###### Abstract  
_Pipper sarmentosum_ (PS) is a traditional medicinal herb used by South East Asians. It demonstrates promising properties against various non-communicable diseases and infectious agents due to its antioxidant and anti-inflammatory properties. Given that oxidative stress and inflammation are involved in developing and exacerbating metabolic syndrome (MetS) and its principal components (central obesity, hyperglyaemia, hypertension, and dyslipidemia), PS could manage MetS and its complications. This review summarises the available literature on the effects of PS on principal components of MetS and their complications. The accumulated evidence suggests that PS prevented adiposity, hyperglyaemia, hypertension, and dyslipidemia in preclinical studies mainly through its antioxidant and anti-inflammatory properties. It also protected against MetS-associated cardiovascular complications. This review has identified research gaps in this field and suggested future studies to guide interested researchers to explore further or affirm the therapeutic potential of PS. One of the most significant challenges to the medical use of PS is the absence of randomised controlled trials in humans. This study gap must be bridged before PS supplementation could be used to manage MetS in humans. cholesterol; inflammation; oxidative stress; hypertension; obesity; diabetes +
Footnote †: journal:  
+++ ==WARNING: Truncated because of repetitions==
Lifestyle and dietary modifications, as well as pharmacological interventions targeting energy metabolism pathways, are the current management strategy for MetS. However, lifestyle and dietary interventions require the long-term compliance of the patients to take effect. Furthermore, since patients often suffer from various metabolic conditions concurrently, each requires specific medications, issues of polypharmacy, drug-drug interactions, and increased medical costs are common [17]. Therefore, the pursuit of a pleiotropic agent to assist MetS management is ongoing. Medicinal plants are a potential source of agents that can fulfil this purpose. They contain various biologically active compounds with health benefits, consumed by local populations for generations [18; 19; 20]. _Piper sarnentosum_ (PS) Roxb. is a herbaceous plant commonly found in South East Asia. It has been used traditionally to treat urological, dermatological, hepatobilary, and gastric diseases. Apart from that, it is also known to possess antipyretic and anti-inflammatory properties [21]. Modern pharmacological studies have validated some medicinal properties of PS, such as antineoplastic [22], hypoglycaemic [23], and hypotensive [24] activities. The biological effects of PS could be attributed to its anti-inflammatory activities [25; 26; 27]. Ethyl acetate and methanolic extracts from the leaves of PS were reported to reduce interleukin (IL)-1\(\beta\) and tumour necrosis factor (TNF)-\(\alpha\) expressions in murine microglial cells stimulated with \(\beta\)-amyloid [27]. In interferon-gamma/lipopolysaccharide-treated macrophages, PS methanolic extract showed significant nitric oxide (NO) inhibitory activity in a concentration-dependent manner, implying potential anti-inflammatory activities [25]. Animal studies also showed that ethanolic extract of PS root reduced acute and chronic inflammation by inhibiting ethyl phenylpropionate-induced ear oedema, carrageenanan-induced paw oedema, and cotton pellet-induced granuloma formation in male rats [26]. Gas chromatography-mass spectrometry analysis of essential oils from leaves, fruits and roots of PS revealed the presence of myristicin and \(\beta\)-caryophyllene [28]. Myristicin decreased inflammation in polyinosinic-polycytidylic acid-induced RAW 264.7 cells by suppressing NO, cytokine, and chemokine production [29]. \(\beta\)-caryophyllene reduced hypoxia-induced inflammation in BV2 microglia cells by inhibiting the release of proinflammatory cytokines [30]. PS also possesses prominent antioxidant properties [31; 32; 33; 34].