The multifunctional “adipose organ” is involved in thermal, metabolic and hormonal body balance. The high content of adult mesenchymal stem cells is recommending adipose tissue as an appealing reservoir of cells to be used in regenerative therapies. Adipose derived stem cells (ASC) have remarkable proliferative and differentiation potential. This paper reviews current scientific knowledge regarding the importance of ASC in the context of regenerative medicine. Recent patents and applications describing methods of human ASC isolation and their use for regenerating musculoskeletal tissues (bone, cartilage, intervertebral disc, tendon and skeletal muscle) are discussed. Several challenges related to cell based product development are presented. Future directions as well as the importance of new genomic technologies in cell source selection and design of patient - oriented treatment algorithms, are outlined.