Mesenchymal stem cells (MSCs) are being explored as a promising platform for targeted drug delivery due to their unique properties, including low immunogenicity, homing ability, and tumor tropism. MSC-based drug delivery strategies include stem cell membrane-coated nanoparticles, stem cell-derived extracellular vesicles, immunomodulatory effects, stem cell-laden scaffolds, and scaffold-free stem cell sheets. These strategies leverage the self-renewal and differentiation capabilities of MSCs to enhance wound healing, tissue regeneration, and cancer therapy. MSCs can be engineered to improve their survival, migration, and therapeutic efficacy through genetic modifications. MSCs also exhibit potent immunosuppressive functions, making them valuable for tissue regeneration and immunomodulation. Stem cell-derived extracellular vesicles (EVs) have low immunogenicity and strong therapeutic potential for tissue repair and regeneration. Scaffold-free stem cell sheets offer a versatile platform for tissue engineering and regeneration across various medical specialties. MSCs have shown great potential for clinical applications in regenerative medicine due to their ability to differentiate into various cell types, secrete bioactive factors, and modulate immune responses. Current research focuses on improving the effectiveness and safety of MSC-based drug delivery systems through advanced technologies such as nanotechnology, genome engineering, and biomimetic approaches. Despite promising results, challenges such as poor quality control, stability issues, and immunocompatibility remain to be addressed for successful clinical translation. MSCs have been studied in over 160 clinical trials for neurological disorders and other conditions, with some indications of safety and moderate clinical benefits. Approved MSC therapies include Cartistem for osteoarthritis and Alofisel for complex perianal fistulas in Crohn's disease. Ongoing research aims to optimize MSC isolation, expansion, and delivery to improve therapeutic outcomes in regenerative medicine and targeted drug delivery.Mesenchymal stem cells (MSCs) are being explored as a promising platform for targeted drug delivery due to their unique properties, including low immunogenicity, homing ability, and tumor tropism. MSC-based drug delivery strategies include stem cell membrane-coated nanoparticles, stem cell-derived extracellular vesicles, immunomodulatory effects, stem cell-laden scaffolds, and scaffold-free stem cell sheets. These strategies leverage the self-renewal and differentiation capabilities of MSCs to enhance wound healing, tissue regeneration, and cancer therapy. MSCs can be engineered to improve their survival, migration, and therapeutic efficacy through genetic modifications. MSCs also exhibit potent immunosuppressive functions, making them valuable for tissue regeneration and immunomodulation. Stem cell-derived extracellular vesicles (EVs) have low immunogenicity and strong therapeutic potential for tissue repair and regeneration. Scaffold-free stem cell sheets offer a versatile platform for tissue engineering and regeneration across various medical specialties. MSCs have shown great potential for clinical applications in regenerative medicine due to their ability to differentiate into various cell types, secrete bioactive factors, and modulate immune responses. Current research focuses on improving the effectiveness and safety of MSC-based drug delivery systems through advanced technologies such as nanotechnology, genome engineering, and biomimetic approaches. Despite promising results, challenges such as poor quality control, stability issues, and immunocompatibility remain to be addressed for successful clinical translation. MSCs have been studied in over 160 clinical trials for neurological disorders and other conditions, with some indications of safety and moderate clinical benefits. Approved MSC therapies include Cartistem for osteoarthritis and Alofisel for complex perianal fistulas in Crohn's disease. Ongoing research aims to optimize MSC isolation, expansion, and delivery to improve therapeutic outcomes in regenerative medicine and targeted drug delivery.