A clear-eyed literature digest on the thymic immune peptide thymosin alpha-1 — what the trials actually found, and where they fall short.
Thymosin Alpha-1 Source

The literature

Thymosin Alpha-1 References

Every numbered citation used across this site, with DOIs and PubMed links.

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About these sources

The Thymosin Alpha-1 references below are the published sources behind every quantitative claim on this site — peer-reviewed trials, meta-analyses, mechanism studies, and regulatory documents, drawn from PubMed and primary journals. Each is numbered to match the inline [N] markers used throughout. Where a source is paywalled, the PubMed record and DOI are still listed so any reader can locate the original.

  1. 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. ↗
  2. 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. ↗
  3. 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. ↗
  4. 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. ↗
  5. 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. ↗
  6. 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. ↗
  7. Costantini C, Bellet MM, Pariano M, et al. A Reappraisal of Thymosin Alpha1 in Cancer Therapy. Front Oncol. 2019;9:873. ↗
  8. Shang W, Zhang B, Ren Y, Wang W, Zhou D, Li Y. Thymosin alpha1 use in adult COVID-19 patients: A systematic review and meta-analysis on clinical outcomes. Int Immunopharmacol. 2022;113(Pt A):109584. ↗
  9. Mao HY, Shi TD. [Treatment with interferon and thymosin alpha-1 versus interferon monotherapy for HBeAg positive chronic hepatitis B: a meta-analysis]. Zhonghua Gan Zang Bing Za Zhi. 2011;19(1):29-33. ↗
  10. Wolf E, Milazzo S, Boehm K, Zwahlen M, Horneber M. Thymic peptides for treatment of cancer patients. Cochrane Database Syst Rev. 2011;(2):CD003993. ↗
  11. Peng D, Xing HY, Li C, Wang XF, Hou M, Li B, Chen JH. The clinical efficacy and adverse effects of Entecavir plus Thymosin alpha-1 combination therapy versus Entecavir Monotherapy in HBV-related cirrhosis: a systematic review and meta-analysis. BMC Gastroenterol. 2020;20(1):348. ↗
  12. Yang YF, Zhao W, Xia HM, et al. Comparison of the efficacy of thymosin alpha-1 and interferon alpha in the treatment of chronic hepatitis B: a meta-analysis. Antiviral Res. 2008;77(2):136-141. ↗
  13. 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. ↗
  14. 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. ↗
  15. Dinetz E, Lee E. Comprehensive Review of the Safety and Efficacy of Thymosin Alpha 1 in Human Clinical Trials. Altern Ther Health Med. 2024. ↗
  16. U.S. Food and Drug Administration. Thymosin alpha-1 (Tα1)-related bulk drug substances: FDA review for the 503A Bulk Drug Substances List. FDA briefing / Pharmacy Compounding Advisory Committee. 2024. ↗
  17. Vitek M, Zvonar Pobirk A, Roškar R, Matjaž MG. Exploiting the potential of in situ forming liquid crystals: development and in vitro performance of long-acting depots for peptide drug thymosin alpha 1 subcutaneous administration. Drug Deliv. 2025;32(1):2460708. ↗