Novel strategies for post-exposure rabies prophylaxis: the role of immunomodulatory and targeted molecular technologies in personalized medicine

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  • Authors: Potupchik T.V.1, Generalov S.V.2, Akaeva A.V.3, Shablinskaya K.S.4
  • Affiliations:
    1. Federal State Budgetary Educational Institution of Higher Education “Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky” of the Ministry of Health of the Russian Federation
    2. Federal state scientific institution “Russian research anti-plague institute “Microbe” of the Federal service for surveillance on consumers rights protection and human well-being
    3. Federal State Budgetary Educational Institution of Higher Education “Perm State Medical University named after academician E.A. Wagner” of the Russian Ministry of Health
    4. “Institute of Plastic Surgery” LLC
  • Issue: Vol 23, No 5 (2025)
  • Pages: 70-78
  • Section: Reviews
  • URL: https://journals.eco-vector.com/1728-2918/article/view/696273
  • DOI: https://doi.org/10.29296/24999490-2025-05-06
  • ID: 696273

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Abstract

Introduction. Rabies is currently a rare but deadly viral disease transmitted through animal bites, mainly dogs. There is no standardized effective therapy for clinically manifest rabies. Patients with developed symptoms are mainly provided with palliative care and intensive therapy. In this regard, the search for new therapeutic solutions for rabies is urgent.

Objective. To analyze current advances in rabies post-exposure prophylaxis (PEP) with emphasis on molecular technologies and their integration into personalized medicine.

Material and methods. Systematic search in PubMed and Scopus databases for 2018–2025 using key terms: rabies, post-exposure prophylaxis, monoclonal antibodies, mRNA vaccine, favipiravir, siRNA, aptamer. Original studies, meta-analyses, systematic reviews, and WHO/CDC guidelines were analyzed.

Results. Rabies maintains nearly 100% fatality rate upon symptom manifestation, causing approximately 59 000 deaths annually, predominantly in Africa and Asia. Standard PEP remains highly effective but is limited by immunoglobulin availability in resource-limited regions. Recent advances include: monoclonal antibodies against rabies virus G-protein (docaravimab/miromavimab) demonstrating favorable safety profile as alternative to human rabies immunoglobulin; mRNA vaccines encoding full-length RABV-G providing complete protection in preclinical studies; nucleoside analogs effective when applied early before CNS penetration; RNA therapeutics (aptamers/siRNA) showing convincing in vitro viral suppression results.

Conclusion. Molecular technologies expand personalized PEP capabilities. Monoclonal antibodies are already entering clinical practice, mRNA vaccines are approaching clinical trials, while RNA therapeutics require solving CNS delivery challenges. Key challenges include proving equivalence to standard therapy, ensuring accessibility in endemic regions, and standardizing combined approaches considering individual risk factors.

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About the authors

Tatyana Vitalievna Potupchik

Federal State Budgetary Educational Institution of Higher Education “Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky” of the Ministry of Health of the Russian Federation

Author for correspondence.
Email: potupchik_tatyana@mail.ru
ORCID iD: 0000-0003-1133-4447

Associate Professor, Department of Pharmacology and Clinical Pharmacology with a postgraduate course, Candidate of Medical Sciences

Russian Federation, Partizana Zheleznyaka St., 1, Krasnoyarsk, 660022

Sergey Vyacheslavovich Generalov

Federal state scientific institution “Russian research anti-plague institute “Microbe” of the Federal service for surveillance on consumers rights protection and human well-being

Email: svgeneraloff@gmail.com
ORCID iD: 0000-0003-1461-5383

Leading Researcher, Candidate of Biological Sciences

Russian Federation, Universitetskaya str., 46, Saratov, 410005

Albina Vladimirovna Akaeva

Federal State Budgetary Educational Institution of Higher Education “Perm State Medical University named after academician E.A. Wagner” of the Russian Ministry of Health

Email: akaeva.01@inbox.ru
ORCID iD: 0009-0008-3612-0385

6th year Student

Russian Federation, Petropavlovskaya Str., 26, Perm, 614990

Ksenia Sergeevna Shablinskaya

“Institute of Plastic Surgery” LLC

Email: shablinskayaksenya@gmail.com
ORCID iD: 0009-0000-9898-3954

Surgeon, Assistant Plastic Surgeon, “Institute of Plastic Surgery” LLC

Russian Federation, Malyy Sukharevskiy Lane, 10, build. 1, Moscow, 127051

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