The article reviews the current strategies and therapeutic applications of mesenchymal stem cell (MSC)-based drug delivery systems. MSCs are emerging as promising candidates for targeted drug delivery due to their unique properties, such as low immunogenicity, homing ability, and tumor tropism. The review covers various approaches, including stem cell membrane-coated nanoparticles (SCMNPs), stem cell-derived extracellular vesicles (EVs), stem cell-laden scaffolds, and scaffold-free stem cell sheets. These strategies leverage the self-renewal and differentiation capabilities of MSCs to enhance tissue regeneration and wound healing. MSCs can be engineered to improve their therapeutic efficacy through genetic modifications, enhancing their survival, proliferation, migration, and growth factor production. The immunosuppressive functions of MSCs are also discussed, highlighting their role in modulating immune responses and promoting tissue repair. The article further explores the potential of stem cell-derived EVs and SCMNPs in targeted drug delivery and tissue repair, emphasizing their low immunogenicity and strong therapeutic potential. Finally, the therapeutic applications of stem cell-laden scaffolds and scaffold-free stem cell sheets in regenerative medicine are highlighted, along with the challenges and future directions in the field. Overall, the review underscores the significant potential of MSC-based drug delivery systems in treating various diseases and advancing regenerative medicine.The article reviews the current strategies and therapeutic applications of mesenchymal stem cell (MSC)-based drug delivery systems. MSCs are emerging as promising candidates for targeted drug delivery due to their unique properties, such as low immunogenicity, homing ability, and tumor tropism. The review covers various approaches, including stem cell membrane-coated nanoparticles (SCMNPs), stem cell-derived extracellular vesicles (EVs), stem cell-laden scaffolds, and scaffold-free stem cell sheets. These strategies leverage the self-renewal and differentiation capabilities of MSCs to enhance tissue regeneration and wound healing. MSCs can be engineered to improve their therapeutic efficacy through genetic modifications, enhancing their survival, proliferation, migration, and growth factor production. The immunosuppressive functions of MSCs are also discussed, highlighting their role in modulating immune responses and promoting tissue repair. The article further explores the potential of stem cell-derived EVs and SCMNPs in targeted drug delivery and tissue repair, emphasizing their low immunogenicity and strong therapeutic potential. Finally, the therapeutic applications of stem cell-laden scaffolds and scaffold-free stem cell sheets in regenerative medicine are highlighted, along with the challenges and future directions in the field. Overall, the review underscores the significant potential of MSC-based drug delivery systems in treating various diseases and advancing regenerative medicine.