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Leveraging their structural tunability, modular chemistry, and high surface area, MOF\u2010based nanozymes have demonstrated redox\u2010mimetic activities such as oxidase\u2010, peroxidase\u2010, catalase\u2010, superoxide dismutase\u2010, and hydrolase\u2010like behavior. This review provides a comprehensive analysis of how structure\u2013activity relationships ranging from pore topology and metal\u2013ligand coordination to framework dimensionality govern catalytic performance. Engineering strategies including defect creation, hybridization with nanoparticles or quantum dots, and post\u2010synthetic functionalization are discussed in the context of optimizing active site accessibility, catalytic kinetics, and redox efficiency. Particular emphasis is placed on the theranostic capabilities of MOF nanozymes, including biomarker detection, multimodal imaging (MRI, CT, fluorescence), ROS\u2010mediated therapy, and targeted drug delivery. 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