Abstract
Silk fibroin (SF) has evolved from a traditional biopolymer to a leading regenerative medicine material. Its combination of mechanical strength, biocompatibility, tunable degradation, and molecular adaptability makes SF a unique matrix that is both bioactive and intelligent. Advances in hydrogel engineering have transformed SF from a passive scaffold into a smart, living hydrogel. These systems can instruct cell fate, sense microenvironmental signals, and deliver therapeutic signals as needed. By incorporating stem cells, progenitors, or engineered immune and microbial populations, SF hydrogels now serve as synthetic niches for organoid maturation and as adaptive implants for tissue regeneration. These platforms replicate extracellular matrix complexity and evolve with tissue, showing self-healing, shape-memory, and stimuli-responsive properties. Such features are redefining biomaterial-cell interactions. SF hydrogels are used for wound healing, musculoskeletal repair, neural and cardiac patches, and developing scalable organoid models for disease and drug research. Challenges remain in maintaining long-term cell viability, achieving clinical scalability, and meeting regulatory standards. This review explores how advances in SF engineering, synthetic biology, and organoid science are enabling SF-based smart living hydrogels in bridging the gap between research and clinical use.