Diatoms are unicellular photosynthetic algae enclosed in porous 3D nanopatterned silica enclosures called "frustules." The diatom frustules are made from biosilica self-assembled into intricate porous shells that feature unique properties including high specific surface area, biocompatibility, tailorable surface chemistry, thermal stability, and high mechanical and chemical resistance. The ability to cultivate diatoms in artificial environments and their abundant availability of diatom frustules as mineable fossilized mineral deposits (diatomite or diatomaceous earth; DE) make diatom silica a promising natural alternative to synthetic porous silica for a broad range of biomedical, environmental, agricultural, and energy applications. This review article provides a comprehensive and current account of the use of natural DE silica materials in biomedical applications focused mainly on drug delivery with some highlights on biosensing, tissue engineering, and clotting agents. The article also covers some basic physical and chemical aspects of DE material such as purification, surface chemical functionalization, biocompatibility, and cellular uptake that are critical for the development of an efficient drug carrier.

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