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Mesenchymal stem cells (MSCs) are pluripotent stem cells with self-renewal, multi-directional differentiation and immunoregulatory capabilities. More and more studies have demonstrated the beneficial role of MSCs in the treatment of immune disorders. However, there is heterogeneity in the immunoregulatory capacity of MSCs obtained in vivo or cultured in vitro, and the immunoregulatory capacity of MSCs is also regulated by the microenvironment. This review provides an overview of the mechanisms of the immunosuppressive and immune supportive abilities of MSCs, introduces recent studies on the immunoregulatory mechanisms of MSCs and the plasticity hypothesis of their immunoregulatory abilities, and discusses strategies to enhance the immunoregulatory abilities of MSCs in the cell production stage. This review aims to provide a reference for the clinical translational research of MSCs.