The reading shelf
Thymosin Alpha-1 source catalogue
The source collection, from the original sequence to the later clinical trials.
Hepatitis and oncology reading
The lamivudine meta-analysis is a useful first stop for the add-on question. The Cochrane hepatitis B protocol includes the background summary of earlier combination trials; it is a protocol for a review, rather than a newly completed set of treatment results. For cancer, the 2019 reappraisal brings together the proposed adjunct role and its biological rationale.
I would read ETASS and TESTS together before making much of the sepsis literature. The comprehensive review and the human safety review offer broader clinical context. The full audited collection follows below, including the mechanistic papers and historical reports.
- Goldstein AL, Low TL, McAdoo M, et al. Thymosin alpha1: isolation and sequence analysis of an immunologically active thymic polypeptide. Proc Natl Acad Sci U S A. 1977;74(2):725-729. ↗
- Wu J, Zhou L, Liu J, et al. The efficacy of thymosin alpha 1 for severe sepsis (ETASS): a multicenter, single-blind, randomized and controlled trial. Crit Care. 2013;17(1):R8. ↗
- Wu J, Pei F, Zhou L, et al. The efficacy and safety of thymosin alpha1 for sepsis (TESTS): multicentre, double blinded, randomised, placebo controlled, phase 3 trial. BMJ. 2025;388:e082583. ↗
- Dominari A, Hathaway III D, Pandav K, et al. Thymosin alpha 1: A comprehensive review of the literature. World J Virol. 2020;9(5):67-78. ↗
- Romani L, Bistoni F, Montagnoli C, et al. Thymosin alpha1 activates dendritic cell tryptophan catabolism and establishes a regulatory environment for balance of inflammation and tolerance. Blood. 2006;108(7):2265-2274. ↗
- Liu Y, Pan Y, Hu Z, et al. Thymosin Alpha 1 Reduces the Mortality of Severe Coronavirus Disease 2019 by Restoration of Lymphocytopenia and Reversion of Exhausted T Cells. Clin Infect Dis. 2020;71(16):2150-2157. ↗
- Matteucci C, Minutolo A, Balestrieri E, et al. Thymosin Alpha 1 Mitigates Cytokine Storm in Blood Cells From Coronavirus Disease 2019 Patients. Open Forum Infect Dis. 2021;8(1):ofaa588. ↗
- Tao N, Xu X, Ying Y, Hu S, Sun Q, Lv G, Gao J. Thymosin alpha1 and Its Role in Viral Infectious Diseases: The Mechanism and Clinical Application. Molecules. 2023;28(8):3539. ↗
- Yang YF, Zhao W, Zhong YD, et al. Treatment with lamivudine versus lamivudine and thymosin alpha-1 for e antigen-positive chronic hepatitis B patients: a meta-analysis. Virol J. 2009;6:63. ↗
- Htet NH, Naing C, Vongpunsawad S, Win TT, Poovorawan Y. Thymosin-alpha-1 for people with chronic hepatitis B (systematic review). Cochrane Database Syst Rev. 2022. ↗
- Ricci D, Etna MP, Severa M, et al. Novel evidence of Thymosin α1 immunomodulatory properties in SARS-CoV-2 infection: Effect on innate inflammatory response in a peripheral blood mononuclear cell-based in vitro model. Int Immunopharmacol. 2023;117:109996. ↗
- Liang J, Cui R, Wang C, et al. Thymosin alpha-1 blocks the accumulation of myeloid suppressor cells in NSCLC by inhibiting VEGF production. Biomed Pharmacother. 2020;131:110740. ↗
- Garaci E, Pica F, Rasi G, Favalli C. Thymosin alpha 1 in the treatment of cancer: from basic research to clinical application. Int J Immunopharmacol. 2000;22(12):1067-1076. ↗
- Costantini C, Bellet MM, Pariano M, et al. A Reappraisal of Thymosin Alpha1 in Cancer Therapy. Front Oncol. 2019;9:873. ↗
- Badamchian M, Goldstein AL, Sztein MB. Immune and neuroendocrine modulation with thymosins: current status of recent clinical trials in the United States. Int J Neurosci. 1990;51(3-4):365-367. ↗
- Pica F, Chimenti MS, Gaziano R, Buè C, Casalinuovo IA, Triggianese P, et al. Serum thymosin alpha1 levels in patients with chronic inflammatory autoimmune diseases. Clin Exp Immunol. 2016;186(1):39-45. ↗
- Dinetz E, Lee E. Comprehensive Review of the Safety and Efficacy of Thymosin Alpha 1 in Human Clinical Trials. Altern Ther Health Med. 2024. ↗