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Randomized clinical trial to assess the impact of oral intervention with cetylpyridinium chloride to reduce salivary SARS-CoV-2 viral load

Año de publicación: 2022


The World Health Organization (WHO) has declared the outbreak of Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, to be a public health emergency of international concern. Most people affected by this disease have mild symptoms associated with the upper-middle respiratory tract. However, a significant number of individuals experience more severe symptoms associated with the lower respiratory tract, including severe pneumonia with symptoms of hypoxia, acute respiratory distress syndrome, and death. In both cases, the upper respiratory tract plays a fundamental role, as it is the route of entry and initial replication of the virus and the area from which it spreads to the different areas of the body, without forgetting that it constitutes the main source of spread of SARS-CoV-2, prompting person-to-person transmission (Madas et al., 2020; Coleman et al., 2021; Wang et al., 2021). For these reasons, the role the oral cavity plays in SARS-CoV-2 infection has been studied. Two fundamental factors for SARS-CoV-2 infection are the host proteins ACE-2 and TMPRSS2; the tissues that harbour these proteins would more likely be infected. Xu, Li, et al. (2020) and Xu, Zhong, et al. (2020) showed that the levels of ACE-2 expression in the tissues of the oral cavity are elevated, being higher in the lingual region. Moreover, analysis of the co-expression of ACE-2 and TMPRSS2 together via in situ hybridization studies has shown that SARS-CoV-2 has strong tropism for most oral tissues, especially acini and ducts of the minor salivary glands, which could act as true reservoirs of the virus; this explains the contamination of and high viral load in saliva in the vast majority of infected individuals. In their study, Huang et al. (2021) considered the possibility that the mouth may be more important than the nose at the time of infection. Like all coronaviruses, SARS-CoV-2 has a lipid envelope. This membrane contains three structural proteins, namely the spike (S), membrane (M), and envelope (E), which fulfil the fundamental functions for entry of the virus into the cell, for its morphogenesis, and assembly of the viral particle (Hartenian et al., 2020; Satarker & Nampoothiri, 2020). SARS-CoV-2 vaccines are among the main measures to mitigate this pandemic. Designed with different strategies, most of them are directed against the protein S of the virus. Although they reduce the probability of hospitalization and death from COVID-19, this strategy is not totally effective since it does not prevent contagion, its effectiveness decreases over time, and there are considerable concerns regarding its efficacy against future variants of the virus (Bian et al., 2021; Tartof et al., 2021). For these reasons, possible measures that reduce the viral load in the oral cavity could help reduce viral transmission (Burton et al., 2020; Herrera et al., 2020; O'Donnell et al., 2020). One of the molecules that has the greatest evidence of antiviral activity, and which is found in mouthwashes, is cetylpyridinium chloride (CPC; Popkin et al., 2017; Shen et al., 2019). In addition, several in vitro studies have shown that this molecule has strong anti-SARS-CoV-2 activity (Komine et al., 2021; Muñoz-Basagoiti et al., 2021). As described previously, the aim of this study was to determine the effect of CPC on SARS-CoV-2 viral load in the saliva of COVID-19 patients.


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