Hypochlorous Acid as a Potential Wound Care Agent Part I. Stabilized Hypochlorous Acid: A Component of the Inorganic Armamentarium of Innate Immunity

Wang L, PhD, ^a Bassiri M, PhD, ^a Najafi R, PhD, ^a Najafi K, MD, ^b Yang J, BS, ^a Khosrovi B, PhD, ^a Hwong W, BS, ^a Barati E, BS, ^a Belisle B, PhD, ^a Celeri C, MS^a , and Robson MC, MD ^c

^aNovaBay Pharmaceuticals, Inc, Emeryville, CA; ^bEye Institute San Rafael, CA; and ^c Institute for  Tissue Regeneration, Repair and Rehabilitation, Bay Pines, FL.

Objective: Hypochlorous acid (HOCl), a major inorganic bactericidal compound of innate immunity, is effective against a broad range of microorganisms. Owing to its chemical nature, HOCl has never been used as a pharmaceutical drug for treating infection. In this article, we describe the chemical production, stabilization, and biological activity of a pharmaceutically useful formulation of HOCl. Methods: Stabilized HOCl is in the form of a physiologically balanced solution in 0.9% saline at a pH range of 3.5 to 4.0. Chlorine species distribution in solution is a function of pH. In aqueous solution, HOCl is the predominant species at the pH range of 3 to 6. At pH values less than 3.5, the solution exists as a mixture of chlorine in aqueous phase, chlorine gas, trichloride (Cl− 3 ), and HOCl. At pH greater than 5.5, sodium hypochlorite (NaOCl) starts to form and becomes the predominant species in the alkaline pH. To maintain HOCl solution in a stable form, maximize its antimicrobial activities, and minimize undesirable side products, the pH must be maintained at 3.5 to 5. Results: Using this stabilized form of HOCl, the potent antimicrobial activities of HOCl are demonstrated against a wide range of microorganisms. The in vitro cytotoxicity profile in L929 cells and the in vivo safety profile of HOCl in various animal models are described. Conclusion: On the basis of the antimicrobial activity and the lack of animal toxicity, it is predicted that stabilized HOCl has potential pharmaceutical applications in the control of soft tissue infection.

Irrigation Solutions in Wound Care and Breast Surgery: Evidence-Based Applications, Regulatory Considerations, and Future Directions

Stephanie M. Mueller ^1,2 , LaYow C. Yu ² , Michael Drake Pike ² , Hannah D. Shi ² and Dennis P. Orgill ^1,2,*

1 Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

2 Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (L.C.Y.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (M.D.P.); 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (H.D.S.)

* Correspondence: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Abstract

Background: Irrigation is a key strategy in reducing bioburden, disrupting biofilms, and supporting wound healing. While saline is the standard for its safety and availability, antiseptic and antibiotic solutions are often used in clinical scenarios that require infection control. However, the rise in antibiotic stewardship and concerns regarding cytotoxicity are reshaping current practices. This review identifies recent trends, current controversies, and persistent gaps in knowledge that warrant further investigation and regulatory attention. Methods: A literature review identified irrigation solutions commonly used in plastic surgery; labeling and concentrations were obtained from Devices@FDA, Drugs@FDA, and DailyMed, and PubMed, Cochrane Central, and Embase were searched (January 2022–July 2025) for human studies on acute wounds, chronic wounds, and implant-based breast surgery. Results: In acute wounds, saline and potable tap water effectively prevent infection. In chronic wounds, such as diabetic foot ulcers and pressure injuries, antiseptic agents, including hypochlorous acid, sodium hypochlorite, polyhexanide, and citrate-based solutions, have shown promise in improving healing and reducing infection. In implant-based breast reconstruction and augmentation, data on antiseptics, such as chlorhexidine, and changes in FDA guidance for povidone–iodine and bacitracin have prompted a reevaluation of intraoperative irrigation practices. Conclusion: Despite widespread use, many antiseptics remain off-label, and high-quality clinical studies comparing efficacy and safety are lacking.

Keywords: wound irrigation; saline irrigation; antiseptic irrigation; surgical site infection/prevention and control; breast pocket irrigation; Povidone–Iodine (PVI); Polyhexamethylene Biguanide/polyhexanide (PHMB); Hypochlorous Acid (HOCl); Sodium Hypochlorite (NaOCl); Triple antibiotic solution (TAS)

Phenotypic Switching Resulting From Developmental Plasticity: Fixed or Reversible?

Warren W. Burggren*

Developmental Integrative Biology, Department of Biological Sciences, University of North Texas, Denton, TX, United States

Fusobacterium nucleatum: More Than Just an Oral Anaerobe

Akash Patel , Monica Patel , Joseph Glowacki

1.Internal Medicine, St. Mary Medical Center, Langhorne , USA 2. Internal Medicine, Temple University Hospital, Philadelphia, USA 3. Internal Medicine, Rowan University School of Medicine, Stratford, USA

Corresponding author: Akash Patel, 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Abstract

Fusobacterium nucleatum is a strict anaerobe that is indigenous to the human oral cavity, where it coexists with more than 500 other species. It is associated with paranasal sinus, odontogenic, and pulmonary infections. In literature, cases of Fusobacterium nucleatum are rare. Here we report a case of a patient with multiple brain abscesses caused by Fusobacterium nucleatum. This case report looks to assist clinicians in determining the true etiology of this organism, which can change patient management based on the current literature review and similar case studies.

