in cholesterol, MVD, and APOE levels within the mice’s cerebral regions, hinting that minimizing the body’s own cholesterol might serve as a potent therapeutic approach against Alzheimer’s (52). The neuroprotective mechanism of safflower flavonoids is illustrated in Figure 4.

Flavonoids primarily combat tumors by inhibiting proliferation, inducing apoptosis, regulating angiogenesis, enhancing immune function, and modulating gene expression and signaling pathways in cancer cells (53). Safflower flavonoids exhibit the four anti-tumor mechanisms and positively impact combating breast, liver, lung, stomach, and ovarian cancers.

Safflower flavonoids positively influence breast cancer treatment. HSYB therapy inhibits the MCF-7 cell cycle at the S phase and reduces the expression of cyclin D1, cyclin E, and cyclin-dependent kinases 2 (CDK2). The compound further suppresses the expression of p-PI3K, phosphatidylinositol 3-kinase (PI3K), Akt, and p-Akt proteins. Additionally, it reduces Bcl2 concentrations while elevating Bax levels. This cascade triggers the activation of caspase-3 and caspase-9, ultimately leading to programmed cell death (54). Doxorubicin (DOX), a primary chemotherapeutic for breast cancer, when combined with HSYB, enhances treatment efficacy by significantly reducing Bcl-2 expression and upregulating caspase-9, Bax, and caspase-3. This combination also increases ROS and cytochrome C release, promoting apoptosis (55).

HSYA, derived from safflower flavonoids, may positively impact hepatocellular carcinoma treatment. The immune landscape within tumors critically influences cancer cell growth and spread. In a recent investigation involving a rodent model of liver cancer, the HSYA treatment proved effective in diminishing the levels of crucial immune environment regulators, such as forkhead box protein P3 (FOXP3) and retinoic acid receptor-related orphan receptor gamma-t (RoRγt) proteins, and lowering the number of regulatory T cells in the spleen at certain dosages (56). HSYA treatment of Hep-G2 cells enhanced Beclin 1 gene expression and inhibited extracellular regulated protein kinases (ERK) phosphorylation, thereby inducing autophagy and reducing hepatocellular carcinoma cell viability (57). Figure 5 illustrates the mechanism of HSYA against hepatocellular carcinoma.

Safflower flavonoids may positively impact the treatment of lung, stomach, and ovarian cancers. Lipopolysaccharide (LPS) promoted the expansion and colony genesis in A549 and H1299 cells, whereas HSYA mitigated this action. Specifically, HSYA down-regulated Bcl-2 expression and increased levels of cleaved caspase-3, cleaved caspase-9, and Bax, promoting apoptosis. It also inhibited IL-6, IL-1β, and TNF-α production while increasing IL-10 levels. Additionally, HSYA reduced COX-2 expression, suppressed inflammatory factor release, and consequently inhibited tumor neovascularization and metastasis. It also suppressed mitochondrial membrane potential (MMP)-2 and MMP-9 expression, both associated with tumor infiltration, thus blocking LPS-stimulated movement and penetration in A549 and H1299 cells (58). HSYA treatment increased peroxisome proliferator-activated receptor-γ (PPARγ) and caspase-3 expression in BGC-823 gastric cancer cells, with its inhibitory, apoptotic, and cycle-blocking effects reliant on PPARγ activation (59). In Skov3 ovarian cancer cells, HSYA dose-dependently inhibited proliferation, reduced WD repeat and SOCS box containing 1 (WSB1) gene expression, and enhanced apoptosis, thereby suppressing neuroblastoma and ovarian cancer cell growth (60).

Numerous studies have established HSYA’s influence on cell proliferation, apoptosis, and pyroptosis, supporting its potential in preventing and treating various conditions. The mechanism of HSYA immunomodulatory action is shown in Figure 6.

