The Efficacy and Immune Mechanism of Thymosin Alpha 1 as a Valuable Adjunctive Therapy for Tuberculosis

Abstract

Tuberculosis remains the leading cause of death among global infectious diseases with increasing challenges of antimicrobial resistance. Conventional anti-tuberculosis chemotherapy is aggravated by a limited success rate, a long course of treatment, and numerous side effects. Once again, we highlighted the significance of immuno-therapy. In this review, we focus on assessing the efficacy and safety of thymosin alpha 1 (Tα1) as a valuable adjunctive therapy for tuberculosis. We aim to examine the potential mechanism through which Tα1 influences the immune system of tuberculosis patients, intending to provide a theoretical foundation for its clinical applications. After reviewing the articles published in PubMed, Web of Science, Embase, BIOSIS Library, and China-national-knowledge-internet, we identified 21 clinical cohort studies investigating Tα1 as an auxiliary treatment for tuberculosis. These studies included 11 articles on pulmonary tuberculosis, 2 articles on tuberculous pleurisy, and 8 articles on intestinal tuberculosis. These studies have demonstrated the safety and effectiveness of Tα1, an immunomodulator, in the treatment of tuberculosis. The probable immune mechanism of Tα1 might involve the up-regulation of T lymphocyte (CD3⁺, CD4⁺), helper T 17 (Th17), natural killer (NK), interferon-γ (IFN-γ), and interleukin-2 (IL-2) levels. Consequently, Tα1 may be suggested as an effective and safe auxiliary treatment for mycobacterium tuberculosis infection in clinical settings. However, several key aspects regarding Tα1 remain unclear, including the molecular mechanism involved in Tα1s upregulation of immune cell differentiation and cytokine secretion, the synergistic association between Tα1 and anti-tuberculosis drugs, and its therapeutic dose and treatment duration for tuberculosis. Therefore, there is an urgent need to investigate these aspects and explore more scientific and effective treatment strategies to provide a reference for the treatment of tuberculosis.