1
|
Seymour D, Forshaw G, Porteous M, Mawer D, Wiggins F, Mitchell A, Hewitt C, Beetar-King T, Davies K, Jackson D, Hannah M, Pitcher M, Arnold U, Strachan R, Killip M, Nixon P. Investigating the effectiveness of commercially available mouthwash on SARS-CoV-2 in vivo using viable virus titre as the primary outcome. A randomised controlled trial. Access Microbiol 2024; 6:000722.v3. [PMID: 39130730 PMCID: PMC11316591 DOI: 10.1099/acmi.0.000722.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/26/2024] [Indexed: 08/13/2024] Open
Abstract
This multi-arm, parallel group, single-blinded randomised controlled trial aimed to assess three commercially available mouthwashes effectiveness against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This manuscript has been written in accordance with the CONSORT statement. Methods. Eligible participants were SARS-CoV-2 positive with a positive test in the last 72 h. All participants had mild to moderate symptoms and could provide five saliva samples over a 60 min period. Participants delivered a baseline saliva sample and then used a mouthwash as per manufacturer's instructions. They provided further saliva samples at minute 1, 10, 30 and 60. Participants were randomised to one of four groups; OraWize+, Total Care Listerine, Cool Mint Listerine and water (control). The lab-based research team were blind to the intervention. The research question was: can SARS-CoV-2 be rendered inactive in saliva by using a mouthwash and how long does this effect last? The primary outcome was the amount of viable infectious SARS-CoV-2 virus in the sample, compared to the baseline sample. The secondary outcome measure was the amount of genetic material from the SARS-CoV-2 virus in the sample, measured via PCR testing. Results. In total 100 participants were recruited (25 per group). Eight participants did not receive the allocated intervention and did not have saliva samples collected. There were no adverse events. In total 42 of the 92 participants had viable virus which could be cultured at baseline. Statistical analysis of the primary outcome was not advised due to the reduced level of viable virus at baseline and the positive skewness present in the distribution of log10(titre) data. Observational data of the primary outcome measure is presented. Analysis of the secondary outcome PCR measure showed that there was strong evidence for a decrease in SARS-CoV-2 RNA levels compared to water for all mouthwashes after 1 min, OraWize+ -0.49 (-0.92, -0.05), p-value 0.029, Cool Mint Listerine -0.81 (-1.25, -0.38), p-value<0.001, Total Care Listerine -1.05 (-1.48, -0.62), p-value<0.001. For the remaining timepoints there was generally no evidence of virus level reduction compared to water although there is weak evidence for a decrease at ten minutes using Total Care Listerine -0.44 (-0.88, 0.01), p-value 0.053. Conclusion. The three mouthwashes included in this trial observationally demonstrated a reduction in virus titre level 1 min after use, with virus levels normalising up to 60 min compared to the control. Although an interesting observation, this result could not be statistically analysed. Using the secondary outcome PCR measure all three included mouthwashes reduced virus levels compared to water at 1 min and these results were statistically significant. Clinically this result does not support the use of the included mouthwashes to reduce SARS-CoV-2 levels in saliva.
Collapse
Affiliation(s)
- D.W. Seymour
- York and Scarborough Teaching Hospitals NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - G. Forshaw
- York and Scarborough Teaching Hospitals NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - M. Porteous
- York and Scarborough Teaching Hospitals NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - D. Mawer
- York and Scarborough Teaching Hospitals NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - F. Wiggins
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, Heslington, York, YO10 5DD, UK
| | - A. Mitchell
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, Heslington, York, YO10 5DD, UK
| | - C. Hewitt
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, Heslington, York, YO10 5DD, UK
| | - T. Beetar-King
- High Containment Microbiology, United Kingdom Health Security Agency, 61 Colindale Avenue, Colindale, London, NW9 5EQ, UK
| | - K.A. Davies
- High Containment Microbiology, United Kingdom Health Security Agency, 61 Colindale Avenue, Colindale, London, NW9 5EQ, UK
| | - D. Jackson
- High Containment Microbiology, United Kingdom Health Security Agency, 61 Colindale Avenue, Colindale, London, NW9 5EQ, UK
| | - M.J. Hannah
- High Containment Microbiology, United Kingdom Health Security Agency, 61 Colindale Avenue, Colindale, London, NW9 5EQ, UK
| | - M. Pitcher
- High Containment Microbiology, United Kingdom Health Security Agency, 61 Colindale Avenue, Colindale, London, NW9 5EQ, UK
| | - U. Arnold
- High Containment Microbiology, United Kingdom Health Security Agency, 61 Colindale Avenue, Colindale, London, NW9 5EQ, UK
| | - R. Strachan
- High Containment Microbiology, United Kingdom Health Security Agency, 61 Colindale Avenue, Colindale, London, NW9 5EQ, UK
| | - M.J. Killip
- High Containment Microbiology, United Kingdom Health Security Agency, 61 Colindale Avenue, Colindale, London, NW9 5EQ, UK
| | - P.J. Nixon
- York and Scarborough Teaching Hospitals NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| |
Collapse
|
2
|
Jirakittayakorn N, Tamboon E, Mitrirattanakul S. Effect of 1% H 2O 2 on Three Salivary Stress Biomarkers, Cortisol, Alpha-Amylase, and sIgA. Int Dent J 2024; 74:343-351. [PMID: 37985342 PMCID: PMC10988260 DOI: 10.1016/j.identj.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Due to the COVID-19 pandemic, several associations worldwide have been recommending the use of 1% hydrogen peroxide solution as a preprocedural mouth rinse before dental treatments to reduce viral load in saliva. This protocol is also employed in stress studies, especially in the context of dental treatment that uses salivary biomarkers as an indicator. However, the effect of 1% hydrogen peroxide as mouth rinse on salivary biomarkers remains unclear. OBJECTIVE This study aims to investigate the effects of 1% hydrogen peroxide solution as a preprocedural mouth rinse on 3 salivary stress biomarkers-salivary cortisol, salivary secretory IgA, and salivary α-amylase-both on chemical influence and mechanical irrigation. MATERIALS AND METHODS Ninety healthy participants with confirmed negative Reverse Transcription Polymerase Chain Reaction results for COVID-19 at most 2 days prior to the experiment were included in this study. All participants were randomly allocated into 3 groups: experimental (1% hydrogen peroxide solution), positive control (distilled water), and negative control (no mouth rinse). Saliva samples were collected before and after mouth rinsing with the respective solutions. Salivary biomarkers were analysed using specific enzyme-linked immunosorbent assay kits. RESULTS Salivary cortisol and salivary α-amylase did not significantly differ before and after rinsing, whilst salivary sIgA levels decreased in all 3 groups. Nonetheless, there were no significant differences in the changes of these biomarkers across the 3 groups. CONCLUSIONS This study shows that using 1% hydrogen peroxide solution as a preprocedural mouth rinse for universal precaution does not alter the levels of these 3 salivary biomarkers.
Collapse
Affiliation(s)
- Nantawachara Jirakittayakorn
- Faculty of Dentistry, Mahidol University, Bangkok, Thailand; School of Dentistry, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Eakapong Tamboon
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Somsak Mitrirattanakul
- Department of Masticatory Science, Faculty of Dentistry, Mahidol University, Bangkok Thailand.
| |
Collapse
|
3
|
Shah SA, Feng ZC, Ziccardi VB. Impact of COVID-19 on emergency oral health care in New Jersey. J Am Dent Assoc 2024; 155:204-212. [PMID: 38069962 DOI: 10.1016/j.adaj.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND The COVID-19 pandemic led to reduced services of private dental practices. The public emergency clinic of Rutgers School of Dental Medicine (RSDM) (Newark, NJ) faced changing demands during various periods of the pandemic. METHODS Records of patients visiting the emergency clinic at RSDM during 3 distinct periods (prelockdown, lockdown, teledentistry) from January 10, 2020, through June 30, 2020, were retrospectively reviewed. Qualitative and quantitative attributes pertaining to patient encounters were reviewed and analyzed. RESULTS A total of 1,799 records were included in this study. Patient visits increased during the early lockdown but were reduced after the implementation of teledentistry. Trends were noted in patient volume, reasons for visits, treatment needs, symptoms, diagnostic methodology, prescription use, and final disposition of patients. CONCLUSIONS The lockdown affected emergency dental clinic services at RSDM. Teledentistry visits played a key role in screening patients and in facilitating the delivery of oral health care and timely follow-ups to patients who needed urgent in-person emergency visits. PRACTICAL IMPLICATIONS Data gathered will lead to a better understanding of patients seen in the emergency clinic and can help with long-term planning for both institutional and smaller outpatient clinics during public health emergencies.
Collapse
|
4
|
Sbricoli L, Schiavon L, Brunello G, Brun P, Becker K, Sivolella S. Efficacy of different mouthwashes against COVID-19: A systematic review and network meta-analysis. JAPANESE DENTAL SCIENCE REVIEW 2023; 59:334-356. [PMID: 37854066 PMCID: PMC10579871 DOI: 10.1016/j.jdsr.2023.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 09/08/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023] Open
Abstract
To evaluate the effectiveness of antiseptic mouthwashes in reducing SARS-CoV-2 load clinically and in vitro. A systematic electronic search (MEDLINE/Scopus/Cochrane) was conducted to identify prospective clinical and in vitro studies published between 2019 included and 16 June 2023 assessing the effectiveness of mouthwashes in reducing SARS-CoV-2 load in saliva or surrogates. Data were summarized in tables and a network meta-analysis was performed for clinical trials. Thirty-five studies (14 RCTs, 21 in vitro) fulfilled the inclusion criteria. The risk of bias was judged to be high for 2 clinical and 7 in vitro studies. The most commonly test product was chlorhexidine alone or in combination with other active ingredients, followed by povidone-iodine, hydrogen peroxide and cetylpyridinium chloride. Overall, the descriptive analysis revealed the effectiveness of the mouthwashes in decreasing the salivary viral load both clinically and in vitro. Network meta-analysis demonstrated a high degree of heterogeneity. Among these studies, only chlorhexidine 0.20% was associated to a significant Ct increase in the saliva 5 min after rinsing compared to non-active control (p = 0.027). Data from clinical and in vitro studies suggested the antiviral efficacy of commonly used mouthwashes. Large well-balanced trials are needed to identify the best rinsing protocols.
