Respiratory syncytial virus (RSV): prevention and antiviral therapeutic strategies

Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infections, particularly among young children and older adults. It specifically targets ciliated epithelial cells, setting off a cascade that includes the release of pro-inflammatory cytokines and the activation of an innate antiviral defense by alveolar macrophages and dendritic cells. Antivirals for the RSV function by preventing the virus from replicating. By interacting with guanosine triphosphate, the nucleoside analog ribavirin prevents the synthesis of viral RNA and causes fatal mutagenesis. Palivizumab, a monoclonal antibody, neutralizes RSV by binding to its F protein, thereby obstructing the virus’s ability to fuse with and penetrate host cells. Another monoclonal antibody that neutralizes RSV and prevents cell infection is nisevimab, which offers prolonged protection. Fusing inhibitors, such as the investigative drug presatovir, disrupt the fusing of viral membranes, thereby preventing the virus from entering host cells. Our increasing knowledge of RSV pathophysiology and immunopathology over the past few decades has led to significant advancements in prevention strategies. Although RSV exerts a profound impact on public health, the available clinical interventions are limited to only two approved drugs: ribavirin and palivizumab. It is important to note that palivizumab is used solely as a preventive measure rather than as a treatment option. Currently, numerous research groups are exploring new treatments for RSV, focusing on three main research areas: small molecules, polymeric drugs (proteins and peptides), and plant-derived compounds. Emphasizing the development of therapies designed to disrupt key stages in the virus’s life cycle, this article examines the advancements and difficulties in this field. We also give an update on the available treatments for acute RSV disease (both non-specific and RSV-specific), as well as other prevention-oriented strategies.