Optimizing RSV Treatment: Insights into Targeted Drug Delivery Strategies and Public Health Implications
DOI:
https://doi.org/10.47611/jsrhs.v14i1.8889Keywords:
RSV Treatment, Pathogenesis, Immune Response, Inflammatory Markers, TNF-α, RSV LRTIAbstract
Respiratory Syncytial Virus (RSV) remains a pressing health issue worldwide, with infants, young children, and elderly individuals, especially vulnerable. In the present study, we reviewed available treatment modalities, Their efficacy rates were measured, and possible improvements of both therapeutic methods and pharmacological delivery methods were explored. Through analysis of recent literature and data, we evaluated the current efficacy of bronchodilators, anti-inflammatory agents, and monoclonal antibodies work in RSV treatment. Notably, while bronchodilators and corticosteroids only offer monoclonal antibodies, such as Palivizumab, confer preventive benefits among those at high risk but with limited alleviation. Additionally, emerging therapeutic options—such as RNA interference and nucleoside analogs—have demonstrated initial potential in thereby minimizing RSV replication. These findings emphasize the need for targeted therapy that is not only specific but also effective in reducing the complications and mortality burden caused by RSV. Others, like Palivizumab, are showing prospects for high-risk groups, RNA interference treatments may offer a new strategy in directly targeting viral replication. Perhaps the best route to reduction incorporates both prevention and direct intervention in a multifaceted approach. Development of RSV, and further research into siRNA-based therapies with enhanced drug delivery. Methodological approaches are important, as our findings have pointed out, for protecting the most vulnerable from RSV.
Downloads
References or Bibliography
Agius, G., Dindinaud, G., Biggar, R. J., Peyre, R., Vaillant, V., Ranger, S., Poupet, J. Y., Cissé, M., & Castets, M. (1990). An epidemic of respiratory syncytial virus in elderly people: Clinical and serological findings. Journal of Medical Virology, 30(2), 117–127. https://doi.org/10.1002/jmv.1890300208
Balasubramani, G., Nowalk, M. P., Eng, H., & Zimmerman, R. K. (2022). Estimating the burden of adult hospitalized RSV infection using local and state data - methodology. Human Vaccines & Immunotherapeutics, 18(1). https://doi.org/10.1080/21645515.2021.1958610
Bennett, B. L., Garofalo, R. P., Cron, S. G., Hosakote, Y. M., Atmar, R. L., Macias, C. G., & Piedra, P. A. (2007). Immunopathogenesis of respiratory syncytial virus bronchiolitis. The Journal of Infectious Diseases, 195(10), 1532–1540. https://doi.org/10.1086/515575
Bitko, V., Musiyenko, A., Shulyayeva, O., & Barik, S. (2004). Inhibition of respiratory viruses by nasally administered siRNA. Nature Medicine, 11(1), 50–55. https://doi.org/10.1038/nm1164
Bucasas, K. L., Mian, A., Demmler-Harrison, G. J., Caviness, A. C., Piedra, P. A., Franco, L. M., Shaw, C. A., Zhai, Y., Wang, X., Bray, M. S., Couch, R. B., & Belmont, J. W. (2013). Global gene expression profiling in infants with acute respiratory syncytial virus broncholitis demonstrates systemic activation of interferon signaling networks. The Pediatric Infectious Disease Journal, 32(2), e68–e76. https://doi.org/10.1097/inf.0b013e318278b4b3
Cane, P. A., Matthews, D. A., & Pringle, C. R. (1994). Analysis of respiratory syncytial virus strain variation in successive epidemics in one city. Journal of Clinical Microbiology, 32(1), 1–4. https://doi.org/10.1128/jcm.32.1.1-4.1994
