Modulation of reactive oxygen species to enhance sonodynamic therapy

Reactive oxygen species (ROS), involving in many biological reactions, play an important role in disease treatment. Among the various ROS-based therapeutic modalities, sonodynamic therapy (SDT) stands out with its unique advantages. In turn, the SDT efficacy is mainly dependent on the ROS levels in the disease microenvironment. Therefore, in recent years, researchers have extensively investigated SDT with high ROS generation capacity. In this review, we focus on effective strategies to improve the therapeutic efficiency of SDT by modulating ROS, overview the basic mechanisms of ROS generation by sonosensitizers, highlight the rational design of sonosensitizers, and summarize strategies to improve the SDT efficacy by modulating disease microenvironment. In addition, multiple ROS synergistic treatment modalities and the prospect of SDT are discussed. We believe that the understanding and exploration of SDT enhancement strategies will facilitate the clinical translation of SDT.