Silk has been used as a textile fiber for more than 6,000 years. Recently, many applications of silk have been studied for use beyond textiles, especially in medical areas. Silk is reported as a safe material with excellent mechanical properties and biocompatibility. In 2000, a transgenic silkworm technology developed based on the transposon piggyBac and microinjection technique, producing transgenic silk fibers having additional new functions to silk, became available. It was expected to expand the application area of silk into medical and other fields. Herein, silk fiber and studies of silk use in medical applications are described, along with an introduction of transgenic silkworm technologies used to produce a smart material based on silk. Cell-adhesive silk fiber with celladhesive peptide "RGDS" will be used for cell scaffolds in tissue engineering. "Affinity silk," with a fused single-chain fragment variable (scFv) of IgG protein to silk fibroin protein, will be valuable for affinity purification systems, diagnosis of diseases, detection of pathogenic microorganisms, and development of therapeutic strategies. Spider silk will become an engineering fiber with excellent mechanical strength from a natural origin. Silk fibers are anticipated for use as a smart material in advanced textiles intended for use in medical and various other fields.