New treatments to rabies virus infections

Rabies disease is the deadliest of all virus infections. Till now, vaccination is the most effective and reliable treatment for controlling rabies. However, despite the high efficiency of inactivated vaccines, multiple-dose vaccinations and the high costs of post exposure prophylaxis cause a large economic burden, especially in tropical regions with limited storages of vaccines. New platforms of Rabies virus vaccines (lyophilized vaccines, mRNA vaccines, DNA vaccines, and especially the single-dose vaccines), rabies monoclonal antibodies (especially the antibodies avoiding immune escape) and new anti-rabies compounds are summarized in this review. Their merits and demerits are analyzed. Development of effective gut-targeted human oral rabies vaccines may be a promising future research direction. Through high-throughput phenotypic antiviral screening assays, some Food and Drug Administration (FDA) approved drugs were found to decrease Rabies virus (RABV) replication at low concentrations. Among them, homoharringtonine might be a good candidate, although further clinical trials are needed. Artificial intelligence (AI) assisted drug design against RABV has also been prospected.