Collapse
Affiliation(s)
- Luca Sbricoli
- Department of Neurosciences, School of Dentistry, University of Padua, 35128 Padua, Italy
| | - Lucia Schiavon
- Department of Neurosciences, School of Dentistry, University of Padua, 35128 Padua, Italy
| | - Giulia Brunello
- Department of Neurosciences, School of Dentistry, University of Padua, 35128 Padua, Italy
- Department of Oral Surgery, University Hospital of Düsseldorf, 40225 Düsseldorf, Germany
| | - Paola Brun
- Department of Molecular Medicine, University of Padua, 35128 Padua, Italy
| | - Kathrin Becker
- Department of Orthodontics and Dentofacial Orthopaedics, Charité - Universitätsmedizin Berlin, 14197 Berlin, Germany
| | - Stefano Sivolella
- Department of Neurosciences, School of Dentistry, University of Padua, 35128 Padua, Italy
| |
Collapse
|
5
|
Nazrine S, Kulal R, Shivaprasad BM, Janardhanan N. In vivo efficacy of 2% povidone iodine, chlorhexidine gluconate, and herbal extract mouthwash on SARS-CoV-2 viral load in saliva: A randomized clinical trial. J Indian Soc Periodontol 2023; 27:607-611. [PMID: 38434502 PMCID: PMC10906800 DOI: 10.4103/jisp.jisp_469_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 03/05/2024] Open
Abstract
Background One of the major techniques to reduce the transmission rate of COVID-19 would be to decrease the viral titers of SARS-CoV-2 in the saliva of infected patients and it is particularly useful in a dental setting. The present study evaluated the change in salivary viral load of COVID-19 patients using povidone iodine (PI), chlorhexidine (CHX), and an herbal extract (RightSure®) oral antiviral herbal mouthwash (HM) at clinically recommended duration and concentrations. Materials and Methods Thirty individuals with SARS-CoV-2 were randomly allocated to three groups: (1) Group 1, PI mouthwash; (2) Group 2, CHX mouthwash; and (3) Group 3, HM mouthwash. A baseline salivary throat sample was collected from all the participants who were later instructed to rinse with their respective mouthwash for 30 s. A second salivary sample was collected 30 min after rinsing. The SARS-CoV-2 viral load was analyzed using real-time reverse-transcription polymerase chain reaction wherein the cyclic threshold (Ct) values were evaluated. Results Independent t-test analysis reported a statistically significant difference concerning the PI group (before-after comparison) (P < 0.05). The rest of the two study groups failed to report any significant difference in the nucleocapsid gene and open reading frame 1a gene levels. Conclusion While all three types of mouthwash increased the Ct values, a statistically significant difference was observed with PI mouthwash, indicating that it might potentially reduce the spread of the SARS-CoV-2 virus, especially via aerosol but further studies with larger sample size and longer follow-up periods are required to investigate this relationship.
Collapse
Affiliation(s)
- Sayana Nazrine
- Department of Periodontology, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
| | - Ritesh Kulal
- Department of Periodontology, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
| | - BM Shivaprasad
- Department of Periodontology, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
| | - Nimmi Janardhanan
- Department of Periodontology, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
6
|
Wu CY, Yang YH, Lin YS, Shu LH, Cheng YC, Liu HT, Lin YY, Lee IY, Shih WT, Yang PR, Tsai YY, Chang GH, Hsu CM, Yeh RA, Wu YH, Wu YH, Shen RC, Tsai MS. The anti-SARS-CoV-2 effect and mechanism of Chiehyuan herbal oral protection solution. Heliyon 2023; 9:e17701. [PMID: 37483781 PMCID: PMC10359827 DOI: 10.1016/j.heliyon.2023.e17701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/07/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
The Chiehyuan herbal oral protection solution (GB-2) is a herbal mixture commonly utilized in Taiwan for combating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as per traditional Chinese medicine practices. This study assessed the clinical impact of GB-2 through prospective clinical trials. With twice-daily use for a week, GB-2 was shown to diminish the expression of angiotensin-converting enzyme 2 (ACE2) in oral mucosal cells. Moreover, after two weeks of use, it could reduce transmembrane protease, serine 2 (TMRPSS2) expression in these cells. Additionally, in vitro experiments demonstrated that GB-2 lessened the entry efficiency of the Omicron, L452R-D614G, T478K-D614G, and L452R-T478K-D614G variants of the SARS-CoV-2 pseudotyped lentivirus. It also impeded the interaction between ACE2 and the receptor-binding domain (RBD) presenting N501Y-K417N-E484A-G339D-Q493R-G496S-Q498R and L452R-T478K mutations. Glycyrrhizic acid, a major compound in GB-2, also hindered the entry of the Omicron variant (BA.1) of the SARS-CoV-2 pseudotyped lentivirus by obstructing the binding between ACE2 and the RBD presenting the N501Y-K417N-E484A-G339D-Q493R-G496S-Q498R mutation. To sum up, these findings suggest that GB-2 can decrease ACE2 and TMPRSS2 expression in oral mucosal cells. Both glycyrrhizic acid and GB-2 were found to reduce the entry efficiency of the Omicron variant (BA.1) of the SARS-CoV-2 pseudotyped lentivirus and block the binding between ACE2 and the RBD with the N501Y-K417N-E484A-G339D-Q493R-G496S-Q498R mutation. This evidence implies that GB-2 might be a potential candidate for further study as a preventative measure against SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Ching-Yuan Wu
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shih Lin
- Department of Pharmacy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Li-Hsin Shu
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Ching Cheng
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hung-Te Liu
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yin-Yin Lin
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - I-Yun Lee
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Tai Shih
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pei-Rung Yang
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ying-Ying Tsai
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Geng-He Chang
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Reming-Albert Yeh
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Huei Wu
- Department of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Heng Wu
- Department of Electrical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Rou-Chen Shen
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
7
|
Ebraham L, Xu C, Wang A, Hernandez C, Siclari N, Rajah D, Walter L, Marras SAE, Tyagi S, Fine DH, Daep CA, Chang TL. Oral Epithelial Cells Expressing Low or Undetectable Levels of Human Angiotensin-Converting Enzyme 2 Are Susceptible to SARS-CoV-2 Virus Infection In Vitro. Pathogens 2023; 12:843. [PMID: 37375533 DOI: 10.3390/pathogens12060843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
The oral cavity is thought to be one of the portals for SARS-CoV-2 entry, although there is limited evidence of active oral infection by SARS-CoV-2 viruses. We assessed the capacity of SARS-CoV-2 to infect and replicate in oral epithelial cells. Oral gingival epithelial cells (hTERT TIGKs), salivary gland epithelial cells (A-253), and oral buccal epithelial cells (TR146), which occupy different regions of the oral cavity, were challenged with replication-competent SARS-CoV-2 viruses and with pseudo-typed viruses expressing SARS-CoV-2 spike proteins. All oral epithelial cells expressing undetectable or low levels of human angiotensin-converting enzyme 2 (hACE2) but high levels of the alternative receptor CD147 were susceptible to SARS-CoV-2 infection. Distinct viral dynamics were seen in hTERT TIGKs compared to A-253 and TR146 cells. For example, levels of viral transcripts were sustained in hTERT TIGKs but were significantly decreased in A-253 and TR146 cells on day 3 after infection. Analysis of oral epithelial cells infected by replication-competent SARS-CoV-2 viruses expressing GFP showed that the GFP signal and SARS-CoV-2 mRNAs were not evenly distributed. Furthermore, we found cumulative SARS-CoV-2 RNAs from released viruses in the media from oral epithelial cells on day 1 and day 2 after infection, indicating productive viral infection. Taken together, our results demonstrated that oral epithelial cells were susceptible to SARS-CoV-2 viruses despite low or undetectable levels of hACE2, suggesting that alternative receptors contribute to SARS-CoV-2 infection and may be considered for the development of future vaccines and therapeutics.
Collapse
Affiliation(s)
- Laith Ebraham
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
| | - Chuan Xu
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
| | - Annie Wang
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
| | - Cyril Hernandez
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
| | - Nicholas Siclari
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
| | - Divino Rajah
- Global Technology Center, Colgate-Palmolive Company, Piscataway, NJ 08855, USA
| | - Lewins Walter
- Global Technology Center, Colgate-Palmolive Company, Piscataway, NJ 08855, USA
| | - Salvatore A E Marras
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
- Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
| | - Sanjay Tyagi
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
| | - Daniel H Fine
- Department of Oral Biology, School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
| | - Carlo Amorin Daep
- Global Technology Center, Colgate-Palmolive Company, Piscataway, NJ 08855, USA
| | - Theresa L Chang
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
- Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07103, USA
| |
Collapse
|
8
|
Ting M, Dahlkemper A, Schwartz JJ, Woodfork M, Suzuki JB. Preprocedural Viral Load Effects of Oral Antiseptics on SARS-CoV-2 in Patients with COVID-19: A Systematic Review. Biomedicines 2023; 11:1694. [PMID: 37371789 DOI: 10.3390/biomedicines11061694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
(1) There are limited clinical trials to support the effectiveness of mouth rinses when used as a preprocedural rinse against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This systematic review aims to evaluate the efficacy of antiseptic mouth rinses as a preprocedural rinse in reducing SARS-CoV-2 oral viral load in-vivo. (2) Methods: A literature search was conducted through November 2022 for the following databases: PubMed, Web of Science, Cochrane Library, and Google Scholar. The evaluated outcomes were quantitative changes in viral load and the statistical significance of that change after using antiseptic mouth rinses. (3) Results: 14 randomized controlled trials (RCT) were selected for risk of bias assessment and data extraction. (4) Conclusion: Within the limits of this systematic review, preprocedural mouth rinses may significantly reduce SARS-CoV-2 in the mouth, thus, reducing the viral particles available for airborne dispersion. Preprocedural mouth rinses may be an effective strategy for reducing airborne SARS-CoV-2 dispersion in the environment. Their use may be a preventive strategy to reduce the spread of COVID-19 in selected medical and healthcare facilities, including dental clinics. Potential preprocedural mouth rinses are identified for use as an integral part of safe practice for healthcare protocols. This systematic review was registered with the National Institute for Health Research, international prospective register of systematic reviews (PROSPERO): CRD42022315177.
