Molecular and Cellular Mechanisms of Respiratory Syncytial Viral Infection: Its Implications for Prophylactic and Therapeutic Pharmaceuticals

Abstract

Respiratory syncytial virus (RSV) is a notorious pathogen that serves as the leading cause of lower respiratory tract infections (LRTI) among infants, the elderly, and immunocompromised individuals. Its widespread prevalence exerts a considerable burden on global healthcare systems and economies, owing to the high rates of hospitalization and the potential for long-term health complications. Significant progress has been achieved in RSV prevention strategies during recent years, with three vaccines currently approved worldwide for active immunization in adults aged 60 years and older, as well as pregnant women. Furthermore, the monoclonal antibody nirsevimab has been approved for the prevention of RSV infections in infants. However, effective antiviral treatments for postinfection cases remain an unmet clinical need. This review comprehensively elaborates the molecular and cellular mechanisms of RSV infection, including viral structure, replication cycle, and pathogenic mechanisms. Meanwhile, we systematically summarize the latest advances in preventive and therapeutic agents and analyze the practical applications and existing limitations of current immunization strategies. Furthermore, we discuss and propose the challenges and future directions in drug development. The review provide insights for developing novel and effective prevention and treatment strategies against RSV infection.