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Mesenchymal stromal/stem cells (MSCs) are multipotent adult stem cells found in bone marrow, adipose tissue, and several other organs, with the ability to differentiate and exert potent immunomodulatory effects. They modulate both innate and adaptive immune responses through paracrine signaling (secretion of cytokines, chemokines, growth factors), direct cell-cell contact, release of extracellular vesicles, and by altering the phenotypes of immune cells such as T cells, B cells, dendritic cells, and macrophages. MSC-mediated effects can be both anti-inflammatory (promoting immune tolerance, limiting autoimmunity or tissue damage) and pro-inflammatory (supporting immune activation in underactive states). This bidirectional activity is context- and environment-dependent and is a key mechanism underlying their therapeutic utility in autoimmune diseases, inflammatory diseases, tissue repair, and as a cell therapy for conditions such as graft-versus-host disease and some cardiovascular diseases[1][2][3][4]. However, "immune system modulation via mesenchymal stromal/stem cell" is not a conventional therapeutic target but rather a therapeutic strategy based on the properties of MSCs as whole cells.
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