Table 1.

Registered clinical trials and animal studies about biotherapy to treat metabolic syndrome.

Biotherapy	Resource	Disease	Outcomes	Mechanism of Action	References
PNS	Male C57BL/6J mice (About 4 weeks old)	Obesity	PNS reduced adiposity in DIO mice but not in mice with induced obesity and impaired leptin signaling	The leptin-AMPK/STAT3 pathway induced by the PNS-mediated modulations in the gut microbiota was involved in beige adipocyte reconstruction	(Gupta, Osadchiy et al., 2020 [54])
the “W-LHIT” capsules	Thirty-seven patients aged 18 to 60 from Wei-En hospital	Obesity	W-LHIT significantly improved body weight and comorbid conditions without obvious adverse reaction or rebound weight gain	Increased abundance of Akkermansia muciniphila and Enterococcus faecium and decreased abundance of Proteobacteria in gut microbiota	(Cao, Wei et al., 2023 [55])
Probiotics+ BBR	T2D patients	Diabetes Mellitus, Type 2	Ant-diabetes effect	BBR can reduce intestinal microbiota bile acid (BA) conversion, thereby reducing intestinal farnesol X receptor (FXR) activity	(Zhang, Gu et al., 2020 [26])
Intermittent Fasting	Adults with MS, age 30 to 50 years	Cardiometabolic Risk Factors	IF induces a significant alteration of the gut microbial community and functional pathways in a manner closely associated with the mitigation of cardiometabolic risk factors.	IF induced significant changes in gut microbiota communities, increased the production of short-chain fatty acids, and decreased the circulating levels of lipopolysaccharides	(Guo, Luo et al., 2023 [56])
GP-derived seasonings	High-risk cardiovascular subjects and healthy subjects	Hyperten sion	GP-seasoning may help in the modulation of cardiometabolic risk factors, mainly in the early stages	Modulation of gut microbiota and functional bacterial communities by grape pomace	(Taladrid, Celis et al., 2022 [42])
sodium reduction with slow sodium or placebo tablets	145 participans (42% Black people, 19% Asian, and 34% female)	Hyperten sion	Reducing dietary intake can lower blood pressure and improve arterial compliance	Reducing dietary sodium can increase short-chain fatty acids in the circulation, supporting the potential impact of dietary sodium on human gut microbiota	(Chen, He et al., 2020 [45])

PNS, notoginsenoside R1 and ginsenosides Rb1, Rd, Re, Rf, and Rg1; W-LHIT capsules were prepared in a GMP facility (Tian-jiang Pharmaceutical, Jiangsu, China); BBR, berberine; GP, grape pomace.