HSYA has been demonstrated to regulate various apoptotic factors linked to PPARγ. HSYA hinders the growth of BGC-823 cells by causing PPARγ-mediated cell cycle pause and programmed cell death, suggesting PPARγ’s involvement in the induction of apoptosis by HSYA in these cells (59). HSYA helps mitigate the harshness of lung injury by cutting down on fluid buildup in the lungs, lowering the levels of acid in the blood, and dampening down inflammation. Additionally, it boosts the levels of oxygen in the blood and keeps key inflammatory proteins under control in cases of acute lung injury, such as TNF-α and intercellular adhesion molecule-1 mRNA (61). Additionally, HSYA impedes SMMC-7721 cell proliferation and adhesion to the extracellular matrix (ECM), suggesting its potential in preventing hepatocellular carcinoma lung metastasis (62). DHI, whose main active component is HSYA, plays a protective role in vascular endothelial cells during hypoxic conditions. It achieves this by increasing the concentration of 6-keto prostaglandin F1α while boosting SOD activity. Additionally, DHI helps balance the activity of plasminogen activator inhibitor (PAI) and tissue-type plasminogen activator (t-PA), as well as regulating endothelin (ET) and NO levels. These combined effects promote vasodilation and preserve normal endothelial function, effectively shielding blood vessels from hypoxia-induced damage (63).

I/R injury remains a pressing worldwide health concern. HSYA enhances cardiac contractility and restores normal field potential patterns in human-induced pluripotent stem cell-derived cardiomyocytes following hypoxia/reoxygenation injury, indicating its therapeutic potential for I/R damage. This compound demonstrates promising cardioprotective effects by addressing both mechanical and electrical dysfunction in compromised heart cells (64). Additionally, HSYA protects against ischemia/reperfusion by inhibiting the mitochondrial permeability transition pore (mPTP) via the mitogen-activated extracellular signal-regulated kinase (MEK)/ERK/Cyclophilin D (CypD) pathway. This research (65) reveals a new pathway for HSYA’s protection against ischemia/reperfusion injury and provides a blueprint for developing mPTP-targeting therapies.

Type II diabetes mellitus (T2DM) and its complications [diabetic nephropathy (DN), etc.] is a complex metabolic disease and a significant global public health issue. HSYA could potentially amplify PI3K/Akt signaling and hinder β-cell apoptosis in diabetic rats, thereby potentially alleviating insulin resistance and modulating glucose-lipid homeostasis (66), HSYA’s participation in the JNK/c-Jun signaling cascade hints at its potential to alleviate oxidative stress triggered by high glucose levels. This discovery could be a game-changer in the fight against diabetes, both in terms of prevention and therapeutic approaches (33).

Safflower contains flavonoids known for their anti-inflammatory properties (67). The anti-inflammatory effects of saffower largely from HSYA, acting through: (1) inhibiting the toll-like receptor 4 (TLR4)/NF-κB pathway; (2) lowering inflammatory mediators such as IL-1β, IL-6, and TNF-α; (3) elevating anti-inflammatory mediators like IL-13, IL-4, and IL-10, thus acting via supplementary pathways.

The transcription factor NF-κB plays a pivotal role in modulating gene expression, particularly in driving pro-inflammatory pathways. According to Lee et al. (68), safflower’s ethanolic extract is a hero in the fight against oxidative stress, as it cleverly adjusts the ROS/NF-κB dance and the Nrf2/HO-1 duet to safeguard HUVECs. Yin et al. (69) suggest a link between depression and inflammation. Chen et al. (70) crafted a chronic, inconsistent, and moderate stress model in mice to study depression. They discovered that a certain enzyme, SE, plays a crucial role in regulating the TLR4-NLRP3 signaling route. It decreases the levels of TLR4, p38, and the phosphorylated form of NF-κB, which in turn stifles neuroinflammation and eases the symptoms of depression.

HSYA demonstrated a notable ability to suppress the production of key pro-inflammatory mediators. In their study, He et al. (71) examined how HSYA influenced Staphylococcus aureus, triggered endometrial inflammation in murine models, observing a significant reduction in TNF-α, IL-1β, and IL-6 concentrations within the affected uterine tissues. HSYA has shown promise in addressing renal fibrosis linked to diabetes in rodent studies. By quelling pro-inflammatory agents like IL-6, TNF-α, TLR4, and NF-κB (p65), it helps mitigate the signs of renal fibrosis (72). Ye et al. (12) developed a rat model of myocardial ischemia/reperfusion treated with HSYA. Test results indicated that HSYA decreased IL-1β and IL-18 release and significantly down-regulated NLRP3, ASC, and caspase-1 expression. HSYA promotes myocardial autophagy through the AMPK/mTOR axis, suppresses NLRP3 inflammasome initiation, and reduces the production of inflammatory markers to protect ischemic heart muscle. Sun et al. (73) revealed that HSYA effectively reduced retinal ganglion cell death in rats with T2DM. This protective effect was achieved by suppressing inflammatory markers like IL-1β and TNF-α while simultaneously boosting the production of key proteins, including Nrf2, HO-1, Bcl-2, and P53. Their findings highlight HSYA’s potential as a neuroprotective agent in diabetic retinopathy.

