Various nanomaterials as biocatalysts could be customâdesigned and modified to precisely match the specific microenvironment of diseases, showing a promise in achieving effective therapy outcome. Compared to conventional biocatalysts, single metal atom catalysts (SMACs) with the maximized atom utilization through wellâdefined structures offer enhanced catalytic activity and selectivity and enable the exploration of catalytic activity and the examination of structureâmechanism interactions. There is still a gap in the comprehensive overview encompassing the interplay among the structure, catalytic mechanism, and biomedical applications of SMACs. Therefore, it is crucial to deeply investigate the role of SMACs in biocatalysis from the atomic structure level and to elucidate their potential mechanisms in biocatalytic processes. In this miniâreview, we summarize catalysis regulation methods of SMACs at the atomic structure level, focusing on the optimization of catalytic active sites, coordination environment, and active siteâsupport interactions, and discuss biocatalytic mechanisms for biomedical applications.