Collapse
Affiliation(s)
- Miriam Ting
- Department of Periodontics, University of Pennsylvania, Philadelphia, PA 19104, USA
- General Practice Residency, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
- Think Dental Learning Institute, Paoli, PA 19301, USA
| | - Alex Dahlkemper
- General Practice Residency, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Jeremy J Schwartz
- General Practice Residency, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Manzel Woodfork
- General Practice Residency, Albert Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Jon B Suzuki
- Department of Graduate Periodontics, University of Maryland, Baltimore, MD 21201, USA
- Department of Graduate Prosthodontics, University of Washington, Seattle, WA 98015, USA
- Department of Graduate Periodontics, Nova Southeastern University, Ft. Lauderdale, FL 33314, USA
| |
Collapse
|
9
|
Van der Weijden F. Aerosol in the oral health-care setting: a misty topic. Clin Oral Investig 2023:10.1007/s00784-023-05034-x. [PMID: 37162570 PMCID: PMC10170433 DOI: 10.1007/s00784-023-05034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/18/2023] [Indexed: 05/11/2023]
Abstract
Studies have shown that mouth and respiratory tract microorganisms can be transported in aerosol and spatter. Due to aerosol-generating procedures, there are potentially various infection risks for patients and those working in health care, especially in oral health care. Dental aerosol can contaminate not only the mucous membranes of the oral health-care professional's mouth, respiratory passages, and eyes but also exposed surfaces and materials in the environment. As such, preventing disease transmission within oral health-care offices is important issue. Since the start of the COVID-19 pandemic, an innumerable amount of (mis)information and advice on how to stay safe and prevent the spread of coronavirus has been published. What preventive measures can and have been taken to counteract this, and what have we learned during the pandemic? This review summarizes relevant literature that has addressed the presence and dispersal of aerosol and spatter as a concern in health care. It includes the sources of dental aerosol, their potential health threats, and strategies for controlling and mitigating their impact. It shows that further research is needed to better understand the potential health risks of dental aerosol and to develop effective strategies for mitigating them. CLINICAL RELEVANCE: Using personal protective equipment, high-volume evacuation systems and pre-procedural antimicrobial agents can help to reduce the potential for infection in oral health-care settings and protect the well-being of oral health-care workers and their patients.
Collapse
Affiliation(s)
- Fridus Van der Weijden
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
| |
Collapse
|
10
|
Sánchez Barrueco A, Mateos-Moreno MV, Villacampa Aubá JM, Campos González A, Bogoya Castaño A, Rubio Yanguas R, Blanco Goñi A, Zapardiel Ferrero J, Cenjor Español C, Ausina Márquez V, García-Esteban S, Artacho A, López Labrador FX, Mira A, Ferrer MD. In vivo effect of mouthwashes on viable viral load of SARS-CoV-2 in saliva: a pilot study. J Oral Microbiol 2023; 15:2198432. [PMID: 37063978 PMCID: PMC10101681 DOI: 10.1080/20002297.2023.2198432] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Current data on the efficacy of antiseptic mouthwashes to reduce viral load are contradictory. Firstly, in vitro data indicate very strong virucidal effects that are not replicated in clinical studies. Secondly, most clinical studies identify a limited effect, do not include a control/placebo group, or do not evaluate viral viability in an infection model. In the current manuscript, we perform a double-blind, randomized clinical trial where salivary viral load was measured before and after the mouthwash, and where saliva samples were also cultured in an in vitro infection model of SARS-CoV-2 to evaluate the effect of mouthwashes on viral viability. Our data show a 90-99% reduction in SARS-CoV-2 salivary copies with one of the tested mouthwashes, although we show that the remaining viruses are mostly viable. In addition, our data suggest that the active ingredient concentration and the overall excipients' formulation can play an important role; and most importantly, they indicate that the effect is not immediate, being significant at 15 min and having maximum effectiveness after 1 h. Thus, we show that some oral mouthwashes can be useful in reducing viral transmission, although their efficacy must be improved through refined formulations or revised protocols.
Collapse
Affiliation(s)
- Alvaro Sánchez Barrueco
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- ENT and Cervicofacial Surgery Department, Villalba General University Hospital, Collado Villalba, Spain
| | | | | | - Alfonso Campos González
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- ENT and Cervicofacial Surgery Department, Villalba General University Hospital, Collado Villalba, Spain
| | - Abel Bogoya Castaño
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Raúl Rubio Yanguas
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Asier Blanco Goñi
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Javier Zapardiel Ferrero
- Microbiology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Microbiology Department, Villalba General University Hospital, Collado Villalba, Spain
| | - Carlos Cenjor Español
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | | | - Alejandro Artacho
- Genomics & Health Department, FISABIO-Public Health Foundation, Valencia, Spain
| | - F. Xavier López Labrador
- Genomics & Health Department, FISABIO-Public Health Foundation, Valencia, Spain
- Department of Microbiology and Ecology, Medical School, University of Valencia, Valencia, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Alex Mira
- Genomics & Health Department, FISABIO-Public Health Foundation, Valencia, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- CONTACT Alex Mira Genomics & Health Department, FISABIO-Public Health Foundation, Valencia, Spain
| | - María D. Ferrer
- Genomics & Health Department, FISABIO-Public Health Foundation, Valencia, Spain
- María D. Ferrer Genomics & Health Department, FISABIO-Public Health Foundation, Valencia, Spain
| |
Collapse
|
11
|
Lim NA, Teng O, Ng CYH, Bao LXY, Tambyah PA, Quek AML, Seet RCS. Repurposing povidone-iodine to reduce the risk of SARS-CoV-2 infection and transmission: a narrative review. Ann Med 2022; 54:1488-1499. [PMID: 35594333 PMCID: PMC9132411 DOI: 10.1080/07853890.2022.2076902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/22/2022] [Accepted: 05/08/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Accumulating data suggest antiviral effects of povidone-iodine against the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. This narrative review aims to examine the antiviral mechanisms of povidone-iodine, efficacy of povidone-iodine against the SARS-CoV-2 virus, and safety of povidone-iodine to human epithelial cells and thyroid function. METHODS We searched the electronic databases PubMed, Embase, Cochrane Library, ClinicalTrials.gov and World Health Organization's International Clinical Trials Registry Platform for articles containing the keywords "povidone-iodine", "SARS-CoV-2" and "COVID-19" from database inception till 3 June 2021. RESULTS Despite in vitro data supporting the anti-SARS-CoV-2 effects of povidone-iodine, findings from clinical studies revealed differences in treatment response depending on study settings (healthy vs. hospitalized individuals), treatment target (nasal vs. oral vs. pharynx), method of administration (oral rinse vs. gargle vs. throat spray) and choice of samples used to measure study endpoints (nasopharyngeal vs. saliva). One large-scale clinical trial demonstrated reduction in the incidence of SARS-CoV-2 infection among participants who administered povidone-iodine 3 times daily during an active outbreak. Povidone-iodine is also used to disinfect the oro-pharyngeal space prior to dental or otolaryngology procedures. Although existing data suggest minimal impact of povidone-iodine on thyroid function, high-quality safety data are presently lacking. CONCLUSIONS Povidone-iodine application to the oropharyngeal space could complement existing non-pharmacological interventions to reduce SARS-CoV-2 infection especially in high exposure settings.Key messagesAccumulating data suggest antiviral effects of povidone-iodine against the SARS-CoV-2 virus.Findings from clinical studies reveal differences in treatment response depending on study settings, treatment target, method of administration and choice of samples used to measure study endpoints. One large-scale clinical trial observed reduction in the incidence of SARS-CoV-2 infection among participants who administered povidone-iodine 3 times daily during an active outbreak.Povidone-iodine application to the oropharyngeal space could complement existing non-pharmacological interventions to reduce SARS-CoV-2 infection especially in high exposure settings.
Collapse
Affiliation(s)
- Nicole-Ann Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ooiean Teng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chester Yan Hao Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lena X. Y. Bao
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Paul Anantharajah Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amy M. L. Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Raymond C. S. Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
12
|
Buonavoglia A, Camero M, Lanave G, Catella C, Trombetta CM, Gandolfi MG, Palazzo G, Martella V, Prati C. Virucidal activity in vitro of mouthwashes against a feline coronavirus type II. Oral Dis 2022; 28 Suppl 2:2492-2499. [PMID: 34739171 PMCID: PMC9788155 DOI: 10.1111/odi.14067] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/12/2021] [Accepted: 11/01/2021] [Indexed: 12/30/2022]
Abstract
Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can occur through saliva and aerosol droplets deriving from the upper aerodigestive tract during coughing, sneezing, talking, and even during oral inspection or dental procedures. The aim of this study was to assess in vitro virucidal activity of commercial and experimental mouthwashes against a feline coronavirus (FCoV) strain. Commercial and experimental (commercial-based products with addition of either sodium dodecyl sulfate (SDS) or thymus vulgaris essential oil (TEO) at different concentrations) mouthwashes were placed in contact with FCoV for different time intervals, that is, 30 s (T30), 60 s (T60), and 180 s (T180); subsequently, the virus was titrated on Crandell Reese Feline Kidney cells. An SDS-based commercial mouthwash reduced the viral load by 5 log10 tissue culture infectious dose (TCID)50 /50 µl at T30 while a cetylpyridinium (CPC)-based commercial mouthwash was able to reduce the viral titer of 4.75 log10 at T60. Furthermore, five experimental mouthwashes supplemented with SDS reduced the viral titer by 4.75-5 log10 according to a dose- (up to 4 mM) and time-dependent fashion.
Collapse
Affiliation(s)
- Alessio Buonavoglia
- Dental SchoolDepartment of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| | - Michele Camero
- Department of Veterinary MedicineUniversity of BariValenzanoItaly
| | - Gianvito Lanave
- Department of Veterinary MedicineUniversity of BariValenzanoItaly
| | | | | | - Maria Giovanna Gandolfi
- Dental SchoolDepartment of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| | - Gerardo Palazzo
- Department of Chemistry, and CSGI (Center for Colloid and Surface Science)University of BariBariItaly
| | - Vito Martella
- Department of Veterinary MedicineUniversity of BariValenzanoItaly
| | - Carlo Prati
- Dental SchoolDepartment of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
| |
Collapse
|
13
|
Cimolai N. Disinfection and decontamination in the context of SARS-CoV-2-specific data. J Med Virol 2022; 94:4654-4668. [PMID: 35758523 PMCID: PMC9350315 DOI: 10.1002/jmv.27959] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/13/2022] [Accepted: 06/24/2022] [Indexed: 11/08/2022]
Abstract
Given the high transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as witnessed early in the coronavirus disease 2019 (COVID-19) pandemic, concerns arose with the existing methods for virus disinfection and decontamination. The need for SARS-CoV-2-specific data stimulated considerable research in this regard. Overall, SARS-CoV-2 is practically and equally susceptible to approaches for disinfection and decontamination that have been previously found for other human or animal coronaviruses. The latter have included techniques utilizing temperature modulation, pH extremes, irradiation, and chemical treatments. These physicochemical methods are a necessary adjunct to other prevention strategies, given the environmental and patient surface ubiquity of the virus. Classic studies of disinfection have also allowed for extrapolation to the eradication of the virus on human mucosal surfaces by some chemical means. Despite considerable laboratory study, practical field assessments are generally lacking and need to be encouraged to confirm the correlation of interventions with viral eradication and infection prevention. Transparency in the constitution and use of any method or chemical is also essential to furthering practical applications.
