Immunomodulators play a crucial role in modern medical practice, offering both stimulatory and suppressive effects to regulate and control the immune response. These substances, which include immunostimulants and immunosuppressants, modulate the immune system by delivering cytokines and stimulating immune cells. Immunosuppressants are vital in liver and kidney transplantation, where they reduce the immune system’s activation to prevent organ rejection. They are also essential in managing autoimmune disorders by providing controlled suppression of immune activities to avoid self-damage. Conversely, immunostimulants enhance the body’s innate immunity, preventing infections, and boosting resistance against various viral and bacterial diseases. These agents strengthen the body’s natural defenses, making them indispensable in infection control and immunoprophylaxis. The mechanisms of immunomodulators are intricate, involving interactions with key molecules such as cytokines and signaling pathways to shape immune responses, mitigate inflammation, and regulate immune cell functions. Mesenchymal stem cells (MSCs) have emerged as a promising component due to their ability to suppress immune reactions, regulate inflammatory responses, induce immune tolerance, and aid in tissue regeneration. MSCs’ unique properties underscore their potential in treating immune-related disorders, supporting organ transplantation, and promoting tissue repair. Clinically, immunomodulators are central to managing autoimmune diseases, enhancing cancer immunotherapy, combating infectious diseases, and preventing organ rejection in transplant recipients. Innovative therapies like checkpoint inhibitors, CAR T-cell therapy, and cancer vaccines have revolutionized oncology by leveraging the immune system's capabilities. This review explores the critical roles and mechanisms of immunomodulators, highlighting their impact on contemporary healthcare and their potential for future therapeutic developments.Graphical Abstract