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RSV vaccine development: advances and fusion protein-focused strategies
Wang Xu1, Revansiddha H Katte1, Maolin Lu1
1Department of Cellular and Molecular Biology, School of Medicine, The University of Texas at Tyler Health Science Center, Tyler, TX, United States.
Insights
Respiratory syncytial virus (RSV) prevention has advanced with new monoclonal antibodies and vaccines targeting the fusion protein. This review covers RSV virology, antibody evolution, and current vaccine platforms for future strategies.
Area of Science:
- Virology
- Immunology
- Vaccinology
Background:
- Respiratory syncytial virus (RSV) is a major cause of severe respiratory illness in vulnerable populations, including infants and the elderly.
- The RSV fusion (F) protein, especially in its prefusion conformation, is a key target for developing effective preventatives.
- Past vaccine development faced challenges, necessitating a focus on the F protein and novel platform technologies.
Purpose of the Study:
- To provide a comprehensive overview of current strategies for RSV prevention.
- To review the molecular virology of RSV and the historical development of prophylactic antibodies.
- To categorize and discuss contemporary RSV vaccine platforms and candidates in clinical development.
Main Methods:
- Literature review focusing on RSV molecular virology, antibody development, and vaccine research.
- Analysis of licensed prophylactic agents and ongoing clinical trials for RSV vaccines.
- Categorization of vaccine platforms including mRNA, protein subunit, virus-like particle/nanoparticle, live-attenuated, and viral vectors.
Main Results:
- Significant progress has been made, leading to approved long-acting monoclonal antibodies (Nirsevimab, Clesrovimab) and adult vaccines (Arexvy, Abrysvo, mRESVIA).
- Multiple vaccine platforms are under active investigation, showing promise for diverse populations.
- The prefusion RSV F protein is central to the success of recent prophylactic interventions.
Conclusions:
- Current RSV prevention landscape includes effective monoclonal antibodies and newly approved vaccines.
- Diverse vaccine platforms offer promising avenues for future RSV prevention strategies.
- Continued research and development are crucial for advancing global RSV control efforts.
Abstract:
Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections, particularly affecting infants, young children, older adults, and immunocompromised individuals. While RSV infection often causes mild, cold-like symptoms, it can progress to severe pulmonary disease in these vulnerable populations, frequently necessitating hospitalization. Decades of research have defined the RSV fusion protein, particularly its prefusion form, as the primary target for prophylaxis and vaccine design. This has advanced transformative milestones, including the approval of long-acting monoclonal antibodies (Nirsevimab, Clesrovimab) and the vaccines for adults (Arexvy, Abrysvo, mRESVIA). This review begins with RSV molecular virology, summarizes the evolution of prophylactic antibody, and revisits lessons from past vaccine failures. It then emphasizes the current landscape of RSV vaccine development, categorizing platforms such as mRNA, protein subunit, virus-like particle/nanoparticle, live-attenuated, and viral vector approaches, highlighting both licensed vaccines and leading candidates under clinical evaluation. This review overviews current RSV vaccines and antibody prophylaxis and aims to inform the development of future prevention strategies.
