The immunosuppressive tumor microenvironment critically influences hepatocellular carcinoma (HCC) progression. To counteract this, we developed cationic lipid nanobubbles (NBs) co-loaded with the sonosensitizer curcumin (CUR) and tumor-suppressive microRNA miR-15a-5p. This nanoplatform enables ultrasound-targeted delivery and real-time contrast-enhanced imaging. Upon ultrasound irradiation, CUR generated cytotoxic reactive oxygen species (ROS; 46.87 % ± 5.34 % ROS-positive cells vs. 1.26 % ± 0.99 % controls), inducing immunogenic cell death (ICD). Concurrently, miR-15a-5p directly targeted CD274 mRNA, suppressing PD-L1 protein expression on tumor cells. In tumor-bearing mice, the combined therapy (miR-15a-5p/CUR-NBs + US) significantly outperformed monotherapies, suppressing tumor growth and promoting apoptosis. This was accompanied by enhanced immune activation: increased cytotoxic T lymphocytes (CTLs) infiltration (10.90 % ± 0.61 % vs. 3.88 % ± 0.08 % in controls) with elevated target cell killing (32.27 % ± 2.95 % vs. 8.88 % ± 2.43 % in controls), and augmented natural killer (NK) cells cytotoxicity (57.34 % ± 6.43 %). The platform also potently remodeled the immunosuppressive tumor milieu by driving a phenotypic shift in tumor-associated macrophages (TAMs) from the M2 to the M1 pole and by effectively reducing myeloid-derived suppressor cells (MDSCs). Critically, the strategy demonstrated favorable biosafety, with no significant weight loss or organ toxicity observed. This theranostic platform effectively overcomes HCC immunosuppression by synergistically integrating sonodynamic therapy with miRNA-mediated immune reprogramming, offering a promising approach for advanced HCC.
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