Current non-toxic or “Generally Recognized as Safe” (GRAS) countermeasures against viral entry into cells in the human body are often inadequate. The objective of this study was to evaluate ProtecTeaV, a novel alcohol-based instant hand sanitizer formulation containing lipophilic EGCG (derived from green tea extract), in comparison to commonly used hand sanitizers either with or without alcohol. A Standard 50% Tissue Culture Infective Dose (TCID50) assay was used for determination of virucidal capacity against Poliovirus 1 (PV 1). Separately, neutralization by an ultra-filtration method was used to evaluate the mechanism of virucidal capacity. The results demonstrated that ProtecTeaV formulations (with and without gelling agent) reduced the TCID50 by a factor of 6 (mean log10–reduction of viral infectivity), 100-fold more than the reduction of viral infectivity (>4 log10) mandated by internationally accepted standards. In addition, the virucidal effect of ProtecTeaV formulations was associated with direct and irreversible inactivation of PV 1, rather than a reversible inhibition mechanism. In contrast, two commonly used instant hand sanitizers failed to reduce PV 1 viral infectivity by >4 log10. In conclusion, ProtecTeaV instant hand sanitizer formulations containing lipophilic EGCG possess effective virucidal capability with the potential for use in novel disinfectant and antiseptic approaches, pending additional research and development.
Alcohol-based instant sanitizers gained popularity due to their ease-of-use and effectiveness against actively growing bacteria, as well as some viruses [1,2]. They are used routinely in clinics, schools, institutions, families, and on cruise ships for the purpose of prevention of microbial infections. However, current alcohol-based hand sanitizers have some weaknesses regarding the prevention of viral infections, and thus far, an alcohol-based hand sanitizer with persistent virucidal capacity has not been described. Alcohol evaporates in a matter of seconds after each application on the skin or other surfaces, leaving the skin surface unprotected until the next application. For example, although the concept “alcohol-based sanitizer is effective to inactivate influenza virus” has been well-accepted, a recent case-control human study indicates that alcohol-based hand sanitizer is not effective in school-aged children during outbreaks of influenza infection in community settings . This result could be due to the short life of alcohol activity. More importantly, many non-enveloped pathogenic viruses such as norovirus, poliovirus, adenovirus and hepatitis A virus are resistant to alcohol [4-7]. Conliffe et al., reported that three of these - norovirus, rotavirus and adenovirus were responsible for the majority of healthcare-associated viral gastroenteritis cases among children in a large pediatric hospital setting . Gastroenteritis caused by these viruses can be severe and costly to patients and healthcare providers . In the US, norovirus alone is responsible for approximately 20 million acute gastroenteritis cases, 400,000 emergency visits, and 70,000 hospitalizations, with up to 800 deaths annually (US CDC, Norovirus: US Trends and Outbreaks). Another weakness of alcohol-based hand sanitizers is that alcohols do not inactivate bacterial endospores effectively [10,11]. Due to the weak virucidal capacity of alcohols against enteric viruses, and inability to inactivate bacterial spores and hydrophilic (non-enveloped) viruses, the US CDC 2008 Guidelines for Disinfection and Sterilization in Healthcare Facilities removed isopropyl alcohol and ethyl alcohol from the list of high-level disinfectants. In 2011, the CDC updated the guidelines for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings. The new guideline for hand hygiene is: “during outbreaks, use soap and water for hand hygiene after providing care or having contact with patients suspected or confirmed with norovirus gastroenteritis”, because “very low-quality evidence was available to suggest that hand hygiene using alcohol-based hand sanitizers may reduce the likelihood of symptomatic norovirus infection”. In fact, the use of alcohol-based hand sanitizer was found to be a risk factor for norovirus spread vs soap and water wash in long-term care facilities . In a human study, a 30-second incubation with alcohol (3% - 95%) was ineffective in reducing the infectivity of norovirus (genomic copy reduction <0.5 log10); this was less effective than liquid soap or water rinse . Although various chemicals inactivate non-enveloped viruses effectively, they are not feasible for use in hand sanitizers due to toxicity.