HSYA can suppress the inflammatory response by competing with pro-inflammatory factor receptors. Liu et al. (74) investigated the inflammatory response in MRC-5 cells induced by TNF-α. Their findings revealed that HSYA treatment allows HSYA to compete with TNF-α for TNF receptor type 1 (TNFR1) binding, thereby obstructing the interaction between TNFR1 and the transforming growth factor-β-activated kinase 1 (TAK1)-TGF-beta activated kinase 1 (map3k7) binding protein 2 (TAB2) complex. HSYA effectively curbed TNF-α-triggered cell proliferation and inflammatory responses in MRC-5 cells by disrupting NF-κB signaling pathways. The compound also blocked activator protein-1 (AP-1) from binding to the TGF-β1 promoter, thereby preventing the cascade of proliferative and pro-inflammatory effects typically induced by TNF-α stimulation. This dual mechanism of action demonstrates HSYA’s potent anti-proliferative and anti-inflammatory properties in this cellular model.

HSYA also exerts anti-inflammatory effects through multiple synergistic pathways. Ren et al. (75) established a chronic neuroinflammation model using Aβ1-42-induced BV-2 microglia and found that HSYA mitigates neuroinflammation via triggering receptor expressed on myeloid cells 2 (TREM2): (1) HSYA significantly downregulates the expression of pro-inflammatory factors IL-1β and IL-6, while upregulating anti-inflammatory factors IL-4, IL-10, and IL-13 via TREM2, thus alleviating neuroinflammation. (2) HSYA modulates Aβ1-42-induced microglia via TREM2, inducing their polarization from pro-inflammatory M1 phenotype (releasing abundant cytotoxic inflammatory mediators) (76) to anti-inflammatory M2 phenotype (increasing expression of anti-inflammatory mediators) (77). (3) HSYA regulates the Aβ1-42-induced TLR4/NF-κB pathway via TREM2, blocking signal transduction of the pathway, significantly downregulating TLR4 expression, and reducing the phosphorylation levels of downstream NF-κB and inhibitor of NF-κB (IκB), thereby exerting neuroprotective effects.

HSYA also inhibits inflammatory responses by competing for pro-inflammatory factor receptors. Liu et al. (74) used TNF-α-induced MRC-5 cells to establish an inflammatory response model. After HSYA treatment, it was found that HSYA could compete with TNF-α for the binding of TNFR1 and block the binding of TNFR1 to TAK1-TAB2 complex. Inhibit the proliferation and inflammatory response of MRC-5 cells induced by TNF-α. At the same time, HSYA can inhibit the activation of NF-κB signaling pathway and the binding of TGF-β1 promoter to AP-1, thereby inhibiting the proliferation and inflammatory response of MRC-5 cells induced by TNF-α.

SY or HSYA can improve glucose metabolism and aids in metabolic control (1, 30). HSYA exhibits significant hypoglycemic effects, particularly at higher doses (120 mg/kg), and is safe for both injection and oral administration (37), this indicates that safflower flavonoids have broad application prospects in regulating glucose metabolism, particularly in diabetes and related diseases.

HSYA shows significant promise for diabetes care. Studies confirm its safety and efficacy for managing early stage T2DM (78, 79). Furthermore, HSYA demonstrated protective effects against glucotoxicity-induced oxidative stress and pancreatic β-cell apoptosis by mitigating oxidative damage and modulating the JNK/c-Jun signaling pathway, supporting its potential use in diabetes prevention and treatment. Zhang et al. (80) indicates that HSYA’s antidiabetic effects are primarily mediated by its antioxidant and anti-inflammatory actions, involving the JNK/c-Jun and NOX4 pathways, as well as macrophage differentiation, as demonstrated in both in vitro and in vivo studies. Yao et al. (81) showed that administering HSYA to streptozotocin-induced diabetic cardiomyopathy (DCM) mice alleviated DCM symptoms through oxidative stress reduction. Mounting evidence highlights the pivotal role of vascular inflammation in driving diabetes complications. Chronically elevated blood glucose wreaks havoc on blood vessels, but promising research suggests HSYA may offer therapeutic benefits by counteracting this vascular deterioration (28, 82).

