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Currently there is limited literature describing the association between gut microbiota and peripheral artery disease (PAD). This review summarizes the evidence surrounding the role of gut microbiota in the initiation of atherosclerosis (through direct infection of atherosclerotic plaque or systemic immune response to bacterial products and metabolites) and how dysbiosis may influence the various treatment modalities for PAD, including medical therapy (pharmacotherapy, lifestyle changes, and supervised exercise training) and surgery (endovascular and open revascularization). In particular, the role of short chain fatty acids (SCFAs), the effects of exercise on SCFA-producing and lactic acid bacteria (LAB) and, consequently, the lack of targeted research into dietary interventions and supplementation are highlighted in this review. This review highlights the potential for gut microbiota as not only a therapeutic target in patients with PAD, but also as a diagnostic and screening tool. It is imperative that the focus of future research is on the potential for personalized treatment which targets the gut microbiota (such as synbiotics, postbiotics, nicotinamide adenine dinucleotide (NAD) supplementation, selective antibiotics, resistance exercise, senolytics, and fecal microbial transplantation [FMT]) to be utilized as adjuncts to already existing treatment options for PAD. This review also highlights the potential role of biobanks and analysis of atherosclerotic plaques in further advancing knowledge and research in this area.<\/jats:p>","DOI":"10.1177\/1358863x251346062","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T09:58:08Z","timestamp":1750759088000},"page":"715-723","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Narrative review of the association between gut microbiota and peripheral artery disease (PAD)"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8778-3296","authenticated-orcid":false,"given":"Joong Min","family":"Park","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, SA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Beckman","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, SA, Australia"},{"name":"College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher L","family":"Delaney","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, SA, Australia"},{"name":"College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.1124234"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2016.183"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2015.01.007"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2015.05.035"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30255-4"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.119.312142"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2024.1340262"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1011383107"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/bph.14483"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2015.10.097"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejphar.2015.06.023"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1109400"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2020.08.028"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.004237"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-017-0675-9"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M114.618249"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/19490976.2017.1293224"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2016.02.011"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2015.11.055"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.molmet.2020.100976"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2019-320204"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpharm.2008.07.009"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1124\/dmd.114.058354"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1089\/omi.2017.0130"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/prp2.601"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2019.01947"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu11061219"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-024-01068-4"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23179588"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1536\/ihj.16-414"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.05.111"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2018.12.014"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2013.12.021"},{"key":"e_1_3_2_35_2","article-title":"Modes of exercise training for intermittent claudication","volume":"8","author":"Jansen SCP","year":"2020","unstructured":"Jansen SCP, Abaraogu UO, Lauret GJ, et al Modes of exercise training for intermittent claudication. 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