Modern nanomedicine aims at delivering drugs or cells specifically to defective cells; therefore, this calls for developing multifunctional nanocarriers for drug delivery and cell-tracking. Mesoporous silica nanoparticles (MSNs) are well suited for this task. In this feature article, we highlight the strategies in the synthesis and functionalization of small, uniform and colloidal stable MSNs. We then discuss cell uptake of MSNs and tracking cells, as both aspects are closely related to the efficacy of drug delivery and theranostics. Some examples of stimulated drug delivery are described. For application considerations, toxicity and pharmacokinetics are critical issues and in vivo studies are summarized.