The effect of thymosin α1 for prevention of infection in patients with severe acute pancreatitis

ABSTRACT

Introduction: Severe acute pancreatitis (SAP) is an acute inflammatory disease with prolonged clinical course, which is complicated by the presence of persistent organ failure and severe infection. Infection mainly occurs in the late phase of SAP and it is found to be the main cause of death. Therefore, developing strategies for the prevention of SAP-related infection has been a crucial approach to improve patients’ outcomes. Due to remarkable immune-cells-regulating properties, thymosin α1 has been recognized as a promising immune therapy, especially in several infectious diseases. Recently, thymosin α1 has been given high expectations to exert clinical benefits in the prevention of SAP-related infection.

Areas covered: The review of currently available strategies for SAP-related infection prevention and the use of thymosin α1 in SAP patients.

Expert opinion: The current available strategies achieve limited success for preventing SAP-related infection. A possible explanation is that the trigger of infection, immunosuppression has not been concurrently resolved. The application of thymosin α1 in a clinical study showed a prophylactic effect against SAP-related infection. However, the use of thymosin α1 in SAP patients is still at an early stage of clinical investigation and requires high-quality and large sample size evidences.

KEYWORDS:

• Immune modulation
• infected pancreatic necrosis
• sepsis
• severe acute pancreatitis
• thymosin α1

Article highlights

• SAP is a complex and potentially lethal clinical condition with high mortality.

• Severe infection is the dominant cause of death in SAP patients.

• Immune suppression and intestinal barrier dysfunction contribute substantially to the development of infectious complications in the late phase of SAP.

• The current available clinical strategies for preventing infection in SAP include prophylactic antibiotics, early enteral nutrition and probiotics, however the results remain highly controversial.

• Thymosin α1 is a promising bidirectional immunomodulatory drug which has been widely used in various infectious diseases.

• Thymosin α1 shows a preventive effect against SAP-related secondary infection both in animal studies and a pilot clinical trial.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the Key Research and Development Program Foundation of Jiangsu Province of China [no.BE2015685]. This paper has been published as part of a supplement issue covering the proceedings of the Fifth International Symposium on Thymosins in Health and Disease and is funded by SciClone Pharmaceuticals.