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Nature Chemical Biology (2026)
Image-guided pharmacotherapy, in which drug activity is strictly confined to disease areas revealed by medical imaging modalities, holds great promise for the development of personalized medicine. A key step in realizing this potential is the development of safe and precise methods for drug activation. Electromagnetic radiation, spanning the energy ranges from γ-rays to ultraviolet–visible and infrared light, has emerged as a method of choice for this purpose. Because many imaging modalities rely on electromagnetic radiation to generate signals (for example, optical and optoacoustic imaging, computed tomography and positron emission tomography), this phenomenon can be used to both activate a drug and monitor tissue response, creating a theranostic synergy. This Perspective outlines the molecular basis for drug activation with electromagnetic radiation, offers a clinical perspective in discussing the most suitable applications and advantages available and discusses the challenges, such as the delivery of light at the site of interest, and steps needed for successful translation into daily clinical practice.
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Images to the left in the graphical abstract reproduced under a Creative Commons license CC BY 4.0: hand, ref. 133; brain, ref. 134; vessels, ref. 135. A.M.S. and W.S. gratefully acknowledge the financial support of the Dutch Cancer Society (KWF) Research & Implementation (grant EXPL15317).
Department of Medicinal Chemistry, Photopharmacology and Imaging, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
Melody E. Boëtius, Quentin Vivien, Albert M. Schulte & Wiktor Szymanski
Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
Melody E. Boëtius, Jasper Vonk, Albert M. Schulte & Wiktor Szymanski
Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
Schelto Kruijff
Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
Schelto Kruijff
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M.E.B., Q.V., J.V., S.K., A.M.S. and W.S. contributed to the discussion and wrote the manuscript. A.M.S. and W.S. coordinated the writing process.
Correspondence to Albert M. Schulte or Wiktor Szymanski.
The authors declare no competing interests.
Nature Chemical Biology thanks G. Woolley and the other, anonymous reviewer(s) for their contribution to the peer review of this work.
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Boëtius, M.E., Vivien, Q., Vonk, J. et al. Image-guided activation of drugs with electromagnetic radiation. Nat Chem Biol (2026). https://doi.org/10.1038/s41589-026-02248-4
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