{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T23:05:59Z","timestamp":1789772759013,"version":"4.0.1"},"reference-count":80,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82174264"],"award-info":[{"award-number":["82174264"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012542","name":"Sichuan Provincial Science and Technology Support Program","doi-asserted-by":"publisher","award":["2023NSFSC1765"],"award-info":[{"award-number":["2023NSFSC1765"]}],"id":[{"id":"10.13039\/100012542","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Immune and inflammatory disorders are part of the complex pathophysiological processes that exacerbate severe acute pancreatitis (SAP) and subsequent infection. Thymosin alpha 1 (T\u03b11) 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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 T\u03b11 as intervention measure with non-T\u03b11 in improving immune regulation for patients with SAP were included. Review Manager 5.3 was used to assess endpoints in the meta-analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five randomized controlled trials comprising 706 patients with SAP were included. The results indicated that T\u03b11 could increase the percentages of CD4<jats:sup>+<\/jats:sup> cells (MD=4.53, 95%CI [3.02, 6.04], P&amp;lt;0.00001) and improve the CD4<jats:sup>+<\/jats:sup>\/CD8<jats:sup>+<\/jats:sup> ratio (MD=0.42, 95%CI [0.26, 0.58], P&amp;lt;0.00001) in SAP patients. There was no statistically significant decrease in CD8<jats:sup>+<\/jats:sup> cells. For inflammation, lower-dose T\u03b11 could significantly reduce C-reactive protein (CRP) levels (mg\/L) (MD=-30.12, 95%CI [-35.75, -24.49], P&amp;lt;0.00001), while higher-dose T\u03b11 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 T\u03b11 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&amp;lt;0.0001), while the reduction in lung infections was not statistically significant. Regarding hospital stay (days), T\u03b11 did not significantly reduce the time spent (MD=-4.22, 95%CI [-11.53, 3.10], P=0.26). However, T\u03b11 reduced the APACHE II score (MD=-1.52, 95%CI [-2.22, -0.83], P&amp;lt;0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>T\u03b11 can regulate the balance of immune cells and alleviate immune suppression in SAP patients, including increasing CD4<jats:sup>+<\/jats:sup> T cells and CD4<jats:sup>+<\/jats:sup>\/CD8<jats:sup>+<\/jats:sup> ratios. T\u03b11 may exert anti-inflammatory and extrapancreatic infection-preventive effects on SAP patients and improve their condition or prognosis. More researches are needed to validate the results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p><jats:uri>https:\/\/www.crd.york.ac.uk\/prospero<\/jats:uri>, identifier CRD42024570517.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1571456","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T04:10:18Z","timestamp":1750133418000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Thymosin alpha 1 alleviates inflammation and prevents infection in patients with severe acute pancreatitis through immune regulation: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Yong","family":"Tian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yihan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengcheng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofang","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjie","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenfu","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"10","DOI":"10.4292\/wjgpt.v8.i1.10","article-title":"Pathogenic 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