Chanock, R. M., Roizman, B., & Myers, R. (1957). Recovery from Infants with Respiratory Illness of a Virus Related to Chimpanzee Coryza Agent (CCA). American Journal of Epidemiology, 66(3), 281–290. https://doi.org/10.1093/oxfordjournals.aje.a119901
Crowe, J. E. (2001). Influence of Maternal Antibodies on Neonatal Immunization against Respiratory Viruses. Clinical Infectious Diseases, 33(10), 1720–1727. https://doi.org/10.1086/322971
DeVincenzo, J. P., Cehelsky, J., Alvarez, R., Elbashir, S. M., Harborth, J., Toudjarska, I., Nechev, L., Murugaiah, V., Van Vliet, A., Vaishnaw, A., & Meyers, R. (2008). Evaluation of the safety, tolerability and pharmacokinetics of ALN-RSV01, a novel RNAi antiviral therapeutic directed against respiratory syncytial virus (RSV). Antiviral Research, 77(3), 225–231. https://doi.org/10.1016/j.antiviral.2007.11.009
DeVincenzo, J. P., Lambkin‐Williams, R., Wilkinson, T., Cehelsky, J., Nochur, S. V., Walsh, E. E., Meyers, R., Gollob, J., & Vaishnaw, A. (2010). A randomized, double-blind, placebo-controlled study of an RNAi-based therapy directed against respiratory syncytial virus. Proceedings of the National Academy of Sciences of the United States of America, 107(19), 8800–8805. https://doi.org/10.1073/pnas.0912186107
DeVincenzo, J. P., Saleeby, C. M. E., & Bush, A. (2005). Respiratory syncytial virus load predicts disease severity in previously healthy infants. The Journal of Infectious Diseases, 191(11), 1861–1868. https://doi.org/10.1086/430008
Falsey, A. R., Hennessey, P., Formica, M. A., Cox, C., & Walsh, E. E. (2005). Respiratory syncytial virus infection in Elderly and High-Risk adults. The New England Journal of Medicine, 352(17), 1749–1759. https://doi.org/10.1056/nejmoa043951
Falsey, A. R., Hennessey, P., Formica, M. A., Cox, C., & Walsh, E. E. (2005). Respiratory syncytial virus infection in Elderly and High-Risk adults. the New England Journal of Medicine (Print), 352(17), 1749–1759. https://doi.org/10.1056/nejmoa043951
Falsey, A. R., Treanor, J. J., Betts, R. F., & Walsh, E. E. (1992). Viral respiratory infections in the Institutionalized elderly: Clinical and epidemiologic findings. Journal of the American Geriatrics Society, 40(2), 115–119. https://doi.org/10.1111/j.1532-5415.1992.tb01929.x
García, C. G., Bhore, R., Soriano-Fallas, A., Trost, M., Chason, R. D., Ramilo, O., & Mejías, A. (2010). Risk factors in children hospitalized with RSV bronchiolitis versus Non–RSV bronchiolitis. Pediatrics, 126(6), e1453–e1460. https://doi.org/10.1542/peds.2010-0507
García, C. S., Soriano-Fallas, A., Lozano, J., Leos, N. K., Gómez, A. M., Ramilo, O., & Mejías, A. (2012). Decreased innate immune cytokine responses correlate with disease severity in children with respiratory syncytial virus and human rhinovirus bronchiolitis. The Pediatric Infectious Disease Journal, 31(1), 86–89. https://doi.org/10.1097/inf.0b013e31822dc8c1
Garofalo, R. P., Dorris, A., Ahlstedt, S., & Welliver, R. C. (1994). Peripheral blood eosinophil counts and eosinophil cationic protein content of respiratory secretions in bronchiolitis: relationship to severity of disease. Pediatric Allergy and Immunology, 5(2), 111–117. https://doi.org/10.1111/j.1399-3038.1994.tb00227.x
Garofalo, R. P., Kimpen, J. L. L., Welliver, R. C., & Ogra, P. L. (1992). Eosinophil degranulation in the respiratory tract during naturally acquired respiratory syncytial virus infection. The Journal of Pediatrics, 120(1), 28–32. https://doi.org/10.1016/s0022-3476(05)80592-x
Glezen, W. P. (1986). Risk of primary infection and reinfection with respiratory syncytial virus. Archives of Pediatrics & Adolescent Medicine, 140(6), 543. https://doi.org/10.1001/archpedi.1986.02140200053026
