In this brief review, I will start by redefining the cells: mesenchymal stem cells should now be called multipotent mesenchymal stromal cells, with the same acronym (MSC). I will review the role of MSC as immunosuppressive and immunoprotected cells, and then go on to describe how cell culture strategies may depend on the desired functionality of MSC. In order to expand MSC in vitro, the cells have to be cultured as adherent cells on plastic surfaces. To obtain the best cell culture conditions, a number of methodological decisions have to be made. Special considerations are necessary if the cells are to be used for the treatment of patients.