In recent years, plant-derived phytochemicals, such as extracts from grape seed, pomegranate, mulberry, cranberry, ginseng, persimmon, green tea and herbal essential oils, have been reported to exert antiviral properties against non-enveloped viruses, including enteric viruses . Epigallocatechin-3-Gallate (EGCG) is the major polyphenol present in green tea leaves and its antiviral activities have been studied extensively. The most suitable derivatives of EGCG for topical applications are lipophilic EGCG compounds due to their global antiviral properties, high potency, persistency, and absence of associated toxicity . Results from a recent phase II clinical trial of the proprietary AverTeaX formula containing lipophilic EGCG for treating herpes labialis demonstrated that topical application of the AverTeaX formula provides high efficacy in treating herpes labialis . Due to its unique antiviral activities, lipophilic EGCG could be used in a novel approach to a new generation of sanitizing products, either with or without alcohol. We hypothesized that lipophilic EGCG in surface-sanitizing formulations would be effective against human pathogenic viruses, with the potential for use as a global virucidal agent to prevent viral infections, particularly from alcohol-resistant non-enveloped viruses.
To test our hypothesis, the current study evaluated two proprietary alcohol-based instant hand sanitizer formulations, ProtecTeaV+cb and ProtecTeaV-cb both containing lipophilic EGCG (with (+) or without (-) gelling thickener), in comparison to two widely used alcohol-based hand sanitizers, one containing alcohol and the other a mixture of iodine and polyvinyl pyrrolidone. The internationally accepted method to test virucidal activity in vitro for disinfectants and cleansing agents was used [EN 14476-2013: Chemical and Antiseptics - Quantitative Suspension Test for the evaluation of virucidal activity in the medical area - test method and requirements (Phase 2/Step 1); Guidance Document Human-Use Antiseptic Drugs 2009, Minister of Health of Canada; and Technical Standard For Disinfection 2002 edition, Department of Health of People’s Republic of China] to determine the efficacy (measured by TCID50 assays) against Poliovirus 1 (PV 1, a non-enveloped virus resistant to alcohol) as a representative of virucidal activity. This virus is considered the most difficult to eradicate. To the best of our knowledge, this was the first attempt to test the virucidal capacity of lipophilic EGCG against a non-enveloped virus in alcohol-based hand sanitizer formulations.
|Product||Active ingredients||Mean log10–reduction of viral infectivity|
|30 s (SD)||60 s (SD)||90 s (SD)|
|ProtecTeaV- with L - EGCG||Ethanol (70%)||6.65 (±0)||6.65 (±0)||6.62 (±0.58)|
|ProtecTeaV+ with L - EGCG||Ethanol (70%)||5.98 (±0.49)||6.02 (±0.42)||6.53 (±0.40)|
|Purell||Ethanol (62%)||3.28 (±1.1)||2.85 (±0.61)||3.24 (±0.51)|
|adf||PVP-Iodine||2.88 (±1.07)||3.12 (±1.31)||2.75 (±0.98)|
Table 1: Efficacy of four hand sanitizers either with alcohol (ProtecTeaV, Purell) or without alcohol (adf) against PV-1 using TCID50 assays. Data are from three independent experiments.
ProtecTeaV-: without thickener agent.
ProtecTeaV+: with thickener agent.
L-EGCG: Lipophilic Epigallocatechin-3-Gallate.
PV-1: poliovirus 1.
SD: Standard Deviation of 3 independent experiments (n=3).
Due to the increasing evidence indicating a weak efficacy of alcohol-based hand sanitizer against non-enveloped viruses, especially norovirus and poliovirus , the 2011 CDC guidelines suggested using “proper hand washing with soap and running water for at least 20 seconds” as the most effective way to reduce norovirus contamination on the hands . However, the implementation of new guidelines has not been associated with a reduction in norovirus outbreaks. Since 2011, rather than a decline in the number of norovirus outbreaks reported to the CDC, there was a spike during 2013-2014 (CDC NoroSTAT, 2009-2015). It is clear that in order to reduce outbreaks and infections from norovirus and other non-enveloped or enveloped viruses, novel hand hygiene approaches that are more effective than hand washing with soap and water are in urgent need.
Results from the current study have demonstrated for the first time that alcohol-based sanitizer formulations containing lipophilic EGCG exert potent virucidal capacity. According to international standards (i.e. European standard for testing EN 14476 and Chinese CDC standard), virucidal disinfectants and antiseptics require a mandatory >4 log10 virus infectivity reduction by 30s or 60s to be classified as such . Our results from TCID50 assays demonstrated that both ProtecTeaV hand sanitizer formulations, either with or without carbomer thickening agent, exceeded this mandatory requirement by 100-fold (>6 log10) within the requisite time frame of 30-90 sec (Figure 1 and Table 1). In contrast, both the conventional alcohol-based hand sanitizer and non-alcohol-based hand sanitizer tested here failed to meet the internationally accepted standards. In addition, results from the neutralization assay indicated that the inactivation of PV 1 by ProtecTeaV formulations was irreversible, as virus incubated with ProtecTeaV formulations for 60s lost infectivity even after the sanitizer formulations were removed by microfiltration (Figure 2). The reduction of PV 1 infectivity in these neutralization assays was consistent with the TCID50 assays (6.1 log10 reduction, Figure 2).