Gonik, B. (2019). The burden of respiratory Syncytial virus infection in Adults and Reproductive-Aged women. Global Health, Science and Practice, 7(4), 515–520. https://doi.org/10.9745/ghsp-d-19-00121
Griffiths, C., Drews, S. J., & Marchant, D. (2017a). Respiratory syncytial Virus: Infection, detection, and new options for prevention and treatment. Clinical Microbiology Reviews, 30(1), 277–319. https://doi.org/10.1128/cmr.00010-16
Hall, C. B., Powell, K. R., MacDonald, N. E., Gala, C. L., Menegus, M. E., Suffin, S. C., & Cohen, H. J. (1986). Respiratory Syncytial Viral Infection in Children with Compromised Immune Function. The New England Journal of Medicine, 315(2), 77–81. https://doi.org/10.1056/nejm198607103150201
Hall, C. B., Weinberg, G. A., Iwane, M. K., Blumkin, A., Edwards, K. M., Staat, M. A., Auinger, P., Griffin, M. R., Poehling, K. A., Erdman, D. D., Grijalva, C. G., Zhu, Y., & Szilâgyi, P. G. (2009). The burden of respiratory syncytial virus infection in young children. The New England Journal of Medicine, 360(6), 588–598. https://doi.org/10.1056/nejmoa0804877
Harrington, R. D., Hooton, T. M., Hackman, R. C., Storch, G. A., Osborne, B. M., Gleaves, C. A., Benson, A. M., & Meyers, J. D. (1992). An outbreak of respiratory syncytial virus in a bone marrow transplant center. The Journal of Infectious Diseases, 165(6), 987–993. https://doi.org/10.1093/infdis/165.6.987
Hasegawa, K., Jartti, T., Mansbach, J. M., Laham, F. R., Jewell, A. M., Espinola, J. A., Piedra, P. A., & Camargo, C. A. (2014). Respiratory syncytial virus genomic load and disease severity among children hospitalized with bronchiolitis: multicenter cohort studies in the United States and Finland. The Journal of Infectious Diseases, 211(10), 1550–1559. https://doi.org/10.1093/infdis/jiu658
Havers, F. P., Whitaker, M., Melgar, M., Chatwani, B., Chai, S. J., Alden, N. B., Meek, J., Openo, K. P., Ryan, P. A., Kim, S., Lynfield, R., Shaw, Y. P., Barney, G., Tesini, B. L., Sutton, M., Talbot, H. K., Olsen, K. P., Patton, M. E., Kirley, P. D., . . . Staten, H. (2023). Characteristics and Outcomes Among Adults Aged ≥60 Years Hospitalized with Laboratory-Confirmed Respiratory Syncytial Virus — RSV-NET, 12 States. MMWR Morbidity and Mortality Weekly Report, 72(40), 1075–1082. https://doi.org/10.15585/mmwr.mm7240a1
Heilman, C. A. (1990). From the National Institute of Allergy and Infectious Diseases and the World Health Organization: Respiratory syncytial and Parainfluenza viruses. Journal of Infectious Diseases, 161(3), 402–406. https://doi.org/10.1093/infdis/161.3.402
Houben, M. L., Coenjaerts, F. E. J., Rossen, J. W. A., Belderbos, M. E., Hofland, R. W., Kimpen, J. L. L., & Bont, L. (2010). Disease severity and viral load are correlated in infants with primary respiratory syncytial virus infection in the community. Journal of Medical Virology, 82(7), 1266–1271. https://doi.org/10.1002/jmv.21771
Ioannidis, I., McNally, B. A., Willette, M., Peeples, M. E., Chaussabel, D., Durbin, J. E., Ramilo, O., Mejías, A., & Flaño, E. (2012). Plasticity and Virus Specificity of the Airway Epithelial Cell Immune Response during Respiratory Virus Infection. Journal of Virology, 86(10), 5422–5436. https://doi.org/10.1128/jvi.06757-11
Jafri, H. S., Wu, X., Makari, D., & Henrickson, K. J. (2013). Distribution of respiratory syncytial virus subtypes A and B among infants presenting to the emergency department with lower respiratory tract infection or apnea. The Pediatric Infectious Disease Journal, 32(4), 335–340. https://doi.org/10.1097/inf.0b013e318282603a