HSYA may effectively treat persistent diabetic foot ulcers. An in vivo diabetic rat wound model showed that HSYA significantly enhanced vascular endothelial growth factor (VEGF) levels, promoted epidermal cell migration for re-epithelialization, and inhibited NO production dose-dependently. This accelerated wound recovery, improved healing quality, and increased TGF-β1 content, aiding epidermal barrier restoration and infection prevention. Furthermore, an in vitro model using HUVECs demonstrated that HSYA significantly enhances neovascularization and keratinocyte migration (83).

In addition, HSYA improves insulin resistance and SY improves insulin sensitivity, which has a positive effect on diabetes. HSYA mitigates fat accumulation, restores glycemic balance, enhances insulin sensitivity, and reduces inflammation (84). Moreover, SY enhances PPARγ expression by stimulating its promoter activity, which in turn boosts the transcription of genes linked to insulin signaling in subcutaneous fat. This mechanism leads to reduced fat accumulation, lower blood sugar levels, and enhanced insulin responsiveness in mice with diet-induced obesity (85).

Numerous studies have found that safflower has liver and lung protective effects, which is why it is widely used in clinical applications (86–88).

Ao et al. (1) indicates a strong correlation between HSYA’s hepatoprotective properties and its ability to combat liver fibrosis and act as an antioxidant. HSYA has an effect on liver fibrosis, liver ischemia and other impaired liver functions. Histological studies have shown that alcohol-induced liver damage, such as liver fibrosis, is significantly reduced by HSYA. HSYA effectively lowered overall cholesterol and triglyceride concentrations in the bloodstream while also inhibiting the activation of mitogen-activated protein kinase (MAPK). Additionally, it downregulated the production of transforming growth factor receptor types I and II in rats with liver fibrosis (89, 90). Wang’s et al. (91) research has demonstrated that the quercetin and kaempferol present in safflower can alleviate hepatic steatosis, improve liver function, reduce inflammation and oxidative stress responses by upregulating the expression of NR1H4.

Hepatocellular carcinoma (HCC) ranks among the most prevalent digestive system cancers. Ma et al. (56) indicates that 1.13 mg/kg HSYA can modulate the immune microenvironment in liver cancer model mice by decreasing splenic Treg cells and the expression of FOXP3 and RORγt in tumor tissues, thereby enhancing immunity and mitigating cisplatin side effects, contributing to its anticancer effects. Additionally, HSYA could suppress tumor growth and trigger cell death by blocking autophagy in liver cancer, indicating its therapeutic promise (92).

All existing studies have shown that HSYA plays a crucial role in safeguarding the lungs, especially for individuals suffering from chronic obstructive pulmonary disease (COPD), acute lung injury (ALI), and lung fibrosis. Ling et al. (93) and Wang et al. (87) has identified SYA, HSYA, and AHSYB, the key bioactive compounds in safflower, as effective agents in reducing lung damage triggered by lipopolysaccharide and reticulation. Safflower’s ability to improve microcirculation and combat inflammation likely plays a pivotal role in easing sepsis-related lung inflammation. HSYA is a potential pulmonary vasorelaxant for treating pulmonary arterial hypertension (PAH) and related diseases. Rather than targeting endothelial cells in the pulmonary artery, this compound works by improving the function of pulmonary vascular smooth muscle. It achieves this by activating Kv channels specifically within pulmonary vascular smooth muscle cells, highlighting its promising therapeutic potential for PAH (94). Additionally, HSYA significantly inhibits airway thickening and collagen deposition in smoking- or LPS-induced rat models of COPD, reducing transforming growth factor-β1 mRNA and protein expression. This treatment also decreases airway hyperresponsiveness in asthmatic mice. HSYA injection was shown to mitigate lung histopathological changes in rats with pulmonary fibrosis, enhance body weight and oxygen partial pressure (PaO₂), and decrease CO₂ partial pressure (PaCO₂), TNF-α, IL-1β, TGF-β1 mRNA expression, IL-6, MDA activity, and NF-κB p65-positive cell counts, thereby providing a protective effect on lung tissue (95).

