Narrative review explores bromelain's potential across multiple chronic diseasesBromelain shows promise for several diseases but needs more human testing

This review summarizes current knowledge on bromelain, a proteolytic enzyme complex derived from Ananas comosus (pineapple), with a focus on its structure, absorption, metabolism, and therapeutic mechanisms. Bromelain exhibits a wide range of biological activities, including antioxidative, anti-inflammatory, immunomodulatory, antinociceptive, antiulcerative, and antihyperlipidemic effects. These effects are primarily mediated through modulation of key inflammatory and oxidative stress pathways, including inhibition of NF-κB signaling via suppression of IκBα degradation, downregulation of MAPK pathways (ERK, JNK, p38), and activation of antioxidant responses through Nrf2 signaling. Emerging evidence suggests that bromelain may have therapeutic potential in cancer, cardiovascular, metabolic, infectious, and neurodegenerative diseases; however, most findings are derived from in vitro and animal studies, with limited clinical evidence. Its efficacy is influenced by its bioavailability, which may be affected by gastrointestinal degradation, although advanced formulation approaches such as enzyme stabilization and delivery systems have been proposed to enhance its systemic activity. While current data support bromelain as a promising adjunct in disease management, further well-designed clinical studies are required to establish optimal dosing, long-term safety, and clinical efficacy.