Collapse
Affiliation(s)
- Nevio Cimolai
- Department of Pathology and Laboratory Medicine, Faculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Pathology and Laboratory MedicineChildren's and Women's Health Centre of British ColumbiaVancouverBritish ColumbiaCanada
| |
Collapse
|
14
|
Idrees M, McGowan B, Fawzy A, Abuderman AA, Balasubramaniam R, Kujan O. Efficacy of Mouth Rinses and Nasal Spray in the Inactivation of SARS-CoV-2: A Systematic Review and Meta-Analysis of In Vitro and In Vivo Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912148. [PMID: 36231450 PMCID: PMC9566636 DOI: 10.3390/ijerph191912148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 05/14/2023]
Abstract
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is a global and evolving pandemic associated with heavy health and financial burdens. Considering the oral cavity as the major reservoir for SARS-CoV-2, a systematic review and meta-analysis were conducted to assess the efficacy of mouth rinses and nasal sprays in reducing the salivary viral load of SARS-CoV-2. All in vivo and in vitro studies that assessed the virucidal efficacy of mouth rinses and nasal sprays against SARS-CoV-2 and were published in the English language from December 2019 to April 2022 were considered for analyses. Special Medical Subject Headings terms were used to search Pubmed, Scopus, Embase Ovid, and Web of Science databases. The toxicological data reliability assessment tool (ToxRToool) was used to assess the quality of the included studies. Thirty-three studies (11 in vivo and 22 in vitro) were deemed eligible for inclusion in this analysis. Results of the pooled data showed that povidone-iodine is the most efficacious intervention in vivo in terms of reducing the SARS-CoV-2 salivary viral load, followed by chlorhexidine. The mean difference in the viral load was 86% and 72%, respectively. Similarly, povidone-iodine was associated with the highest log10 reduction value (LRV) in vitro, followed by cetylpyridinium chloride, (LRV = 2.938 (p < 0.0005) and LRV = 2.907 (p = 0.009), respectively). Povidone-iodine-based oral and nasal preparations showed favourable results in terms of reducing SARS-CoV-2 viral loads both in vivo and in vitro. Considering the limited number of patients in vivo, further studies among larger cohorts are recommended.
Collapse
Affiliation(s)
- Majdy Idrees
- UWA Dental School, The University of Western Australia, Nedlands, WA 6009, Australia
| | | | - Amr Fawzy
- UWA Dental School, The University of Western Australia, Nedlands, WA 6009, Australia
| | | | | | - Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, WA 6009, Australia
- Correspondence:
| |
Collapse
|
15
|
Gutierrez-Camacho JR, Avila-Carrasco L, Martinez-Vazquez MC, Garza-Veloz I, Zorrilla-Alfaro SM, Gutierrez-Camacho V, Martinez-Fierro ML. Oral Lesions Associated with COVID-19 and the Participation of the Buccal Cavity as a Key Player for Establishment of Immunity against SARS-CoV-2. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11383. [PMID: 36141654 PMCID: PMC9517300 DOI: 10.3390/ijerph191811383] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Some oral lesions have been described in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); the possibility has been raised that the buccal lesions observed in patients with the coronavirus disease 2019 (COVID-19) are due to this virus and the patient's systemic condition. The aim of this review was to integrate the knowledge related to the oral lesions associated with COVID-19 and the participation of the buccal cavity in the establishment of immunity against SARS-CoV-2. METHODS A literature search on the manifestations of buccal lesions from the beginning of the pandemic until October 2021 was carried out by using the PubMed database. A total of 157 scientific articles were selected from the library, which included case reports and reports of lesions appearing in patients with COVID-19. RESULTS Oral lesions included erosions, ulcers, vesicles, pustules, plaques, depapillated tongue, and pigmentations, among others. The oral cavity is a conducive environment for the interaction of SARS-CoV-2 with the mucosal immune system and target cells; direct effects of the virus in this cavity worsen the antiviral inflammatory response of underlying oral disorders, immunodeficiencies, and autoimmunity primarily. CONCLUSIONS The oral cavity is an accessible and privileged environment for the interaction of SARS-CoV-2 with the mucosal immune system and target cells; the direct effects of the virus in this cavity worsen the antiviral inflammatory response of underlying oral disorders, in particular those related to immunodeficiencies and autoimmunity.
Collapse
|
16
|
Oral Antiseptics against SARS-CoV-2: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148768. [PMID: 35886619 PMCID: PMC9316971 DOI: 10.3390/ijerph19148768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/04/2022]
Abstract
Dentists are health care workers with the highest risk of exposure to COVID-19, because the oral cavity is considered to be a reservoir for SARS-CoV-2 transmission. The identification of SARS-CoV-2 in saliva, the generation of aerosols, and the proximity to patients during dental procedures are conditions that have led to these health care workers implementing additional disinfection strategies for their protection. Oral antiseptics are widely used chemical substances due to their ability to reduce the number of microorganisms. Although there is still no evidence that they can prevent the transmission of SARS-CoV-2, some preoperative oral antiseptics have been recommended as control measures, by different health institutions worldwide, to reduce the number of microorganisms in aerosols and droplets during dental procedures. Therefore, this review presents the current recommendations for the use of oral antiseptics against SARS-CoV-2 and analyzes the different oral antiseptic options used in dentistry.
Collapse
|
17
|
Kramer A, Eggers M, Exner M, Hübner NO, Simon A, Steinmann E, Walger P, Zwicker P. Recommendation of the German Society of Hospital Hygiene (DGKH): Prevention of COVID-19 by virucidal gargling and virucidal nasal spray - updated version April 2022. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc13. [PMID: 35909651 PMCID: PMC9285112 DOI: 10.3205/dgkh000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The German Society of Hospital Hygiene develops guidelines, recommendations and standard operation procedures on a voluntary basis, published on the DGKH-website (https://www.krankenhaushygiene.de/). The original German version of this recommendation was published in April 2022 and has now been made available to the international professional public in English. Evaluating the current data on the efficacy of virucidal gargle/mouthwash solutions and nasal sprays against SARS-CoV-2 in vitro and in clinical trials, conducted with preventive or therapeutic objectives, recommendations are given for the prevention of COVID-19. The following areas are considered: Protection of the community when regional clusters or high incidences of infection become knownProtection of the community at low risk of infectionPre-exposure prophylaxis for the protection of healthcare workersPost-exposure prophylaxis.
Collapse
Affiliation(s)
- Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany,German Society of Hospital Hygiene, Berlin, Germany,*To whom correspondence should be addressed: Axel Kramer, , E-mail:
| | - Maren Eggers
- Labor Prof. Gisela Enders MVZ GbR, Stuttgart, Germany
| | - Martin Exner
- German Society of Hospital Hygiene, Berlin, Germany,Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Nils-Olaf Hübner
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany,German Society of Hospital Hygiene, Berlin, Germany,Central Unit for Infection Prevention and Control, University Medicine Greifswald, Greifswald, Germany
| | - Arne Simon
- Pediatric Oncology and Hematology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Eike Steinmann
- Institute of Hygiene and Microbiology, Department for Molecular & Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - Peter Walger
- German Society of Hospital Hygiene, Berlin, Germany,Bonn, Germany
| | - Paula Zwicker
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany,Section Clinical Antisepsis of the German Society of Hospital Hygiene, Berlin, Germany
| |
Collapse
|
18
|
Barrueco ÁS, Mateos-Moreno MV, Martínez-Beneyto Y, García-Vázquez E, González AC, Ferrero JZ, Castaño AB, Rueda IA, Villacampa Aubá JM, Español CC, Moreno-Parrado L, Ausina-Márquez V, García-Esteban S, Artacho A, Xavier López-Labrador F, Mira A, Ferrer MD. Effect of Oral Antiseptics in Reducing SARS-CoV-2 Infectivity: Evidence from a Randomized Double-blind Clinical Trial. Emerg Microbes Infect 2022; 11:1833-1842. [PMID: 35796097 PMCID: PMC9336498 DOI: 10.1080/22221751.2022.2098059] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: In vitro studies have shown that several oral antiseptics have virucidal activity against SARS-CoV-2. Thus, mouthwashes have been proposed as an easy to implement strategy to reduce viral transmission. However, there are no data measuring SARS-CoV-2 viability after mouthwashes in vivo. Methods: In this randomized double-blind, five-parallel-group, placebo-controlled clinical trial, SARS-CoV-2 salivary viral load (by quantitative PCR) and its infectious capacity (incubating saliva in cell cultures) have been evaluated before and after four different antiseptic mouthwashes and placebo in 54 COVID-19 patients. Results: Contrary to in vitro evidence, salivary viral load was not affected by any of the four tested mouthwashes. Viral culture indicated that cetylpyridinium chloride (CPC) significantly reduced viral infectivity, but only at 1-hour post-mouthwash. Conclusion: These results indicate that some of the mouthwashes currently used to reduce viral infectivity are not efficient in vivo and, furthermore, that this effect is not immediate, generating a false sense of security. Trial registration:ClinicalTrials.gov identifier: NCT04707742..
