Synthetic biology-driven microbial therapeutics: Integrated platforms for disease diagnosis and intervention

Synthetic biology made the design of microbes as versatile therapeutic platforms possible, thereby transforming bacteria and synthetic microbial communities into programmable systems for health applications. This review summarizes recent progress in engineered bacterial therapeutics, emphasizing their roles in metabolic compensation, immune modulation, targeted delivery, and diagnostic sensing. Engineered strains have advanced from early proof-of-concept designs to sophisticated circuits that integrate environmental cues, respond to external stimuli, and achieve spatiotemporal control of therapeutic outputs. Similarly, synthetic microbial communities strategies provide ecological stability, functional redundancy, and customizable community interactions, offering advantages over single-strain interventions. Together, these approaches demonstrate a shift from conventional probiotics toward rationally designed microbial therapeutics that restore physiological balance and actively intervene in disease processes. Ongoing efforts address challenges, including colonization efficiency, biosafety, and regulatory adaptation, whereas emerging frameworks integrate multimodal sensing, intelligent feedback control, and clinical translation. This review emphasizes their potential to reshape future strategies for disease prevention, intervention, and personalized medicine by situating microbial therapeutics within the broader landscape of health engineering.