Overcoming rabies immune evasion via monoclonal antibody therapeutics

Rabies is a lethal acute viral encephalitis caused by neurotropic lyssaviruses, particularly Lyssavirus rabies. The current treatment for rabies exposure involves post-exposure prophylaxis (PEP), which includes the administration of the rabies vaccine and rabies immunoglobulins (RIGs). No effective treatments exist to cure symptomatic rabies. Due to the limited availability and high cost of PEP, tens of thousands of deaths still occur worldwide every year. Monoclonal antibodies (mAbs) represent an effective and economical alternative to RIGs. Moreover, recent preclinical studies have provided evidence that monoclonal antibodies can effectively treat symptomatic rabies, overcoming mechanisms of viral immune evasion. In this review, we critically summarize recent studies, focusing on the treatment of rabies exposures using monoclonal antibodies and the potential of monoclonal antibody-based therapies to combat symptomatic rabies.