Translating microbial knowledge into clinical biofilm therapies

Biofilms are highly organized microbial communities that adhere to living or nonliving surfaces and are enclosed in a self-produced extracellular matrix. Their tolerance against antimicrobial agents and host defenses makes them a major challenge across clinical, industrial, and environmental fields. This review offers an in-depth analysis of biofilm formation, structure, and dispersal mechanisms, highlighting the genetic and molecular regulators that underlie their development. This review also provides extensive details of advanced and investigative strategies for biofilm eradication, including antibody-based approaches, photodynamic therapy, nanotechnology-driven solutions, surface modification of biomaterials, biological and phage-based approaches, the integration of smart and responsive systems, and host immune modulation methods. By integrating recent advances in imaging, experimental modeling, therapeutic innovations, artificial intelligence, and machine learning models, this work highlights not only the complexity of biofilm biology but also the research and development prospects for effective intervention tools. Finally, this review discusses major translational challenges associated with moving antibiofilm strategies from laboratory research to clinical and device-related applications. This review also proposes practical guidelines to overcome these challenges. Overall, the review highlights the requirements for interdisciplinary collaboration across microbiology, materials science, clinical medicine, and regulatory frameworks. Unlike traditional descriptive reviews, this review adopts a decision-oriented framework, providing clear research guidance for researchers.