Ginsenosides are the primary bioactive constituents of Panax ginseng, exhibiting multiple pharmacological activities, including neuroprotection, antitumor effects, anti-aging properties, and metabolic regulation. In this review, the molecular mechanisms of ginsenosides in treating neurodegenerative diseases, cancer, and metabolic disorders are summarized, and the current status of clinical translational research on ginsenosides in advanced gastric cancer, breast cancer, stroke, and diabetes is introduced, incorporating critical evidence regarding safety assessments and potential toxicity risks. In addition, recent advances in biotransformation and modern preparation technologies are reviewed. Innovative solutions, including nanodelivery systems, structural modifications, and AI-driven formulation design, are systematically discussed to address the current issues, such as low oral bioavailability and limited blood–brain barrier permeability. The future development of ginsenosides continues to face several critical challenges, including a scarcity of high-quality clinical evidence, an incomplete understanding of their mechanisms of action, a dearth of long-term safety data, and variations in quality between batches.

Lysine acetyltransferase 8 (KAT8) is a member of the MYST family of histone acetyltransferases. It catalyzes the acetylation of histone H4 at lysine 16 (H4K16ac) and non-histone proteins. Abnormal upregulation or downregulation of KAT8 and its associated H4K16ac have been observed in malignant tumors, suggesting its close association with tumorigenesis and progression. Characterized by structural diversity and multi-target mechanisms, natural agents have been increasingly shown to possess significant antitumor activity. This review focuses on KAT8, summarizing its molecular mechanisms in regulating tumor development by catalyzing substrate protein acetylation, which impacts tumor cell proliferation, cell cycle regulation, apoptosis, DNA damage repair, and autophagy. It also systematically discusses the pharmacological activities and molecular mechanisms of small-molecule agents that target KAT8 to inhibit tumor proliferation, including natural compounds, synthetic drugs, and non-coding RNAs.