Kristensen, K., Hjuler, T., Ravn, H., Simões, E. a. F., & Stensballe, L. G. (2012). Chronic diseases, chromosomal abnormalities, and congenital malformations as risk factors for respiratory syncytial virus hospitalization: A Population-Based Cohort study. Clinical Infectious Diseases, 54(6), 810–817. https://doi.org/10.1093/cid/cir928
Larrañaga, C., Ampuero, S., Luchsinger, V., Carrión, F., Aguilar, N. V., Morales, P. R., Palomino, M. A., Tapia, L. I., & Avendaño, L. F. (2009). Impaired immune response in severe human lower tract respiratory infection by respiratory syncytial virus. The Pediatric Infectious Disease Journal, 28(10), 867–873. https://doi.org/10.1097/inf.0b013e3181a3ea71
Martin, E. T., Kuypers, J., Heugel, J., & Englund, J. A. (2008). Clinical disease and viral load in children infected with respiratory syncytial virus or human metapneumovirus. Diagnostic Microbiology and Infectious Disease, 62(4), 382–388. https://doi.org/10.1016/j.diagmicrobio.2008.08.002
Mazur, N. I., Martinón‐Torres, F., Baraldi, E., Fauroux, B., Greenough, A., Heikkinen, T., Manzoni, P., Mejías, A., Nair, H., Papadopoulos, N. G., Polack, F. P., Ramilo, O., Sharland, M., Stein, R. T., Madhi, S. А., & Bont, L. (2015). Lower respiratory tract infection caused by respiratory syncytial virus: current management and new therapeutics. The Lancet. Respiratory Medicine (Print), 3(11), 888–900. https://doi.org/10.1016/s2213-2600(15)00255-6
Mehta, R., Scheffler, M., Tapia, L. I., Aideyan, L., Patel, K., Jewell, A. M., Avadhanula, V., Mei, M., Garofalo, R. P., & Piedra, P. A. (2014). Lactate dehydrogenase and caspase activity in nasopharyngeal secretions are predictors of bronchiolitis severity. Influenza and Other Respiratory Viruses, 8(6), 617–625. https://doi.org/10.1111/irv.12276
Meissner, H. C. (2016). Viral bronchiolitis in children. The New England Journal of Medicine (Print), 374(1), 62–72. https://doi.org/10.1056/nejmra1413456.
Mejías, A., & Ramilo, O. (2015). New options in the treatment of respiratory syncytial virus disease. Journal of Infection, 71, S80–S87. https://doi.org/10.1016/j.jinf.2015.04.025
Mella, C., Suarez-Arrabal, M. C., Lopez, S. M. C., Stephens, J., Fernández, S., Hall, M. W., Ramilo, O., & Mejías, A. (2012). Innate Immune Dysfunction is Associated with Enhanced Disease Severity In Infants with Severe Respiratory Syncytial Virus Bronchiolitis. The Journal of Infectious Diseases, 207(4), 564–573. https://doi.org/10.1093/infdis/jis721
Oey, A., McClure, M. W., Symons, J., Chanda, S., Fry, J., Smith, P. F., Luciani, K., Fayon, M., Chokephaibulkit, K., Uppala, R., Bernatoniene, J., Furuno, K., Stanley, T., Huntjens, D., & Witek, J. (2023). Lumicitabine, an orally administered nucleoside analog, in infants hospitalized with respiratory syncytial virus (RSV) infection: Safety, efficacy, and pharmacokinetic results. PloS One, 18(7), e0288271. https://doi.org/10.1371/journal.pone.0288271
Ogra, P. L. (2004). Respiratory syncytial virus: The virus, the disease and the immune response. Paediatric Respiratory Reviews, 5, S119–S126. https://doi.org/10.1016/s1526-0542(04)90023-1
Openshaw, P. (2002). Potential therapeutic implications of new insights into respiratory syncytial virus disease. Respiratory Research, 3(S1). https://doi.org/10.1186/rr184
Osterweil, D., & Norman, D. C. (1990). An outbreak of an Influenza-Like illness in a nursing home. Journal of the American Geriatrics Society, 38(6), 659–662. https://doi.org/10.1111/j.1532-5415.1990.tb01425.x
Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. (1998). Pediatrics, 102(3), 531–537. https://doi.org/10.1542/peds.102.3.531
