Potential Role of Oral Rinses Targeting the Viral Lipid Envelope in SARS-CoV-2 Infection

Valerie B O'Donnell, David Thomas, Richard Stanton, Jean-Yves Maillard, Robert C Murphy, Simon A Jones, Ian Humphreys, Michael J O Wakelam, Christopher Fegan, Matt P Wise, Albert Bosch, Syed A Sattar, Valerie B O'Donnell, David Thomas, Richard Stanton, Jean-Yves Maillard, Robert C Murphy, Simon A Jones, Ian Humphreys, Michael J O Wakelam, Christopher Fegan, Matt P Wise, Albert Bosch, Syed A Sattar

Abstract

Emerging studies increasingly demonstrate the importance of the throat and salivary glands as sites of virus replication and transmission in early COVID-19 disease. SARS-CoV-2 is an enveloped virus, characterized by an outer lipid membrane derived from the host cell from which it buds. While it is highly sensitive to agents that disrupt lipid biomembranes, there has been no discussion about the potential role of oral rinsing in preventing transmission. Here, we review known mechanisms of viral lipid membrane disruption by widely available dental mouthwash components that include ethanol, chlorhexidine, cetylpyridinium chloride, hydrogen peroxide, and povidone-iodine. We also assess existing formulations for their potential ability to disrupt the SARS-CoV-2 lipid envelope, based on their concentrations of these agents, and conclude that several deserve clinical evaluation. We highlight that already published research on other enveloped viruses, including coronaviruses, directly supports the idea that oral rinsing should be considered as a potential way to reduce transmission of SARS-CoV-2. Research to test this could include evaluating existing or specifically tailored new formulations in well-designed viral inactivation assays, then in clinical trials. Population-based interventions could be undertaken with available mouthwashes, with active monitoring of outcome to determine efficacy. This is an under-researched area of major clinical need.

Keywords: coronavirus; envelope; lipid; oropharynx; respiratory; virus.

© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physiological Society.

Figures

Figure 1.
Figure 1.
Cartoon Representation of the SARS-CoV-2 Glycoprotein, Embedded in the Viral Envelope, along with Membrane Disrupting Agents. Ribbon diagram was obtained from Wrapp et al., chemical structures were from PubChem (https://pubchem.ncbi.nlm.nih.gov/) and Nieto-Garai et al.

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