Collapse
Affiliation(s)
- Álvaro Sánchez Barrueco
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, Madrid (Spain).,ENT and Cervicofacial Surgery Department, Villalba General University Hospital, Collado Villalba (Spain)
| | | | - Yolanda Martínez-Beneyto
- Department of Dermatology, Stomatology and Radiology. University of Murcia (SPAIN), Murcian Institute of Biosanitary Research (IMIB), Murcia (SPAIN)
| | - Elisa García-Vázquez
- Infectious Diseases Unit, Virgen de la Arrixaca University Clinical Hospital, IMIB, Murcia (Spain)
| | - Alfonso Campos González
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, Madrid (Spain)
| | - Javier Zapardiel Ferrero
- Microbiology Department. Fundación Jiménez Díaz University Hospital, Madrid (Spain); and Villalba General University Hospital, Collado Villalba (Spain)
| | - Abel Bogoya Castaño
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, Madrid (Spain)
| | - Ignacio Alcalá Rueda
- ENT and Cervicofacial Surgery Department, Villalba General University Hospital, Collado Villalba (Spain)
| | | | - Carlos Cenjor Español
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, Madrid (Spain)
| | - Laura Moreno-Parrado
- Microbiology Service. Murcian Institute of Biosanitary Research. Virgen de la Arrixaca University Clinical Hospital, Murcia (Spain)
| | | | | | - Alejandro Artacho
- Genomics & Health Department, FISABIO-Public Health Foundation, Valencia (Spain)
| | - F Xavier López-Labrador
- Genomics & Health Department, FISABIO-Public Health Foundation, Valencia (Spain).,Department of Microbiology and Ecology, Medical School, University of Valencia (Spain).,CIBER in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid (Spain)
| | - Alex Mira
- Genomics & Health Department, FISABIO-Public Health Foundation, Valencia (Spain).,CIBER in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid (Spain)
| | - María D Ferrer
- Genomics & Health Department, FISABIO-Public Health Foundation, Valencia (Spain)
| |
Collapse
|
19
|
Is Lipid Specificity Key to the Potential Antiviral Activity of Mouthwash Reagent Chlorhexidine against SARS-CoV-2? MEMBRANES 2022; 12:membranes12060616. [PMID: 35736323 PMCID: PMC9230368 DOI: 10.3390/membranes12060616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
Abstract
Chlorhexidine (CHX), a popular antibacterial drug, is widely used for oral health. Emerging pieces of evidence suggest that commercially available chlorhexidine mouthwash formulations are effective in suppressing the spread of SARS-CoV-2, possibly through destabilization of the viral lipid envelope. CHX is known for its membrane-active properties; however, the molecular mechanism revealing how it damages the viral lipid envelope is yet to be understood. Here we used extensive conventional and umbrella sampling simulations to quantify the effects of CHX on model membranes mimicking the composition of the SARS-CoV-2 outer lipid membrane as well as the host plasma membrane. Our results show that the lipid composition and physical properties of the membrane play an important role in binding and insertion, with CHX binding favorably to the viral membrane over the plasma membrane. Among the simulated lipids, CHX preferentially binds to anionic lipids, PS and PI, which are more concentrated in the viral membrane. The deeper and stable binding of CHX to the viral membrane results in more pronounced swelling of the membrane laterally with a thinning of the bilayer. The overall free energies of pore formation are strongly reduced for the viral membrane compared to the plasma membrane; however, CHX has a larger concentration-dependent effect on free energies of pore formation in the plasma membrane than the viral membrane. The results indicate that CHX is less toxic to the human plasma membrane at low concentrations. Our simulations reveal that CHX facilitates pore formation by the combination of thinning the membrane and accumulation at the water defect. This study provides insights into the mechanism underlying the anti-SARS-CoV-2 potency of CHX, supporting its potential for application as an effective and safe oral rinse agent for preventing viral transmission.
Collapse
|
20
|
Tan H, Hu Y, Jadhav P, Tan B, Wang J. Progress and Challenges in Targeting the SARS-CoV-2 Papain-like Protease. J Med Chem 2022; 65:7561-7580. [PMID: 35620927 PMCID: PMC9159073 DOI: 10.1021/acs.jmedchem.2c00303] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Indexed: 01/18/2023]
Abstract
SARS-CoV-2 is the causative agent of the COVID-19 pandemic. The approval of vaccines and small-molecule antivirals is vital in combating the pandemic. The viral polymerase inhibitors remdesivir and molnupiravir and the viral main protease inhibitor nirmatrelvir/ritonavir have been approved by the U.S. FDA. However, the emergence of variants of concern/interest calls for additional antivirals with novel mechanisms of action. The SARS-CoV-2 papain-like protease (PLpro) mediates the cleavage of viral polyprotein and modulates the host's innate immune response upon viral infection, rendering it a promising antiviral drug target. This Perspective highlights major achievements in structure-based design and high-throughput screening of SARS-CoV-2 PLpro inhibitors since the beginning of the pandemic. Encouraging progress includes the design of non-covalent PLpro inhibitors with favorable pharmacokinetic properties and the first-in-class covalent PLpro inhibitors. In addition, we offer our opinion on the knowledge gaps that need to be filled to advance PLpro inhibitors to the clinic.
Collapse
Affiliation(s)
- Haozhou Tan
- Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Rutgers, the State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Yanmei Hu
- Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Rutgers, the State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Prakash Jadhav
- Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Rutgers, the State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Bin Tan
- Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Rutgers, the State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Jun Wang
- Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Rutgers, the State University of New Jersey, Piscataway, New Jersey 08854, United States
| |
Collapse
|
21
|
Takenaka S, Sotozono M, Ohkura N, Noiri Y. Evidence on the Use of Mouthwash for the Control of Supragingival Biofilm and Its Potential Adverse Effects. Antibiotics (Basel) 2022; 11:727. [PMID: 35740134 PMCID: PMC9219991 DOI: 10.3390/antibiotics11060727] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 12/14/2022] Open
Abstract
Antimicrobial mouthwash improves supragingival biofilm control when used in conjunction with mechanical removal as part of an oral hygiene routine. Mouthwash is intended to suppress bacterial adhesion during biofilm formation processes and is not aimed at mature biofilms. The most common evidence-based effects of mouthwash on the subgingival biofilm include the inhibition of biofilm accumulation and its anti-gingivitis property, followed by its cariostatic activities. There has been no significant change in the strength of the evidence over the last decade. A strategy for biofilm control that relies on the elimination of bacteria may cause a variety of side effects. The exposure of mature oral biofilms to mouthwash is associated with several possible adverse reactions, such as the emergence of resistant strains, the effects of the residual structure, enhanced pathogenicity following retarded penetration, and ecological changes to the microbiota. These concerns require further elucidation. This review aims to reconfirm the intended effects of mouthwash on oral biofilm control by summarizing systematic reviews from the last decade and to discuss the limitations of mouthwash and potential adverse reactions to its use. In the future, the strategy for oral biofilm control may shift to reducing the biofilm by detaching it or modulating its quality, rather than eliminating it, to preserve the benefits of the normal resident oral microflora.
Collapse
Affiliation(s)
- Shoji Takenaka
- Division of Cariology, Operative Dentistry and Endodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (M.S.); (N.O.); (Y.N.)
| | | | | | | |
Collapse
|
22
|
Buonavoglia A, Lanave G, Marchi S, Lorusso P, Montomoli E, Martella V, Camero M, Prati C, Trombetta CM. In vitro
virucidal activity of mouthwashes on SARS‐CoV‐2. Oral Dis 2022; 28 Suppl 2:2509-2515. [PMID: 35398970 PMCID: PMC9115502 DOI: 10.1111/odi.14205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
Objectives Materials and Methods Results Conclusions
Collapse
Affiliation(s)
- Alessio Buonavoglia
- Dental School Department of Biomedical and Neuromotor Sciences University of Bologna 40126 Bologna Italy
| | - Gianvito Lanave
- Department of Veterinary Medicine University of Bari 70010 Valenzano Italy
| | - Serena Marchi
- Department of Molecular and Developmental Medicine University of Siena 53100 Siena Italy
| | - Pantaleo Lorusso
- Section of Anesthesia and Intensive Care Department of Emergency and Organ Transplantation Aldo Moro University of Bari 70121 Bari Italy
| | - Emanuele Montomoli
- Department of Molecular and Developmental Medicine University of Siena 53100 Siena Italy
- VisMederi srl 53100 Siena Italy
- VisMederi Research srl 53100 Siena Italy
| | - Vito Martella
- Department of Veterinary Medicine University of Bari 70010 Valenzano Italy
| | - Michele Camero
- Department of Veterinary Medicine University of Bari 70010 Valenzano Italy
| | - Carlo Prati
- Dental School Department of Biomedical and Neuromotor Sciences University of Bologna 40126 Bologna Italy
| | | |
Collapse
|
23
|
Xu C, Wang A, Honnen W, Pinter A, Weston WK, Harness JA, Narayanan A, Chang TL. Brilacidin, a Non-Peptide Defensin-Mimetic Molecule, Inhibits SARS-CoV-2 Infection by Blocking Viral Entry. EC MICROBIOLOGY 2022; 18:1-12. [PMID: 35695877 PMCID: PMC9186380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Brilacidin (PMX-30063), a non-peptide defensin-mimetic small molecule, inhibits SARS-CoV-2 viral infection but the anti-viral mechanism is not defined. Here we determined its effect on the specific step of the viral life cycle. Brilacidin blocked SARS-CoV-2 infection but had no effect after viral entry. Brilacidin inhibited pseudotyped SARS-CoV-2 viruses expressing spike proteins from the P.1 Brazil strain and the B.1.1.7 UK strain. Brilacidin affected viral attachment in hACE2-dependent and independent manners depending on the concentrations. The inhibitory effect on viral entry was not mediated through blocking the binding of either the spike receptor-binding domain or the spike S1 protein to hACE2 proteins. Taken together, brilacidin inhibits SARS-CoV-2 infection by blocking viral entry and is active against SARS-CoV-2 variants.
Collapse
Affiliation(s)
- Chuan Xu
- Public Health Research Institute, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ, USA
| | - Annie Wang
- Public Health Research Institute, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ, USA
| | - William Honnen
- Public Health Research Institute, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ, USA
| | - Abraham Pinter
- Public Health Research Institute, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ, USA
| | - Warren K Weston
- Innovation Pharmaceuticals, Inc., Wakefield, Massachusetts, USA
| | - Jane A Harness
- Innovation Pharmaceuticals, Inc., Wakefield, Massachusetts, USA
| | - Aarthi Narayanan
- National Center for Biodefense and Infectious Diseases, George Mason University, Manassas, Virginia, USA
| | - Theresa L Chang
- Public Health Research Institute, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ, USA
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|
24
|
Efficacy of Pre-Procedural Mouthwashes against SARS-CoV-2: A Systematic Review of Randomized Controlled Trials. J Clin Med 2022; 11:jcm11061692. [PMID: 35330016 PMCID: PMC8955331 DOI: 10.3390/jcm11061692] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 01/27/2023] Open
Abstract
The oral mucosa is one of the first sites to be affected by the SARS-CoV-2. For this reason, healthcare providers performing aerosol-generating procedures (AGPs) in the oral cavity are at high risk of infection with COVID-19. The aim of this systematic review is to verify whether there is evidence in the literature describing a decrease in the salivary viral load of SARS-CoV-2 after using different mouthwashes. An electronic search of the MEDLINE database (via PubMed), Web of Science, SCOPUS, and the Cochrane library database was carried out. The criteria used were those described by the PRISMA® Statement. Randomized controlled trial studies that have used mouthwashes as a form of intervention to reduce the viral load in saliva were included. The risk of bias was analyzed using the Joanna Briggs Institute Critical Appraisal Tool. Ultimately, eight articles were included that met the established criteria. Based on the evidence currently available in the literature, PVP-I, CHX and CPC present significant virucidal activity against SARS-CoV-2 in saliva and could be used as pre-procedural mouthwashes to reduce the risk of cross-infection.
