Thymosin alpha 1 alleviates inflammation and prevents infection in patients with severe acute pancreatitis through immune regulation: a systematic review and meta-analysis

Yong Tian¹Jiaqi Yao¹Yihan Ma²Pengcheng Zhang¹Xiaofang Zhou²Wenjie Xie³Wenfu Tang^1,4*

• ¹West China Hospital, Sichuan University, Chengdu, China
• ²Department of Gastroenterology and Hepatology, Chengdu First People’s Hospital, Chengdu, Sichuan Province, China
• ³Department of General Surgery, The Third Hospital of Mianyang Sichuan Mental Health Center, Mianyang, Sichuan, China, Mianyang, China
• ⁴West China Center of Excellence for Pancreatitis, West China Hospital, Sichuan University, Chengdu, China, Chengdu, Sichuan Province, China

Background: Immune and inflammatory disorders are part of the complex pathophysiological processes that exacerbate severe acute pancreatitis (SAP) and subsequent infection. Thymosin alpha 1 (Tα1) is an important immunomodulatory agent in clinical practice, but there is a lack evidence to prove its effectiveness in improving the condition of SAP patients. In this study, we aimed to evaluate the efficacy in meta-analysis.We systematically searched PubMed, Embase, Web of Science, Cochrane Library and China National Knowledge Infrastructure (CNKI) up to February 1, 2025.Randomized controlled studies comparing the efficacy of Tα1 as intervention measure with non-Tα1 in improving immune regulation for patients with SAP were included. Review Manager 5.3 was used to assess endpoints in the meta-analysis.Results: Five randomized controlled trials comprising 706 patients with SAP were included. The results indicated that Tα1 could increase the percentages of CD4 + cells (MD=4.53, 95%CI [3.02, 6.04], P<0.00001) and improve the CD4 + / CD8 + ratio (MD=0.42, 95%CI [0.26, 0.58], P<0.00001) in SAP patients. There was no statistically significant decrease in CD8 + cells. For inflammation, lower-dose Tα1 could significantly reduce C-reactive protein (CRP) levels (mg/L) (MD=-30.12, 95%CI [-35.75, -24.49], P<0.00001), while higher-dose Tα1 showed no statistically significant difference (MD=-3.83, 95%CI [-12.14, 4.49], P=0.37). In terms of infection, the immunomodulatory therapy of Tα1 obviously reduced the overall incidence of extrapancreatic infections in SAP patients (RR=0.56, 95%CI [0.40, 0.78], P=0.0005), especially for blood (RR=0.60, 95%CI [0.38, 0.94], P=0.03) and abdominal (RR=0.38, 95%CI [0.19, 0.78], P<0.0001), while the reduction in lung infections was not statistically significant. Regarding hospital stay (days), Tα1 did not significantly reduce the time spent (MD=-4.22, 95%CI [-11.53, 3.10], P=0.26). However, Tα1 reduced the APACHE II score (MD=-1.52, 95%CI [-2.22, -0.83], P<0.0001).Tα1 can regulate the balance of immune cells and alleviate immune suppression in SAP patients, including increasing CD4 + T cells and CD4 + / CD8 + ratios.Tα1 may exerts further anti-inflammatory and extrapancreatic infection-preventive effects on SAP patients and through immune regulation, improvinge their condition and or prognosis. More researches are needed to validate the results.