Disease-tailored drug delivery microneedle systems: Precision engineering for unmet clinical needs

Microneedles, as a painless and minimally invasive transdermal drug delivery tool, are an attractive alternative to conventional administration routes such as oral and injectable methods. However, each diseases have a particular microenvironment with well-defined characteristics, which promotes deeper selection criteria of microneedles to meet the disease needs. Recent advances, encompassing bioinspired designs, piezoelectric actuation, stimuli-responsive materials, and gas-propelled systems, have transformed microneedles from passive administration into intelligent, multifunctional therapeutic platforms. Here, we critically examine the evolution of microneedle design, highlight disease-driven engineering strategies, and assess the translational landscape spanning approved devices and ongoing clinical trials. Finally, we outline key opportunities, including programmable delivery, integration with digital health, and synergistic use with emerging therapeutic modalities, that are poised to define the next era of microneedle medicine.