• MSCs offer dual therapeutic potential in ITP by modulating immune responses and repairing the bone marrow niche.
• Patient-derived MSCs exhibit intrinsic functional abnormalities, while exogenous MSCs from distinct tissue sources show corrective potential.
• Optimization of culture conditions, priming strategies, and cellular engineering can enhance MSC therapeutic efficacy and safety.
• A translational framework integrating mechanistic insights is essential for advancing MSC-based therapies for ITP.