The application of gene editing technology and viral vectors has significantly enhanced the survival and function of adipose⁃derived stem cells (ADSCs) in harsh microenvironment, and achieved stable expression of therapeutic genes. Epigenetic regulation further finely regulates the differentiation process of ADSCs. These engineered ADSCs can not only be used as a source of cell replacement, but also play a multiple repair mechanism through paracrine and microenvironment reconstruction, and have exhibited favorable therapeutic effects in many fields such as nerve regeneration, bone and cartilage repair, metabolic diseases, angiogenesis, smooth muscle function reconstruction, and degenerative diseases. This paper systematically reviews the research progress and application potential of engineered ADSCs in the treatment of multisystem diseases, aiming to provide a theoretical basis for future individualized and precise regenerative medicine strategies.

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