Categories: Internal Medicine, Infectious Disease, Neurosurgery

Keywords: anaerobes of clinical importance, colon cancer surveillance, periodontal disease, brain abscess, fusobacterium nucelatum

Hypochlorous acid inactivates oral pathogens and a SARS-CoV-2-surrogate

Kento Tazawa^1,2, Rutuja Jadhav¹ , Mariane Maffei Azuma¹ , J. Christopher Fenno³ , Neville J. McDonald1 and Hajime Sasaki^1*

Abstract

Background Droplets and aerosols produced during dental procedures are a risk factor for microbial and viral transmission. Unlike sodium hypochlorite, hypochlorous acid (HOCl) is nontoxic to tissues but still exhibits broad microbicidal effect. HOCl solution may be applicable as a supplement to water and/or mouthwash. This study aims to evaluate the effectiveness of HOCl solution on common human oral pathogens and a SARS-CoV-2 surrogate MHVA59 virus, considering the dental practice environment.

Methods HOCl was generated by electrolysis of 3% hydrochloric acid. The effect of HOCl on human oral pathogens, Fusobacterium nucleatum, Prevotella intermedia, Streptococcus intermedius, Parvimonas micra, and MHV A59 virus was studied from four perspectives: concentration; volume; presence of saliva; and storage. HOCl solution in different conditions was utilized in bactericidal and virucidal assays, and the minimum inhibitory volume ratio that is required to completely inhibit the pathogens was determined.

Results In the absence of saliva, the minimum inhibitory volume ratio of freshly prepared HOCl solution (45–60 ppm) was 4:1 for bacterial suspensions and 6:1 for viral suspensions. The presence of saliva increased the minimum inhibitory volume ratio to 8:1 and 7:1 for bacteria and viruses, respectively. Applying a higher concentration of HOCl solution (220 or 330 ppm) did not lead to a significant decrease in the minimum inhibitory volume ratio against S. inter-medius and P. micra. The minimum inhibitory volume ratio increases in applications of HOCl solution via the dentalunit water line. One week of storage of HOCl solution degraded HOCl and increased the minimum growth inhibition volume ratio.

Conclusions HOCl solution (45–60 ppm) is still effective against oral pathogens and SAR-CoV-2 surrogate viruses even in the presence of saliva and after passing through the dental unit water line. This study indicates that the HOCl solution can be used as therapeutic water or mouthwash and may ultimately reduce the risk of airborne infection in dental practice.

Keywords Hypochlorous acid (HOCl), Dental practice, Airborne infection, Oral pathogens, SARS-CoV-2, Disinfectant, Mouthwash, Minimum inhibitory volume ratio

Evaluation of Liquid- and Fog-Based Application of Sterilox Hypochlorous Acid Solution for Surface Inactivation of Human Norovirus

Geun Woo Park,^{1 *} Deyanna M. Boston,² Julie A. Kase,¹ Mark N. Sampson,² and Mark D. Sobsey¹

Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill,

North Carolina,¹ and PuriCore Inc., 508 Lapp Road, Malvern, Pennsylvania 19355²

Received 6 December 2006/Accepted 27 April 2007

Noroviruses (NVs) are the most frequent cause of outbreaks of gastroenteritis in common settings, with surface-mediated transfer via contact with fecally contaminated surfaces implicated in exposure. NVs are environmentally stable and persistent and have a low infectious dose. Several disinfectants have been evaluated for efficacy to control viruses on surfaces, but the toxicity and potential damage to treated materials limits their Sterilox hypochlorous acid (HOCl) solution (HAS) has shown broad-spectrum antimicrobial activity while being suitable for general use. The objectives of this study were to evaluate the efficacy of HAS to reduce NV both in aqueous suspensions and on inanimate carriers. HOCl was further tested as a fog to decontaminate large spaces. HOCl effectiveness was evaluated using nonculturable human NV measured by reverse transcriptase PCR (RT-PCR) and two surrogate viruses, coliphage MS2 and murine NV, that were detected by both infectivity and RT-PCR. Exposing virus-contaminated carriers of ceramic tile (porous) and stainless steel (nonporous) to 20 to 200 ppm of HOCl solution resulted in >99.9% (>3 log10) reductions of both infectivity and RNA titers of tested viruses within 10 min of exposure time. HOCl fogged in a confined space reduced the infectivity and RNA titers of NV, murine NV, and MS2 on these carriers by at least 99.9% (3 log10), regardless of carrier location and orientation. We conclude that HOCl solution as a liquid or fog is likely to be effective in disinfecting common settings to reduce NV exposures and thereby control virus spread via fomites.