The high potency of the ProtecTeaV hand sanitizer formulations demonstrated here was consistent with the antiviral properties of lipophilic EGCG, and previous studies showing antiviral activities of EGCG or its derivatives that did not use alcohol as the primary solvent. Although a synergistic effect might occur between alcohol and lipophilic EGCG, the contribution of alcohol is likely to be rather small, based on prior measures of EGCG effectiveness. Medications such as Veregen ointment against genital warts primarily induced by human papilloma virus and AverTeaX ointment for treating herpes labialis, either have EGCG (Veregen) or lipophilic EGCG (AverTeaX), but do not contain alcohol [16,20]. Previous studies using Dimethyl Sulfoxide (DMSO) as a solvent demonstrated that lipophilic EGCG is 24-fold more effective than native EGCG against influenza virus (H1N1) . Another study using ethanol as a solvent showed lipophilic EGCG is 8.7 fold more effective against Herpes Simplex Virus 1 (HSV-1), in comparison to native hydrophilic EGCG . In both studies, 50 µM of EGCG-mono-palmitate was sufficient to completely inhibit plaque formation by H1N1 and HSV-1 [21,22]. Although native green tea extract and EGCG exert significant antiviral activities against a wide spectrum of viral species, including Ebola virus, native EGCG is not able to effectively inactivate poliovirus within a concentration range (µM) that is active against other types of viruses [23,24]. The current study indicates that lipophilic EGCG in alcohol-based ProtecTeaV hand sanitizer formulations possesses high efficacy against poliovirus (Figures 1 and 2 & Table 1). It is interesting to note that Veregen ointment contains 15% of tea polyphenols (sinecatechins) with the majority being native EGCG (>55%). That is, the EGCG concentration in this prescription drug is >8.25%. In contrast, the lipophilic EGCG in AverTeaX ointment is significantly less than 1% (undisclosed proprietary formula). In summary, alcohol is not an important contributor to the virucidal capacity of lipophilic EGCG in the tested formulations, and the antiviral efficacy of lipophilic EGCG is significantly higher than native EGCG.
It is known that auto-oxidation is the major cause of instability of EGCG due to its antioxidant activity in aqueous preparations or beverages [25,26]. Acylation of EGCG not only enhanced the antiviral activity but also increased stability by 10-fold . Matsumoto et al., reported that EGCG-palmitate exhibits antibacterial and antifungal activities, with rapid bactericidal activity against MRSA ATCC43300 at > 16 µg/ml . Thus, lipophilic EGCG in an alcohol-based hand sanitizer (and other forms of surface disinfectants) is expected to have both strong virucidal and bactericidal activity. Future studies should include testing the persistency of the virucidal activity after application to determine the duration of protection by lipophilic EGCG on skin or other surfaces. In addition, lipophilic EGCG sanitizer formulations need to be tested against other non enveloped viruses, such as norovirus, adenovirus and enteric virus 71 (EV71), which work is underway in our laboratories (manuscript in preparation).
In conclusion, the ProtecTeaV alcohol-based hand sanitizer formulations containing lipophilic EGCG irreversibly inactivate non-enveloped polio virus 1 and exceeded the international standard for virucidal disinfectants and antiseptics. With superior antiviral activity and stability in comparison to native EGCG, lipophilic EGCG has the potential for use as a novel, effective and nontoxic component for the next generation of approaches to prevention of pathogenic viral infections.
The views expressed in this manuscript are those of the author(s) and do not reflect official policy or position of the Department of the Army, Department of Defense or the US Government.
The authors thank Ms. Rhonda Powell for her work on the graphs.
Citation: Zhang Q, Yang Q, Yang W, Wu K, Wu J, et al. (2016) Virucidal Capacity of Novel ProtecTeaV Sanitizer Formulations Containing Lipophilic Epigallocatechin-3-Gallate (EGCG). J Antivir Antiretrovir Res Ther 1: 002.
Copyright: © 2016 Qi Zhang, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.