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Metabolic syndrome has emerged as a significant global health issue, associated with various metabolic diseases, including obesity, diabetes, hypertension, dyslipidemia, chronic kidney disease, metabolic dysfunction\u2010associated steatotic liver disease, and other metabolic disorders. Here, we summarize the intricate mechanisms including insulin resistance, chronic low\u2010grade inflammation, oxidative stress, and epigenetic modifications, and how they contribute to the disease progression of metabolic syndrome. The gut\u2013adipose tissue axis in the progression of metabolic syndrome is emphasized here, mainly involving adipocyte\u2010derived extracellular vesicles and adipokines, as well as specific gut microbiota and their secreted factors, such as lipopolysaccharide, short\u2010chain fatty acids, endocannabinoids, bile acids, aryl hydrocarbon receptor ligands, and tryptophan derivatives. Furthermore, the contemporary management for metabolic syndrome mainly includes some established pharmacological treatments such as GLP\u20101 receptor agonists, SGLT2 inhibitors, and RAAS inhibitors, as well as promising emerging therapies targeting the gut\u2013adipose tissue axis such as lifestyle modifications, prebiotics, probiotics, synbiotic supplements, FMT, bariatric surgery, CB1R antagonists, and novel pharmacological agents. These strategies may pave the way for the development of effective treatments for metabolic diseases in future research.<\/jats:p>","DOI":"10.1002\/mco2.70934","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T07:09:08Z","timestamp":1787555348000},"source":"Crossref","is-referenced-by-count":0,"title":["Metabolic Syndrome: From Mechanisms to Therapeutic Interventions"],"prefix":"10.1002","volume":"7","author":[{"given":"Mengyao","family":"Yan","sequence":"first","affiliation":[{"name":"Institute of Clinical Pharmacology Peking University First Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8245-2611","authenticated-orcid":false,"given":"Qian","family":"Xiang","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacology Peking University First Hospital  Beijing China"},{"name":"Department of Pharmacy Administration and Clinical Pharmacy School of 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