Sonogenetics for Precision Medicine: A Focus on Immunoengineering and Genome Engineering

Ultrasound can penetrate centimetres of soft tissue, focus energy with millimetre precision, and operate safely under real-time image guidance. Leveraging these advantages, sonogenetics combines therapeutic ultrasound with genetic, cellular, and molecular engineering to create remotely programmable living systems. While widely applied in neuronal modulation, this review highlights recent progress in precision medicine, focusing on immunoengineering and genome engineering, illustrating how sonogenetics is moving beyond neuromodulation to enable precise control of immune responses and targeted genetic modifications. We introduce the fundamental principles of sonogenetics and key ultrasound-responsive biological actuators, including heat-shock promoters, thermosensitive and mechanosensitive ion channels, gas vesicles, microbubbles, and acoustically responsive nanoparticles. These convert acoustic signals into biological responses and are integrated into synthetic genetic circuits to control cell behaviour with high spatial and temporal precision. We then overview immunoengineering and genome engineering, covering cellular therapies such as CAR-T and engineered bacteria, synthetic materials, and CRISPR-based genome and transcriptome editors. This context supports recent applications, including ultrasound-guided immune modulation, remote control of CAR-T cells, tumour microenvironment reprogramming, targeted genome editing, and epigenetic regulation in vivo. We also discuss the emerging role of artificial intelligence in optimizing sonogenetic designs and outline translational challenges, including actuator safety and immunogenicity, ultrasound penetration limits, targeting accuracy, and regulatory pathways for device-biologic combinations. Key priorities include closed-loop dosimetry, scalable vector delivery, and actuator optimization. In summary, sonogenetics provides a programmable, non-invasive toolkit for controlling cellular functions, opening opportunities in basic research, diagnostics, and next-generation therapeutics.