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Bioiontronics is an interdisciplinary field emerging from a confluence of breakthroughs in iontronics and bioengineering. Bioiontronics promotes communication with living matter through ions and biological molecules, thereby mediating the detection and modulation of biological activities. This process can function at abiotic-biotic interfaces in an autonomous fashion or in integral, modular components of biomedical devices. The clinical need to use specific biomolecular information, such as ion concentrations and biomarker levels, for personalized diagnostics and treatments has driven the rapid evolution of bioiontronics, through the convergence of fundamental science and application-oriented engineering. However, several challenges remain, including control of ion transport, device miniaturization, biocompatible encapsulation for long-term implantation and tools to decipher and then harness multimodal biological signals. In this Review, we discuss the underlying mechanisms and recent prototypes of bioiontronic devices and describe challenges in the fabrication and application of such systems.