SUDAN VIRUS DISEASE: MOLECULAR PATHOGENESIS, PHARMACOLOGICAL TARGETS AND EMERGING THERAPEUTIC STRATEGIES
TL;DR
A review of current understanding of SUDV molecular biology, host–pathogen interactions, and immunopathology with emerging pharmacological opportunities integrates current understanding of SUDV molecular biology, host–pathogen interactions, and immunopathology with emerging pharmacological opportunities.
Abstract
Sudan virus disease (SVD) is a severe, often fatal zoonotic infection caused by Sudan virus (SUDV; Orthoebolavirussudanense) and remains a major therapeutic challenge in East and Central Africa. Since its recognition in 1976, recurrent outbreaks, including those in Uganda in 2022 and 2025, have highlighted the absence of licensed SUDV-specific vaccines or therapeutics. This review integrates current understanding of SUDV molecular biology, host–pathogen interactions, and immunopathology with emerging pharmacological opportunities. Key targets include glycoprotein-mediated entry, endosomal trafficking, the RNA-dependent RNA polymerase complex, VP35 and VP24-mediated immune evasion, VP40-mediated assembly, and pathological inflammatory, endothelial, and coagulation pathways. Emerging countermeasures include nucleoside analogues, monoclonal antibodies, RNA-based therapeutics, host-directed agents, and vaccine platforms. However, limited clinical evidence, treatment timing, model-to-human translation, and outbreak-related trial challenges remain significant barriers. Adaptive clinical trials, optimized supportive care, and coordinated outbreak preparedness are essential for advancing effective SUDV countermeasures.