Collapse
|
25
|
Garcia-Sanchez A, Peña-Cardelles JF, Salgado-Peralvo AO, Robles F, Ordonez-Fernandez E, Ruiz S, Végh D. Virucidal Activity of Different Mouthwashes against the Salivary Load of SARS-CoV-2: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10030469. [PMID: 35326947 PMCID: PMC8956107 DOI: 10.3390/healthcare10030469] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 12/16/2022] Open
Abstract
The saliva of COVID-19-confirmed patients presents a high viral load of the virus. Aerosols generated during medical and dental procedures can transport the virus and are a possible causative agent of cross-infection. Since the onset of the pandemic, numerous investigations have been attempting to mitigate the risk of transmission by reducing the viral load in saliva using preprocedural mouthwashes. This study aims to review the most up-to-date in vitro and in vivo studies investigating the efficacy of different mouthwashes on reducing the salivary viral load of SARS-CoV-2, giving particular attention to the most recent randomized control trials published.
Collapse
Affiliation(s)
- Alvaro Garcia-Sanchez
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA
- Correspondence: (A.G.-S.); (J.-F.P.-C.)
| | - Juan-Francisco Peña-Cardelles
- Department of Health Sciences, Rey Juan Carlos University, 28040 Madrid, Spain
- Oral and Maxillofacial Surgery Department, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA
- Department of Prosthodontics, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA
- Correspondence: (A.G.-S.); (J.-F.P.-C.)
| | | | - Flor Robles
- Division of General Dentistry, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA; (F.R.); (E.O.-F.); (S.R.)
| | - Esther Ordonez-Fernandez
- Division of General Dentistry, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA; (F.R.); (E.O.-F.); (S.R.)
| | - Steve Ruiz
- Division of General Dentistry, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA; (F.R.); (E.O.-F.); (S.R.)
| | - Dániel Végh
- Department of Prosthodontics, Semmelweis University, 1085 Budapest, Hungary;
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, 8010 Graz, Austria
| |
Collapse
|
26
|
Garcia-Sanchez A, Peña-Cardelles JF, Ordonez-Fernandez E, Montero-Alonso M, Kewalramani N, Salgado-Peralvo AO, Végh D, Gargano A, Parra G, Guerra-Guajardo LI, Kozuma W. Povidone-Iodine as a Pre-Procedural Mouthwash to Reduce the Salivary Viral Load of SARS-CoV-2: A Systematic Review of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2877. [PMID: 35270569 PMCID: PMC8909935 DOI: 10.3390/ijerph19052877] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 12/13/2022]
Abstract
The use of pre-procedural rinses has been investigated to reduce the number of viral particles and bacteria in aerosols, potentially decreasing the risk of cross-infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during medical and dental procedures. This review aims to confirm whether there is evidence in the literature describing a reduction in salivary load of SARS-CoV-2 when povidone-iodine (PVP-I) is used as a pre-intervention mouthwash. An search of the MEDLINE, Embase, SCOPUS, and the Cochrane library databases was conducted. The criteria used followed the PRISMA® Statement guidelines. Randomized controlled trials investigating the reduction of salivary load of SARS-CoV-2 using PVP-I were included. Ultimately, four articles were included that met the established criteria. According to the current evidence, PVP-I is effective against SARS-CoV-2 in saliva and could be implemented as a rinse before interventions to decrease the risk of cross-infection in healthcare settings.
Collapse
Affiliation(s)
- Alvaro Garcia-Sanchez
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA
| | - Juan-Francisco Peña-Cardelles
- Department of Health Sciences, Rey Juan Carlos University, 28040 Madrid, Spain;
- Oral and Maxillofacial Surgery Department, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA
- Department of Prosthodontics, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA;
| | - Esther Ordonez-Fernandez
- Division of General Dentistry, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA; (E.O.-F.); (A.G.); (G.P.); (L.-I.G.-G.)
| | | | - Naresh Kewalramani
- Department of Nursery and Stomatology, Rey Juan Carlos University, 28922 Madrid, Spain;
| | | | - Dániel Végh
- Department of Prosthodontics, Semmelweis University, 1085 Budapest, Hungary;
- Division of Oral Surgery and Orthodontics, Department of Dentistry and Oral Health, Medical University of Graz, 8010 Graz, Austria
| | - Angélica Gargano
- Division of General Dentistry, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA; (E.O.-F.); (A.G.); (G.P.); (L.-I.G.-G.)
| | - Gabriela Parra
- Division of General Dentistry, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA; (E.O.-F.); (A.G.); (G.P.); (L.-I.G.-G.)
| | - Lourdes-Isabela Guerra-Guajardo
- Division of General Dentistry, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA; (E.O.-F.); (A.G.); (G.P.); (L.-I.G.-G.)
| | - Wataru Kozuma
- Department of Prosthodontics, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA;
- Department of Regenerative and Reconstructive Dental Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| |
Collapse
|
27
|
Anderson ER, Patterson EI, Richards S, Pitol AK, Edwards T, Wooding D, Buist K, Green A, Mukherjee S, Hoptroff M, Hughes GL. CPC-containing oral rinses inactivate SARS-CoV-2 variants and are active in the presence of human saliva. J Med Microbiol 2022; 71. [PMID: 35180046 PMCID: PMC8941951 DOI: 10.1099/jmm.0.001508] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction. The importance of human saliva in aerosol-based transmission of SARS-CoV-2 is now widely recognized. However, little is known about the efficacy of virucidal mouthwash formulations against emergent SARS-CoV-2 variants of concern and in the presence of saliva. Hypothesis. Mouthwashes containing virucidal actives will have similar inactivation effects against multiple SARS-CoV-2 variants of concern and will retain efficacy in the presence of human saliva. Aim. To examine in vitro efficacy of mouthwash formulations to inactivate SARS-CoV-2 variants. Methodology. Inactivation of SARS-CoV-2 variants by mouthwash formulations in the presence or absence of human saliva was assayed using ASTM International Standard E1052-20 methodology. Results. Appropriately formulated mouthwashes containing 0.07 % cetylpyridinium chloride but not 0.2 % chlorhexidine completely inactivated SARS-CoV-2 (USA-WA1/2020, Alpha, Beta, Gamma, Delta) up to the limit of detection in suspension assays. Tests using USA-WA1/2020 indicates that efficacy is maintained in the presence of human saliva. Conclusions. Together these data suggest cetylpyridinium chloride-based mouthwashes are effective at inactivating SARS-CoV-2 variants. This indicates potential to reduce viral load in the oral cavity and mitigate transmission via salivary aerosols.
Collapse
Affiliation(s)
- Enyia R Anderson
- Liverpool School of Tropical Medicine, Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool L3 5QA, UK
| | - Edward I Patterson
- Liverpool School of Tropical Medicine, Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool L3 5QA, UK.,Brock University, Department of Biological Sciences, St. Catharines, L2S 3A1, Canada
| | - Siobhan Richards
- Liverpool School of Tropical Medicine, Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool L3 5QA, UK
| | - Ana K Pitol
- Liverpool School of Tropical Medicine, Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool L3 5QA, UK
| | - Thomas Edwards
- Liverpool School of Tropical Medicine, Centre for Drugs and Diagnostics, Liverpool, L3 5QA, UK
| | - Dominic Wooding
- Liverpool School of Tropical Medicine, Centre for Drugs and Diagnostics, Liverpool, L3 5QA, UK
| | - Kate Buist
- Liverpool School of Tropical Medicine, Centre for Drugs and Diagnostics, Liverpool, L3 5QA, UK
| | - Alison Green
- Unilever Research and Development, Port Sunlight CH63 3JW, UK
| | | | | | - Grant L Hughes
- Liverpool School of Tropical Medicine, Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool L3 5QA, UK
| |
Collapse
|
28
|
Lewis DSM, Ho J, Wills S, Kawall A, Sharma A, Chavada K, Ebert MCCJC, Evoli S, Singh A, Rayalam S, Mody V, Taval S. Aloin isoforms (A and B) selectively inhibits proteolytic and deubiquitinating activity of papain like protease (PLpro) of SARS-CoV-2 in vitro. Sci Rep 2022; 12:2145. [PMID: 35140265 PMCID: PMC8828865 DOI: 10.1038/s41598-022-06104-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
The most common host entry point of human adapted coronaviruses (CoV) including SARS-CoV-2 is through the initial colonization in the nostril and mouth region which is responsible for spread of the infection. Most recent studies suggest that the commercially available oral and nasal rinse products are effective in inhibiting the viral replication. However, the anti-viral mechanism of the active ingredients present in the oral rinses have not been studied. In the present study, we have assessed in vitro enzymatic inhibitory activity of active ingredients in the oral mouth rinse products: aloin A and B, chlorhexidine, eucalyptol, hexetidine, menthol, triclosan, methyl salicylate, sodium fluoride and povidone, against two important proteases of SARS-CoV-2 PLpro and 3CLpro. Our results indicate only aloin A and B effectively inhibited proteolytic activity of PLpro with an IC50 of 13.16 and 16.08 μM. Interestingly, neither of the aloin isoforms inhibited 3CLpro enzymatic activity. Computational structural modelling of aloin A and B interaction with PLpro revealed that, both aloin isoforms form hydrogen bond with Tyr268 of PLpro, which is critical for their proteolytic activity. Furthermore, 100 ns molecular dynamics (MD) simulation studies predicted that both aloin isoforms have strong interaction with Glu167, which is required for PLpro deubiquitination activity. Our results from the in vitro deubiquitinase inhibition assay show that aloin A and B isomers exhibit deubiquitination inhibitory activity with an IC50 value of 15.68 and 17.51 µM, respectively. In conclusion, the isoforms of aloin inhibit both proteolytic and the deubiquitinating activity of SARS-CoV-2 PLpro, suggesting potential in inhibiting the replication of SARS-CoV-2 virus.
