Proposed mechanism of increased RSV B neutralization potency with nirsevimab binding site substitution Q209R.
VIRUS
Red indicates the electrostatics of the negatively charged pocket on nirsevimab, created by glutamic and aspartic acids (E55 and D101). Green dashed lines indicate polar contacts. F fusion protein, RSV respiratory syncytial virus.A subsequent investigation into the RSV B I64T:K68E and N208S substitutions that were associated with nirsevimab resistance was also performed. I64, K68, and N208 have all been reported to interact with nirsevimab