Potential Role of Xylitol Plus Grapefruit Seed Extract Nasal Spray Solution in COVID-19: Case Series

Abstract

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.

Naringenin as a Possible Candidate Against SARS-CoV-2 Infection and in the Pathogenesis of COVID-19

“…GSE showed anti-viral activity against enveloped viruses, but not against non-enveloped viruses 208. A study by Go et al showed that GSE plus xylitol as a nasal spray solution, commercially available as Xlear nasal spray, can be used as a potential adjunct treatment of COVID-19 209. In silico analysis showed that several components of grapefruit seed extract, including naringenin, bind with Mpro with a binding affinity of −8.2 kcal/mol 195.…”

Nasally inhaled therapeutics and vaccination for COVID‐19: Developments and challenges

“…There are also other nasal spray formulations for COVID‐19 management and therapeutics that are either before clinical trials or do not have a COVID‐19 (S) protein. These include (1) Xlear nasal spray that contains grapefruit seed extract (GSE) to kill SARS‐CoV‐2 virus and xylitol as a virus decoy, 31 (2) a composite‐based spray that contains algae‐isolated carrageenan and a gellan polysaccharide studied at the University of Birmingham, 32 and (3) an aerosolized formulation termed AeroNabs that contains engineered nanobodies similar to those in llamas and camels to impede spike–ACE2 interactions. 33 …”

Can the Nasal Cavity Help Tackle COVID-19?

“…A newly published case-report series [107] presented three patients with minimalto-moderate risk for morbidity and mortality from COVID-19. The study demonstrated improvement in the symptoms and reduction in the clinical outcome after the use of xylitol and GSE in the form of Xlear nasal spray TM , as an adjunct to their ongoing treatment.…”