Collapse
Affiliation(s)
- Devin S M Lewis
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine - Georgia Campus, Room 3031, 625 Old Peachtree Road, Suwanee, GA, 30024, USA
| | - Joanna Ho
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine - Georgia Campus, Room 3031, 625 Old Peachtree Road, Suwanee, GA, 30024, USA
| | - Savannah Wills
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine - Georgia Campus, Room 3031, 625 Old Peachtree Road, Suwanee, GA, 30024, USA
| | - Anasha Kawall
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine - Georgia Campus, Room 3031, 625 Old Peachtree Road, Suwanee, GA, 30024, USA
| | - Avini Sharma
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine - Georgia Campus, Room 3031, 625 Old Peachtree Road, Suwanee, GA, 30024, USA
| | - Krishna Chavada
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine - Georgia Campus, Room 3031, 625 Old Peachtree Road, Suwanee, GA, 30024, USA
| | | | - Stefania Evoli
- Chemical Computing Group, 910-1010 Sherbrooke W, Montreal, QC, H3A 2R7, Canada
| | - Ajay Singh
- Department of Pharmaceutical Sciences, South University, School of Pharmacy, Savannah, GA, USA
| | - Srujana Rayalam
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine - Georgia Campus, Room 3031, 625 Old Peachtree Road, Suwanee, GA, 30024, USA
| | - Vicky Mody
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine - Georgia Campus, Room 3031, 625 Old Peachtree Road, Suwanee, GA, 30024, USA.
| | - Shashidharamurthy Taval
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine - Georgia Campus, Room 3031, 625 Old Peachtree Road, Suwanee, GA, 30024, USA.
| |
Collapse
|
29
|
Mezarina Mendoza JPI, Trelles Ubillús BP, Salcedo Bolívar GT, Castañeda Palacios RDP, Herrera Lopez PSG, Padilla Rodríguez DA, Uchima Koecklin KH. ANTIVIRAL EFFECT OF MOUTHWASHES AGAINST SARS-COV-2: A SYSTEMATIC REVIEW. Saudi Dent J 2022; 34:167-193. [PMID: 35125835 PMCID: PMC8806023 DOI: 10.1016/j.sdentj.2022.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 01/05/2023] Open
Abstract
Objective This systematic review aimed to evaluate the antiviral effect of mouthwashes against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Material and methods An electronic search was performed on PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ProQuest, and Google Scholar, and was complemented by a manual search. Both clinical and in vitro studies that focused on the antiviral effect of mouthwashes against SARS-CoV-2 were included. Risk of bias assessment was performed only on the clinical studies using the RoB-2 and ROBINS-I tools. Results A total of 907 records were found; after initial selection by title and abstract, 33 full-text articles were selected to be evaluated for eligibility. Finally, a total of 27 studies were included for the qualitative synthesis, including 16 in vitro studies and 11 clinical trials. Antiviral effects were evaluated separately for the in vitro and clinical studies. In vitro studies included mouthwashes containing hydrogen peroxide, chlorhexidine digluconate, povidone-iodine, essential oils, cetylpyridinium chloride, and other compounds; in vivo studies included mouthwashes containing hydrogen peroxide, chlorhexidine digluconate, povidone-iodine, cetylpyridinium chloride, essential oils, chlorine dioxide, β-cyclodextrin-citrox, and sorbitol with xylitol. Povidone-iodine, cetylpyridinium chloride, and essential oils were effective in vitro, while hydrogen peroxide, chlorhexidine digluconate, povidone-iodine, cetylpyridinium chloride, β-cyclodextrin-citrox, and sorbitol with xylitol were effective in vivo. Unclear or high risk of bias was found for almost all clinical studies, and only one study presented with a low risk of bias. No further quantitative analysis was performed. Conclusion Although povidone-iodine, cetylpyridinium chloride, and essential oils may be an alternative to reduce the viral load in vitro and in vivo, more studies are needed to determine the real antiviral effect of these different mouthwashes against SARS-CoV-2. This work was not funded. The protocol was registered in PROSPERO (identification number: CRD42021236134).
Collapse
Affiliation(s)
- Jhon Paul Iakov Mezarina Mendoza
- Faculty of Dentistry, National University of San Marcos, Lima, Perú
- Corresponding author at: Faculty of Dentistry, National University of San Marcos, Av. German Amezaga No. 375 – Ciudad Universitaria, Cercado de Lima, Lima, Peru.
| | | | | | | | | | | | | |
Collapse
|
30
|
Lippi G, Nocini R, Henry BM, Plebani M. Virucidal effects of mouthwashes or mouth rinses: a world of caution for molecular detection of SARS-CoV-2 in saliva. Diagnosis (Berl) 2022; 9:285-287. [PMID: 35092657 DOI: 10.1515/dx-2022-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Riccardo Nocini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology-Unit of Otorhinolaryngology, University of Verona, Verona, Italy
| | - Brandon M Henry
- Clinical Laboratory, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Disease Intervention & Prevention and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| |
Collapse
|
31
|
Gao JC, Hood C, Safai B, Marmon S. Evidence for the Use of Mouthwash as a Preprocedural Preventive Measure Against COVID-19: Should We Rinse and Repeat? JAAD Int 2021; 6:109-110. [PMID: 34961850 PMCID: PMC8695191 DOI: 10.1016/j.jdin.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Affiliation(s)
- Jia C Gao
- Department of Dermatology, New York Medical College, Valhalla, New York
| | - Channing Hood
- Department of Dermatology, New York Medical College, Valhalla, New York
| | - Bijan Safai
- Department of Dermatology, New York Medical College, Valhalla, New York
| | - Shoshana Marmon
- Department of Dermatology, New York Medical College, Valhalla, New York.,Department of Dermatology, Coney Island Hospital, Brooklyn, New York.,Department of Dermatology, Cumberland Diagnostic and Treatment Center, Brooklyn, New York
| |
Collapse
|
32
|
Silva A, Azevedo M, Sampaio-Maia B, Sousa-Pinto B. The effect of mouthwashes on SARS-CoV-2 viral load: a systematic review. J Am Dent Assoc 2021; 153:635-648.e16. [PMID: 35287944 PMCID: PMC8716175 DOI: 10.1016/j.adaj.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/17/2021] [Accepted: 12/26/2021] [Indexed: 11/30/2022]
Abstract
Background Considering that the oral cavity is a major entryway and reservoir for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the aim of the authors was to perform a systematic review of in vivo and in vitro studies to assess the effectiveness of mouthrinses on SARS-CoV-2 viral load. Types of Studies Reviewed The authors searched PubMed, Web of Science, Scopus, MedRxiv, and bioRxiv databases, including in vitro and in vivo studies assessing the virucidal effect of mouthrinses on SARS-CoV-2 or surrogates. From a total of 1,622 articles retrieved, the authors included 39 in this systematic review. Results Povidone-iodine was the most studied mouthrinse (14 in vitro and 9 in vivo studies), frequently showing significant reductions in viral load in in vitro assays. Similarly, cetylpyridinium chloride also showed good results, although it was evaluated in fewer studies. Chlorhexidine gluconate and hydrogen peroxide showed conflicting results on SARS-CoV-2 load reduction in both in vitro and in vivo studies. Practical Implications Povidone-iodine–based mouthrinses appear to be the best option as an oral prerinse in the dental context for SARS-CoV-2 viral load reduction. Although the results of primary studies are relevant, there is a need for more in vivo studies on mouthrinses, in particular, randomized controlled clinical trials, to better understand their effect on SARS-CoV-2 viral load and infection prevention.
Collapse
|
33
|
Costa DD, Brites C, Vaz SN, de Santana DS, Dos Santos JN, Cury PR. Chlorhexidine mouthwash reduces the salivary viral load of SARS-CoV-2: A randomized clinical trial. Oral Dis 2021; 28 Suppl 2:2500-2508. [PMID: 34837305 DOI: 10.1111/odi.14086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effect of 0.12% chlorhexidine gluconate on the salivary load of SARS-CoV-2. MATERIALS AND METHODS A randomized, double-blind, placebo-controlled trial was performed on 100 participants positive for SARS-CoV-2. In the test group (n = 50), volunteers gargled with a mouthwash containing 15 ml of 0.12% chlorhexidine gluconate for 1 min, while the control group (n = 50) used a placebo. Saliva samples were obtained before (baseline) and 5 and 60 min after using the solutions. Real-time reverse transcription polymerase chain reaction assays (qRT-PCR) were carried out and the cycle threshold (Ct) was computed. The chi-square test and t-test were used for group comparison (p ≤ 0.05). RESULTS The differences in Ct values between the 5-min evaluation and baseline (test group: 2.19 ± 4.30; control: -0.40 ± 3.87, p = 0.002) and between 60 min and baseline (test group: 2.45 ± 3.88; control: 0.76 ± 4.41, p = 0.05) were significantly greater in the test group, revealing a reduction of viral load. Furthermore, there was a reduction in the load of SARS-CoV-2 in 72% of the volunteers using chlorhexidine versus 30% in the control group (p = 0.001). CONCLUSIONS Chlorhexidine gluconate (0.12%) was effective in reducing salivary SARS-CoV-2 load for at least 60 min.