Cardiovascular diseases (CVD) encompass conditions affecting the heart vessels, such as acute coronary syndrome and angina, as well as cerebral vessels, including stroke, cerebral embolism, and hemorrhage. The incidence of CVD is increasing globally, so the search for new promising treatment options is becoming an urgent issue. Recently, there has been a growing focus on clinical herbal medicine in drug development. Chinese medicine is increasingly favored for disease treatment due to its minimal toxicity and side effects (96). HSYA, sourced from the therapeutic plant safflower, has shown therapeutic benefits for cardiovascular conditions, malignancies, and diabetes (97). Thus, Meng et al. (98) emphasize HSYA’s key biological effects, such as anti-inflammatory and antioxidant capabilities, along with its cardiovascular protection. Consequently, HSYA shows promising potential for preventing ischemia/reperfusion injury and treating cardiovascular diseases, as detailed in Supplementary Table 1.

Safflower flavonoids can decrease myocardial infarction size and alleviate cardiac damage due to their anti-inflammatory properties. HSYA demonstrates strong potential as a therapeutic agent for cardiovascular conditions, especially myocardial ischemia and infarction (99). HSYA enhances ischemic cardiogenic flow dynamics, boosts survival rates in mice, and mitigates ischemic cardiac dysfunction in acute MI models (10). It mitigates myocardial apoptosis and fibrosis, enhances endothelial progenitor cell activity in vitro, and eases cardiac injury in myocardial infarction models (100). HSYA serves as a non-toxic alternative for modulating mPTP to treat hypoxia/reoxygenation-induced injuries, protecting cardiomyocytes from pore damage (65).

Zhang et al. (80) indicates that HSYA’s pharmacokinetic properties support its extensive clinical use as an injectable for treating microvascular complications. HSYA is expected to emerge as an oral medication offering improved absorption and anti-inflammatory effects through advanced delivery technologies. Moreover, studies conducted by Yu et al. (101) underscore HSYA’s neuroprotective effects, demonstrating its ability to preserve cognitive abilities and maintain synaptic flexibility after cerebral ischemia-reperfusion damage. These findings point to HSYA’s therapeutic potential in aiding mental recovery following such injuries.

Stroke is the world’s second-highest cause of mortality and a primary cause of impairments (102), with ischemic stroke being the most prevalent subtype and a significant cause of mortality (19). Since 2005, the State Food and Drug Administration of China has approved HSYA for clinical use in treating acute myocardial infarction, angina pectoris, and other cardiac ischemia, primarily due to its antiplatelet aggregation properties (Drug Licence Document Z20050146) (103). At present, HSYA has not received marketing authorization from the U.S. Food and Drug Administration and the European Medicines Agency. HSYA shows promise in combating atherosclerosis by stifling the development of foam cells, stimulating the growth and movement of vascular smooth muscle cells, and rectifying the dysfunction of vascular endothelial cells (28). Related products include safflower injection (SFI), safflower yellow injection (SYI), DHI, and Guhong injection (GHI). A meta-analysis by Lu et al. (104) indicates that integrating SFI with conventional medication may enhance the efficacy and safety of treatment for acute coronary syndrome (ACS) patients. Li et al. (105) demonstrated that SYI combined therapy is more efficient, safer, and cost-effective, with fewer adverse effects compared to Panax ginseng injection. Xuan et al. (106) found that combining SYI with conventional therapy significantly improved therapeutic efficacy and cost-effectiveness in treating Chinese patients with stable angina pectoris compared to conventional therapy alone. Furthermore, DHI reduces blood–brain barrier impairment caused by mannitol (107). Widely employed in China for managing coronary heart disease, angina, myocardial infarction, pulmonary hypertension, and ischemic stroke (108, 109). Additionally, utilizing a warm microemulsion technique, Zhao et al. (110) developed HSYA solid lipid nanoparticles (SLN) with a water-in-oil emulsion structure to improve HSYA’s oral absorption and pharmacological efficacy. Moreover, the study by Gao et al. (83) demonstrated, through in vitro experiments, that HSYA dramatically spurred the development of new blood vessels and the movement of keratinocytes within HUVECs. Applying HSYA locally has been found to notably expedite the healing process in living organisms. Consequently, HSYA offers a viable treatment option for persistent non-healing conditions.

