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Differential Effects of Antiseptic Mouth Rinses on SARS-CoV-2 Infectivity In Vitro

Xu et al., Pathogens, doi:10.3390/pathogens10030272
Mar 2021  
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PVP-I for COVID-19
12th treatment shown to reduce risk in February 2021
*, now known with p = 0.000000004 from 21 studies.
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No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,000+ studies for 60+ treatments.
In Vitro study showing that PVP-I and other mouthwashes inactivated replication-competent SARS-CoV-2.
9 preclinical studies support the efficacy of povidone-iodine for COVID-19:
Xu et al., 1 Mar 2021, peer-reviewed, 7 authors.
In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
This PaperPovidone-Iod..All
Differential Effects of Antiseptic Mouth Rinses on SARS-CoV-2 Infectivity In Vitro
Chuan Xu, Annie Wang, Eileen R Hoskin, Carla Cugini, Kenneth Markowitz, Theresa L Chang, Daniel H Fine
Pathogens, doi:10.3390/pathogens10030272
Severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) is detectable in saliva from asymptomatic individuals, suggesting a potential benefit from the use of mouth rinses to suppress viral load and reduce virus spread. Published studies on the reduction of SARS-CoV-2-induced cytotoxic effects by mouth rinses do not exclude antiseptic mouth rinse-associated cytotoxicity. Here, we determined the effect of commercially available mouth rinses and antiseptic povidone-iodine on the infectivity of replication-competent SARS-CoV-2 viruses and of pseudotyped SARS-CoV-2 viruses. We first determined the effect of mouth rinses on cell viability to ensure that antiviral activity was not a consequence of mouth rinse-induced cytotoxicity. Colgate Peroxyl (hydrogen peroxide) exhibited the most cytotoxicity, followed by povidone-iodine, chlorhexidine gluconate (CHG), and Listerine (essential oils and alcohol). The potent antiviral activities of Colgate Peroxyl mouth rinse and povidone-iodine were the consequence of rinse-mediated cellular damage when the products were present during infection. The potency of CHG was greater when the product was not washed off after virus attachment, suggesting that the prolonged effect of mouth rinses on cells impacts the antiviral outcome. To minimalize mouth rinse-associated cytotoxicity, mouth rinse was largely removed from treated viruses by centrifugation prior to infection of cells. A 5% (v/v) dilution of Colgate Peroxyl or povidone-iodine completely blocked viral infectivity. A similar 5% (v/v) dilution of Listerine or CHG had a moderate suppressive effect on the virus, but a 50% (v/v) dilution of Listerine or CHG blocked viral infectivity completely. Mouth rinses inactivated the virus without prolonged incubation. The new infectivity assay, with limited impacts of mouth rinse-associated cytotoxicity, showed the differential effects of mouth rinses on SARS-CoV-2 infection. Our results indicate that mouth rinses can significantly reduce virus infectivity, suggesting a potential benefit for reducing SARS-CoV-2 spread.
In conclusion, all mouth rinses tested inactivated replication-competent SARS-CoV-2 viruses and pseudotyped viruses expressing spike proteins. The cytotoxic effects of mouth rinses should be considered when assessing their antiviral activities. Since diluted Listerine and CHG exhibited no cytotoxic effects, these products may be good candidates to reduce virus spread. Studies of the antiviral effects of mouth rinses are needed for determining their clinical efficacy in reducing virus spread, particularly in asymptomatic individuals. Supplementary Materials: The following are available online at 7/10/3/272/s1. Figure S1
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