Collapse
Affiliation(s)
- Denis Damião Costa
- Postgraduate Program in Dentistry and Health, Federal University of Bahia, Salvador, Brazil
| | - Carlos Brites
- Infectious Diseases Research Laboratory, Professor Edgard Santos Hospital, Federal University of Bahia, Salvador, Brazil.,Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | - Sara Nunes Vaz
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | | | - Jean Nunes Dos Santos
- Postgraduate Program in Dentistry and Health, Federal University of Bahia, Salvador, Brazil.,Department of Oral Pathology, School of Dentistry, Federal University of Bahia, Salvador, Brazil
| | - Patricia Ramos Cury
- Postgraduate Program in Dentistry and Health, Federal University of Bahia, Salvador, Brazil.,Department of Periodontology, School of Dentistry, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
34
|
Abstract
This study aimed to systematically review the literature about the virucidal efficacy of CHX in comparison to other substances used in the oral cavity. Electronic searches were performed in four databases (PubMed, Scopus, Embase, and Web of Science). Only studies that presented the following characteristics were included: (1) verified virucidal efficacy of CHX against Herpes Simplex Type-1 (HSV-1), any Influenza, or any human coronavirus (HcoV); and (2) compared the virucidal efficacy of CHX with essential oils (Listerine®), quaternary ammonium compounds, povidone-iodine, hydrogen peroxide, negative control substance, and absence of therapy. Two researchers independently selected the studies, extracted data and evaluated the risk of bias. A narrative data synthesis was used. Twenty-five studies were included, of which 21 were in vitro and four were randomized clinical trials (RCT). Studies assessed the virucidal efficacy of CHX against Herpes Simplex Type-1 (HSV-1) (10 studies), Influenza A (InfluA) (4 studies), human coronavirus (HCoV) (4 studies) and Severe Acute Respiratory Syndrome-Related Coronavirus (SARS-CoV-2) (11 studies). Most studies demonstrated that CHX has a positive virucidal efficacy against HSV-1 and InfluA strains. However, lower efficacy was shown to InfluA strain in comparison to povidone-iodine. Lower to none virucidal efficacy of CHX is expected for HCoV and SARS-CoV-2 strains for in vitro studies. Three RCT demonstrated that CHX was able to significantly reduce the viral load of SARS-CoV-2 for a short period. CHX may present an interesting virucidal efficacy against HSV-1 and InfluA viruses. CHX also presents transient efficacy against SARS-CoV-2 when used as a mouthwash.
Collapse
|
35
|
Shet M, Hong R, Igo D, Cataldo M, Bhaskar S. In Vitro Evaluation of the Virucidal Activity of Different Povidone-Iodine Formulations Against Murine and Human Coronaviruses. Infect Dis Ther 2021; 10:2777-2790. [PMID: 34581973 PMCID: PMC8477977 DOI: 10.1007/s40121-021-00536-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/13/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction Polyvinylpyrrolidone–iodine (PVP-I) demonstrates broad-spectrum anti-infective activity and is available in different formulations for oral rinse and topical use in medical and personal care settings. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has underscored the need to supplement available preventive strategies. Methods We assessed virucidal activity of PVP-I formulations, including 0.5% (w/v) solution, 5.0% (w/v) solution, 7.5% (w/v) scrub, and 10.0% (w/v) solution, versus placebos when challenged with coronaviruses in two in vitro studies. Murine coronavirus strain A59 (American Type Culture Collection [ATCC]® VR-764™), human coronavirus strain OC43 (ZeptoMetrix Corp. #0810024CF), human coronavirus strain NL63 (ZeptoMetrix Corp. #0810228CF), and human coronavirus strain 229E (ATCC® VR-740™) were used as surrogates for SARS-CoV-2. Both studies used the American Society for Testing and Materials in vitro time-kill method. Results All active PVP-I formulations in study 1 demonstrated virucidal activity at 15 s, with mean log10 reduction of greater than 4.56 or greater than 99.99% inactivation; a cytotoxic effect against the National Collection of Type Cultures clone 1469 host cells was observed with 5.0% (w/v) solution, 7.5% (w/v) scrub, and 10.0% (w/v) solution. Active PVP-I formulations in study 2 demonstrated effective virucidal activity against coronaviruses in less than 15 s; log10 reduction in viral titer for each coronavirus strain was consistently higher for 10.0% (w/v) solution and 0.5% (w/v) solution versus 7.5% (w/v) scrub. Conclusion Both studies demonstrated in vitro virucidal activity of PVP-I formulations when challenged with SARS-CoV-2 surrogate coronaviruses. Although promising, further investigations are needed to evaluate SARS-CoV-2 inactivation.
Collapse
Affiliation(s)
- Manjunath Shet
- Imbrium Therapeutics, 201 Tresser Blvd, Stamford, CT, 06901, USA
| | - Rosa Hong
- Avrio Health L.P., 201 Tresser Blvd, Stamford, CT, 06901, USA
| | - David Igo
- Imbrium Therapeutics, 201 Tresser Blvd, Stamford, CT, 06901, USA
| | - Marc Cataldo
- Purdue Pharma L.P., 201 Tresser Blvd, Stamford, CT, 06901, USA.
| | - Sailaja Bhaskar
- Imbrium Therapeutics, 201 Tresser Blvd, Stamford, CT, 06901, USA
| |
Collapse
|
36
|
Estimating salivary carriage of severe acute respiratory syndrome coronavirus 2 in nonsymptomatic people and efficacy of mouthrinse in reducing viral load: A randomized controlled trial. J Am Dent Assoc 2021; 152:903-908. [PMID: 34561086 PMCID: PMC8193024 DOI: 10.1016/j.adaj.2021.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/02/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022]
Abstract
Background Many people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) never develop substantial symptoms. With more than 34 million people in the United States already infected and highly transmissible variants rapidly emerging, it is highly probable that post- and presymptomatic people will form an important fraction of those seeking dental care. Salivary carriage rates in these populations are not known. Moreover, although preventing transmission is critical for controlling spread, the efficacy of mouthrinses in reducing oral viral load is poorly studied. Methods The authors recruited 201 asymptomatic, presymptomatic, postsymptomatic, and symptomatic people and measured copy numbers of SARS-CoV-2 in unstimulated saliva using real-time reverse transcriptase quantitative polymerase chain reaction. Subsequently, the authors inducted 41 symptomatic people into a randomized, triple-blinded study and instructed them to rinse with saline, 1% hydrogen peroxide, 0.12% chlorhexidine, or 0.5% povidone-iodine for 60 seconds. The authors measured viral load 15 and 45 minutes after rinsing. Results Salivary SARS-CoV-2 was detected in 23% of asymptomatic, 60% of postsymptomatic, and 28% of presymptomatic participants. Neither carriage rate nor viral load correlated with COVID-19 symptomatology, age, sex, or race or ethnicity. All 4 mouthrinses decreased viral load by 61% through 89% at 15 minutes and by 70% through 97% at 45 minutes. The extent of reduction correlated significantly with initial viral load. Conclusions Nonsymptomatic people can pose a risk of transmitting the virus, and mouthrinses are simple and efficacious means of reducing this risk, especially when the load is less than 104 copies per milliliter. Practical Implications At a time when resources are stretched, the findings of this study contribute to evidence-based selection of personal protection equipment and simple infection-control practices to reduce contagion at source. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT04603794.
Collapse
|
37
|
Human Defensins Inhibit SARS-CoV-2 Infection by Blocking Viral Entry. Viruses 2021; 13:v13071246. [PMID: 34206990 PMCID: PMC8310277 DOI: 10.3390/v13071246] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 12/14/2022] Open
Abstract
Innate immunity during acute infection plays a critical role in the disease severity of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and is likely to contribute to COVID-19 disease outcomes. Defensins are highly abundant innate immune factors in neutrophils and epithelial cells, including intestinal Paneth cells, and exhibit antimicrobial and immune-modulatory activities. In this study, we investigated the effects of human α- and β-defensins and RC101, a θ-defensin analog, on SARS-CoV-2 infection. We found that human neutrophil peptides (HNPs) 1-3, human defensin (HD) 5 and RC101 exhibited potent antiviral activity against pseudotyped viruses expressing SARS-CoV-2 spike proteins. HNP4 and HD6 had weak anti-SARS-CoV-2 activity, whereas human β-defensins (HBD2, HBD5 and HBD6) had no effect. HNP1, HD5 and RC101 also inhibited infection by replication-competent SARS-CoV-2 viruses and SARS-CoV-2 variants. Pretreatment of cells with HNP1, HD5 or RC101 provided some protection against viral infection. These defensins did not have an effect when provided post-infection, indicating their effect was directed towards viral entry. Indeed, HNP1 inhibited viral fusion but not the binding of the spike receptor-binding domain to hACE2. The anti-SARS-CoV-2 effect of defensins was influenced by the structure of the peptides, as linear unstructured forms of HNP1 and HD5 lost their antiviral function. Pro-HD5, the precursor of HD5, did not block infection by SARS-CoV-2. High virus titers overcame the effect of low levels of HNP1, indicating that defensins act on the virion. HNP1, HD5 and RC101 also blocked viral infection of intestinal and lung epithelial cells. The protective effects of defensins reported here suggest that they may be useful additives to the antivirus arsenal and should be thoroughly studied.
Collapse
|
38
|
Human Immunodeficiency Viruses Pseudotyped with SARS-CoV-2 Spike Proteins Infect a Broad Spectrum of Human Cell Lines through Multiple Entry Mechanisms. Viruses 2021; 13:v13060953. [PMID: 34064066 PMCID: PMC8224355 DOI: 10.3390/v13060953] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 12/19/2022] Open
Abstract
Severe acute respiratory syndrome-related coronavirus (SARS-CoV-2), the causative agent of coronavirus disease 19 (COVID-19), enters cells through attachment to the human angiotensin converting enzyme 2 (hACE2) via the receptor-binding domain (RBD) in the surface/spike (S) protein. Several pseudotyped viruses expressing SARS-CoV-2 S proteins are available, but many of these can only infect hACE2-overexpressing cell lines. Here, we report the use of a simple, two-plasmid, pseudotyped virus system comprising a SARS-CoV-2 spike-expressing plasmid and an HIV vector with or without vpr to investigate the SARS-CoV-2 entry event in various cell lines. When an HIV vector without vpr was used, pseudotyped SARS-CoV-2 viruses produced in the presence of fetal bovine serum (FBS) were able to infect only engineered hACE2-overexpressing cell lines, whereas viruses produced under serum-free conditions were able to infect a broader range of cells, including cells without hACE2 overexpression. When an HIV vector containing vpr was used, pseudotyped viruses were able to infect a broad spectrum of cell types regardless of whether viruses were produced in the presence or absence of FBS. Infection sensitivities of various cell types did not correlate with mRNA abundance of hACE2, TMPRSS2, or TMPRSS4. Pseudotyped SARS-CoV-2 viruses and replication-competent SARS-CoV-2 virus were equally sensitive to neutralization by an anti-spike RBD antibody in cells with high abundance of hACE2. However, the anti-spike RBD antibody did not block pseudotyped viral entry into cell lines with low abundance of hACE2. We further found that CD147 was involved in viral entry in A549 cells with low abundance of hACE2. Thus, our assay is useful for drug and antibody screening as well as for investigating cellular receptors, including hACE2, CD147, and tyrosine-protein kinase receptor UFO (AXL), for the SARS-CoV-2 entry event in various cell lines.
Collapse
|