Safflower flavonoids exhibit significant antioxidant and anti-inflammatory properties, along with other physiological activities. Safflower is extensively utilized for treating gynecological disorders such as PCOS, endometriosis, dysmenorrhea, and irregular menstruation (6), as demonstrated in Supplementary Table 2.

HSYA was able to treat PCOS by reducing ovarian cysts and restoring normal ovulatory cycles in mice. HSYA modulates the expression of essential genes involved in ovarian steroid hormone synthesis. HSYA demonstrates antioxidant properties in PCOS ovaries by lowering MDA levels and boosting antioxidant defenses (41). HSYA has been shown to mitigate oxidative stress and reduce ROS levels, thereby inhibiting the inflammatory response in the peritoneal cavity and effectively treating endometriosis (111). Taohong Siwu Decoction (TSD), a Chinese herbal formula comprising safflower, peach kernel, angelica sinensis, chuanxiong, white peony, and ripened dihuang, is effective in treating irregular menstruation, dysmenorrhea, and gynecological inflammation. Some studies have proved that the safflower flavonoid components, kaempferol and quercetin, are the main compounds in the treatment of primary dysmenorrhea in safflower four-substance soup. Furthermore, the HSYA aspect of TSD has demonstrated its efficacy in alleviating the inflammatory reactions linked to irregular menstrual bleeding (39).

Safflower is also potentially important for food production and can make meals nutritious (112). Due to the occurrence of food safety incidents such as Sudan red and malachite green, people are therefore paying more and more attention to the development and application of natural colors. Research indicates that safflower pigments are commonly utilized in various food items, including meat products (113), cake toppings (9), desserts, jellies, confectionery (114), etc. Machewad et al. (115) assessed SY in’s effectiveness as an ice cream colorant, the results show that the addition of SY (0.06 mL) in the ice cream can achieve the best sensory acceptance. Variations in this amount negatively impacted flavor, color, and texture evaluations. Furthermore, research by Hong et al. (116) demonstrated that compared to plain yogurt, yogurt supplemented with SE exhibited a significant increase in total phenolic and flavonoid contents. This enhancement led to improved antioxidant activity without negatively affecting the yogurt’s characteristics. Additionally, this modified yogurt showed inhibitory effects on key enzymes involved in the digestion and absorption of carbohydrates and lipids, playing a positive role in the regulation of hyperglycemia and hyperlipidemia.

At the same time, SY pigment added to the feed of different animals has many positive effects in animal production applications. SY pigment enhances egg production in laying hens and boosts growth in piglets when added to their feed. An et al. (117) indicates that incorporating crude SE into daily poultry feed can significantly enhance the egg production rate and daily egg yield of laying hens without affecting egg weight. Regarding lipid metabolism regulation, it reduces hepatic total cholesterol and triglyceride levels while elevating hepatic 3-hydroxy-3-methylglutaryl-coenzyme A reductase activity. This intervention increases neutral sterol excretion, thereby aiding in serum cholesterol reduction. Furthermore, it demonstrates no adverse effects on yolk nutritional components (total cholesterol, triglycerides, etc.) or fatty acid composition. Research by Cho et al. (118) also revealed the potential of safflower as a feed additive. Supplementing rat feed with SE reduced plasma total cholesterol, triglycerides, and hepatic total cholesterol in ovariectomized rats while increasing plasma high density lipoprotein cholesterol levels. It improved blood lipid profiles by promoting fecal total cholesterol excretion, with no adverse effects on bile acid excretion. Furthermore, administering HSYA to dairy cattle helps prevent and manage endometritis. In summary, safflower flavonoids demonstrate significant application potential in food and feed industries. However, their primary active components exhibit high solubility in water but limited solubility in oil, coupled with poor gut mucosal permeability. These properties result in low oral bioavailability, thereby constraining their broader utilization in food and feed applications (119). Therefore, enhancing the bioavailability of safflower flavonoids in food and feed applications requires addressing their physicochemical solubility disparities and intestinal absorption barriers. Strategies such as nanoscale encapsulation (110), natural deep eutectic solvents (120) for stability optimization, and novel composite materials (119) to improve gut mucosal permeability can be employed. These approaches will fully unlock their bioactive potential, including antioxidant and metabolic regulatory functions, ultimately establishing a robust foundation for their scaled utilization in functional food development and feed additive formulations. The application of safflower and its flavonoids in food and feed is shown in Figure 7.