Potential Role of Xylitol Plus Grapefruit Seed Extract Nasal Spray Solution in COVID-19: Case Series
Camille Celeste Go, Krunal Pandav, Marcos A Sanchez-Gonzalez, Gustavo Ferrer
Cureus, doi:10.7759/cureus.11315
The SARS-CoV-2 virus has created an unprecedented impact on healthcare globally. Being a novel virus, several treatments have been explored against COVID-19. During the early stages of the disease, treatment is mainly supportive. While several studies have suggested different treatment modalities, there is still no definitive treatment against COVID-19. Re-purposing already established medications, with excellent safety profiles, is a possible approach for treating the disease in its early stage. Having a mode of transmission as a droplet mode, several studies have supported how the nose can contain the primary route of entry of SARS-CoV-2. Hence, we postulated that re-purposing a commercially available nasal spray containing xylitol and grapefruit seed extract (GSE), namely Xlear Nasal Spray® (Xlear, Inc., American Fork, USA) could be used as an adjunct treatment of COVID-19. With a well-established safety profile, the components of this nasal spray have been studied and have been shown to have potential efficacy against viral pathogens, including coronavirus, and may potentially regulate pathways important in the initial entry of infection, replication, and systemic response to SARS-CoV-2. We present a series of three mild-moderate risks, symptomatic, COVID-19 patients, treated with the intranasal combination, as an adjuvant to their ongoing treatment, with rapid clinical improvement and shorten time to negativization on repeat intranasal swab test via PCR. No safety issues were noted during the course of treatment. Xlear nasal spray, containing xylitol plus GSE, given its established safety profile and compelling clinical results described here, could be a potential adjunct treatment option in mild-moderate COVID-19 cases.
Additional Information Disclosures
References
Bitter, Suter-Zimmermann, Surber, Nasal drug delivery in humans, Curr Probl Dermatol,
doi:10.1159/000321044
Garcia, Schroeter, Segal, Stanek, Foureman et al., Dosimetry of nasal uptake of watersoluble and reactive gases: a first study of interhuman variability, Inhal Toxicol,
doi:10.1080/08958370802320186
Gengler, Wang, Speth, Sedaghat, Sinonasal pathophysiology of SARS-CoV-2 and COVID-19: a systematic review of the current evidence, Laryngoscope Investig Otolaryngol,
doi:10.1002/lio2.384
Helassa, Garnett, Farrant, A novel fluorescent sensor protein for detecting changes in airway surface liquid glucose concentration, Biochem J,
doi:10.1042/BJ20141041
Jia, Look, Shi, ACE2 receptor expression and severe acute respiratory syndrome coronavirus infection depend on differentiation of human airway epithelia, J Virol,
doi:10.1128/JVI.79.23.14614-14621.2005
Komura, Suzuki, Sangsriratanakul, Inhibitory effect of grapefruit seed extract (GSE) on avian pathogens, J Vet Med Sci,
doi:10.1292/jvms.18-0754
Pires, Fortuna, Alves, Falcão, Intranasal drug delivery: how, why and what for?, J Pharm Pharm Sci,
doi:10.18433/j3nc79
Sungnak, Huang, Bécavin, SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes, Nat Med,
doi:10.1038/s41591-020-0868-6
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"unstructured": "Iota-carrageenan and Xylitol inhibit SARS-CoV-2 in cell culture. (2020). Accessed. October 6, 2020: https://www.biorxiv.org/content/10.1101/2020.08.19.225854v1."
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"journal-title": "JAMA",
"key": "ref7",
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"volume": "323",
"year": "2020"
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"volume": "21",
"year": "2009"
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"DOI": "10.2174/156720112803529828",
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"author": "Gizurarson S",
"doi-asserted-by": "publisher",
"journal-title": "Current Drug Delivery",
"key": "ref11",
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"volume": "9",
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"author": "Hou YJ",
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"key": "ref15",
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"volume": "182",
"year": "2020"
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"volume": "79",
"year": "2005"
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"key": "ref17",
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