The promising interplay between sonodynamic therapy and nanomedicine

onodynamic therapy (SDT) is a non-invasive approach for cancer treatment in which chemical com-pounds, named sonosensitizers, are activated by non-thermal ultrasound (US), able to deeply penetrate into the tissues. Despite increasing interest, the underlying mechanisms by which US triggers the sonosensitizer therapeutic activity are not yet clearly elucidate, slowing down SDT clinical application. In this review we will discuss the main mechanisms involved in SDT with particular attention to the sonosensitizers involved for each described mechanism, in order to highlight how much important are the physicochemical properties of the sonosensitizers and their cellular localization to predict their bio-effects. Moreover, we will also focus our attention on the pivotal role of nanomedicine providing the son-odynamic anticancer approach with the ability to shape US-responsive agents to enhance specific sonodynamic effects as the sonoluminescence-mediated anticancer effects. Indeed, SDT is one of the biomedical fields that has significantly improved in recent years due to the increased knowledge of nano-sized materials. The shift of the nanosystem from a delivery system for a therapeutic agent to a therapeu-tic agent in itself represents a real breakthrough in the development of SDT. In doing so, we have also highlighted potential areas in this field, where substantial improvements may provide a valid SDT imple-mentation as a cancer therapy.