Molecular Mechanisms of Respiratory Syncytial Virus Pathogenesis

Annu Rev Pathol. 2026 Jan;21(1):269-294. doi: 10.1146/annurev-pathmechdis-042424-114052. Epub 2025 Oct 16.

Abstract

Respiratory syncytial virus (RSV) is one of the leading causes of infant hospitalization and mortality worldwide. RSV pathogenesis is a result of various virus-host interactions. While significant work has been done to elucidate mechanisms of RSV pathogenesis at a systemic level from the host perspective, here we examine how RSV pathogenesis occurs on a molecular level. While each RSV protein plays an essential role in establishing and advancing disease, each one also executes multifaceted strategies for evasion of host detection. In this review, we outline how each component of the RSV replication cycle works to co-opt host cell proteins and modulate host immune responses during entry, transcription, replication, translation, assembly, and egress. We examine the latest literature regarding RSV protein function and discuss outstanding questions in the field.

Keywords: molecular virology; pathogenesis; respiratory syncytial virus; respiratory viruses; virus–host interactions.

Publication types

  • Review

MeSH terms

  • Animals
  • Host-Pathogen Interactions
  • Humans
  • Respiratory Syncytial Virus Infections* / immunology
  • Respiratory Syncytial Virus Infections* / pathology
  • Respiratory Syncytial Virus Infections* / virology
  • Respiratory Syncytial Virus, Human* / genetics
  • Respiratory Syncytial Virus, Human* / immunology
  • Respiratory Syncytial Virus, Human* / pathogenicity
  • Respiratory Syncytial Virus, Human* / physiology
  • Viral Proteins / metabolism
  • Virus Replication

Substances

  • Viral Proteins