Saleeby, C. M. E., Bush, A. J., Harrison, L. M., Aitken, J. A., & DeVincenzo, J. P. (2011). Respiratory syncytial virus load, viral dynamics, and disease severity in previously healthy naturally infected children. The Journal of Infectious Diseases, 204(7), 996–1002. https://doi.org/10.1093/infdis/jir494
Shay, D. K., Holman, R. C., Newman, R. D., Liu, L. L., Stout, J., & Anderson, L. J. (1999). Bronchiolitis-Associated hospitalizations among US children, 1980-1996. JAMA, 282(15), 1440. https://doi.org/10.1001/jama.282.15.1440
Sheeran, P., Jafri, H. S., Carubelli, C. M., Saavedra, J., Johnson, C., Krisher, K., Sánchez, P. J., & Ramilo, O. (1999). Elevated cytokine concentrations in the nasopharyngeal and tracheal secretions of children with respiratory syncytial virus disease. The Pediatric Infectious Disease Journal, 18(2), 115–122. https://doi.org/10.1097/00006454-199902000-00007
Sigurs, N. (2001). Epidemiologic and clinical evidence of a respiratory Syncytial Virus–Reactive Airway Disease link. American Journal of Respiratory and Critical Care Medicine, 163(supplement_1), S2–S6. https://doi.org/10.1164/ajrccm.163.supplement_1.2011109
Staat, M. A. (2002). Respiratory syncytial virus infections in children. Seminars in Respiratory Infections, 17(1), 15–20. https://doi.org/10.1053/srin.2002.31688
Sugawara, M., Czaplicki, J., Ferrage, J., Haeuw, J., Power, U. F., Corvaı̈A, N., Nguyen, T. N., Beck, A., & Milton, A. (2002). Structure−antigenicity relationship studies of the central conserved region of human respiratory syncytial virus protein G. Journal of Peptide Research, 60(5), 271–282. https://doi.org/10.1034/j.1399-3011.2002.21027.x
Thompson, W., Shay, D. K., Weintraub, E., Brammer, L., Cox, N. J., Anderson, L. J., & Fukuda, K. (2003). Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA, 289(2), 179. https://doi.org/10.1001/jama.289.2.179
Welliver, R. C., Wong, D., Sun, M., Middleton, E., Vaughan, R. S., & Ogra, P. L. (1981). The Development of Respiratory Syncytial Virus-Specific IgE and the Release of Histamine in Nasopharyngeal Secretions after Infection. The New England Journal of Medicine, 305(15), 841–846. https://doi.org/10.1056/nejm198110083051501
Wright, P. F., Gruber, W. C., Peters, M. R., Reed, G. W., Zhu, Y., Robinson, F. W., Coleman-Dockery, S. D., & Graham, B. S. (2002). Illness Severity, Viral Shedding, and Antibody Responses in Infants Hospitalized with Bronchiolitis Caused by Respiratory Syncytial Virus. The Journal of Infectious Diseases, 185(8), 1011–1018. https://doi.org/10.1086/339822
Wright, P. F., Gruber, W. C., Peters, M. R., Reed, G. W., Zhu, Y., Robinson, F. W., Coleman-Dockery, S. D., & Graham, B. S. (2002b). Illness Severity, Viral Shedding, and Antibody Responses in Infants Hospitalized with Bronchiolitis Caused by Respiratory Syncytial Virus. The Journal of Infectious Diseases, 185(8), 1011–1018. https://doi.org/10.1086/339822
Xing, Y., & Proesmans, M. (2019). New therapies for acute RSV infections: where are we? European Journal of Pediatrics, 178(2), 131–138. https://doi.org/10.1007/s00431-018-03310-7
Zamora, M. R., Budev, M., Rolfe, M. W., Gottlieb, J., Humar, A., DeVincenzo, J. P., Vaishnaw, A., Cehelsky, J., Albert, G., Nochur, S. V., Gollob, J., & Glanville, A. R. (2011). RNA Interference Therapy in Lung Transplant Patients Infected with Respiratory Syncytial Virus. American Journal of Respiratory and Critical Care Medicine, 183(4), 531–538. https://doi.org/10.1164/rccm.201003-0422oc
Published
How to Cite
Issue
Section
Copyright (c) 2025 Sai Lakkimsetti; Dr. Kathryn Wilwohl, Jothsna Kethar

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright holder(s) granted JSR a perpetual, non-exclusive license to distriute & display this article.


