Journal of Foresight and Health Governance 3092-6173 2 Serial Number 6 2025 12 10 Synthetic Biology and the Future of Therapeutic Platforms: Horizon Scanning of Programmable Cells, Living Medicines, and Bioengineered Immunotherapies Synthetic Biology and the Future of Therapeutic Platforms: Horizon Scanning of Programmable Cells, Living Medicines, and Bioengineered Immunotherapies 1 18 EN Journal Article 2025 10 17 <table> <tbody> <tr> <td> <p>The objective of this study was to systematically review and horizon scan the current landscape of synthetic biology-based therapeutic platforms, with a particular focus on programmable cells, living medicines, engineered microbial therapeutics, synthetic gene circuits, and bioengineered immunotherapies, in order to identify emerging therapeutic trends, translational opportunities, and future directions for clinical implementation. This study was conducted as a systematic review using a horizon-scanning framework and followed PRISMA-based methodological principles. Comprehensive searches were performed in PubMed/MEDLINE, Scopus, Web of Science, Embase, and IEEE Xplore for peer-reviewed studies published between 2010 and 2025. After screening and eligibility assessment, 139 studies were included in the final qualitative synthesis. Data were extracted using a structured framework capturing study characteristics, therapeutic platform type, engineering strategies, disease applications, translational readiness, safety considerations, and future development pathways. A qualitative thematic synthesis and horizon-scanning analysis were conducted to identify dominant therapeutic paradigms, emerging innovations, and implementation challenges. The findings demonstrated that bioengineered immunotherapies currently represent the most mature and clinically advanced synthetic biology-based therapeutic platform, while programmable mammalian cells, engineered microbial therapeutics, and synthetic gene circuits constitute rapidly expanding areas of innovation. The analysis revealed a clear shift from conventional drug-centered treatment models toward adaptive, biologically intelligent systems capable of sensing disease signals, processing biological information, and generating context-dependent therapeutic responses. Horizon scanning identified logic-gated immune-cell therapies, autonomous living medicines, microbiome engineering, AI-assisted therapeutic design, and hybrid biomaterial-integrated systems as major future directions. However, significant translational barriers remain, particularly regarding safety control, manufacturing scalability, delivery efficiency, long-term stability, regulatory governance, and clinical validation. Synthetic biology is transforming therapeutic development by enabling programmable, responsive, and self-regulating biological interventions that extend beyond the capabilities of traditional medicines.</p> </td> </tr> </tbody> </table> https://www.journalfph.com/index.php/jfph/article/download/65/70