Spatial organization of mAbs in complex with the virus glycoprotein determines the success of intravenous rabies therapy
Rabies is a complex disease that has defied efforts to develop an effective treatment. Although it can be successfully prevented through vector control or pre- or post-exposure prophylaxis, no therapeutic options exist for symptomatic rabies, and the disease is still responsible for about 59 000 human deaths each year. Following our successful attempts to use the human monoclonal antibodies RVC20 and RVC58 for intracerebroventricular treatment of rabies, we report here on the effects of these mAbs when administered intravenously and intramuscularly to symptomatic mice. Only a small proportion of mAbs was detected to cross the blood-brain barrier, yet this limited amount sufficiently cleared the viral infection and improved the survival rate of infected mice. Remarkably, these mAbs appeared more effective when used individually than when combined as a cocktail. RVC58 achieved an 80% survival rate, potentially due to its distinct binding topography, potent viral neutralization, and enhanced Fc{gamma}R engagement in the presence of virions. These findings suggest that monotherapy with a single mAb fully capable of engaging Fc{gamma}R may be possible, which could substantially lower the costs and improve treatment accessibility in under-resourced settings, potentially contributing to improved equity of global health. Taken together, this study supports mAb therapy as a promising preclinical approach for symptomatic rabies and provides a foundation for further development of an accessible treatment option.