Piezo1, a mechanosensitive ion channel protein, is a highly promising target for drug development. We systematically review the latest advances in its structural features, signal transduction mechanisms, and functional roles in various pathological processes including neurological diseases, cardiovascular diseases, and cancer. Furthermore, we provide an in-depth analysis of three key challenges in developing Piezo1-targeted drugs, including the complexity of its dynamic structure and regulatory network, the difficulty of achieving specific targeting, and the off-target risks and potential systemic toxicity arising from its widespread physiological functions. Finally, we highlight that integrating cutting-edge technologies, such as super-resolution imaging, artificial intelligence (AI)-assisted drug design, and organoid/organ-on-a-chip models, holds great promise for overcoming these challenges and accelerating the development and clinical translation of Piezo1-targeted drugs.Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.