Adult multipotent mesenchymal stromal cells (MMSCs) are considered now as one of the key players in physiological and pathological tissue remodeling. Clarification of the mechanisms that mediate MMSC functions, is one of the most intriguing issues in modern cell physiology. Present Review summarizes current understanding of the MMSC effects on different types of immune cells. The realization of MMSC immunomodulatory capacity is considered as a contribution of direct cell-to-cell contacts, soluble mediators and of local microenvironmental factors, the most important of which is the partial pressure of oxygen. MMSCs and immune cells interaction is discussed in the terms of reciprocal effects, modifying properties of all "partner cells". Special attention is paid to the influence of immune cells on the MMSCs. "Immunosuppressive" phenomenon of MMSCs is considered as the integral part of the "response to injury" mechanism.