Activating Drugs with Sound: Mechanisms Behind Sonodynamic Therapy and the Role of Nanomedicine

Sonodynamic therapy (SDT) is a promising therapeutic platform for minimally invasive cancer treatment in which acoustically susceptible drug agents, sonosensitizers, are activated by deep-tissue-penetrating low frequency ultrasound. Despite growing research in recent years, the field has yet to clearly elucidate broadly applicable mechanisms by which acoustic cavitation triggers sonosensitizer therapeutic activity, creating difficulties in achieving substantial and translatable therapeutic efficacy. In this review, we will critically analyze the proposed mechanisms underlying SDT and overview how nanomedicines can complement and extend these mechanisms to deliver more efficacious SDT. In doing so, we aim to highlight potential avenues toward viable implementation of SDT as a cancer therapy.