Ultrasound-responsive nanoweapons: covalent organic frameworks for cancer sonodynamic therapy

Sonodynamic therapy (SDT), characterized by its non-invasiveness, low toxicity, and deep tissue penetration, has emerged as a promising therapeutic modality for anticancer treatments. Recently, covalent organic frameworks (COFs) have garnered significant attention in the SDT realm as a powerful and versatile toolbox. Notably, COF-based SDT has achieved many encouraging outcomes owing to the remarkable potential of COFs, and the volume of related research has experienced continuous growth. Therefore, we strive to provide a timely and comprehensive review that thoroughly summarizes the advancements in COF-based SDT. This review begins with a concise yet comprehensive summary of ultrasonic cavitation and sonodynamic effects, elucidating the fundamental principles and potential mechanisms of SDT. Subsequently, it delves into the chemistry of COFs, examining intricate structure designs, various types of linkages, and diverse synthetic methods. The primary focus of this review is to summarize COF-based sonosensitizers, including construction strategies and product properties. More importantly, the role of COFs in SDT combined therapies is described in detail, aiming to highlight the advantages of COF-enhanced SDT and synergistic treatments. Finally, the review points out the current challenges and future opportunities in this rapidly evolving research field. Overall, the deliberations and overviews of COF-based sonosensitizers and SDT strategies are expected to facilitate advancements, leading to early-stage clinical benefits for patients.