Respiratory syncytial virus (RSV) is the most important virus mediating lower respiratory tract illness in infants and young children. RSV infection is associated with pulmonary inflammation and increased levels of substance P (SP), making the airways and leukocytes that express SP receptors susceptible to the proinflammatory effects of this peptide. This study examines combining neutralizing anti-F glycoprotein and anti-SP antibody treatment of RSV-infected BALB/c mice to inhibit RSV replication and inflammation associated with infection. BALB/c mice were prophylactically treated with antibody prior to RSV infection or were therapeutically treated at day 2 or 6 post-RSV infection. Prophylactic or therapeutic treatment with anti-SP antibodies promptly reduced pulmonary inflammatory cell infiltration and decreased the number of cells expressing proinflammatory cytokines, while anti-F antibody treatment reduced virus titers. The results suggest that combined anti-viral and anti-SP antibody treatment may be effective in treating RSV disease.Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract disease in infants and young children worldwide. A member of the Paramyxoviridae family, RSV is an enveloped virus containing a negative-sense single-stranded RNA genome. The protective immune response to RSV infection is primarily directed against the two major surface viral glycoproteins, i.e., the G (attachment) and F (fusion) glycoproteins. The F glycoprotein appears to be most important for induction of protective immunity and is associated with a high serum neutralizing antibody response (6, 37) and activation of CD14 and Toll-like receptor-4 (21). Some monoclonal antibodies against the F glycoprotein provide passive protection against RSV disease (8,13,18,42); therefore, the F glycoprotein has been the focus for therapeutic intervention in RSV disease.At present, there is no RSV vaccine available, and the only options to address disease are prophylactic administration of enriched anti-RSV human immune globulin (Respigam) or anti-F glycoprotein monoclonal antibodies (palivizumab [Synagis]), both of which are recommended only for young children at high risk for RSV disease. In addition, ribavirin (Virazole), the only specific antiviral agent approved for RSV infection, has limited efficacy (10, 19, 41; M. I. Marks and J. McBride, abstract from Ribavirin Therapy for Respiratory Syncytial Virus Infections: a Scientific Workshop, Sept., 1989, Pediatr. Infect. Dis. J. 9:S84, 1990), and its use is limited for treatment of RSV infection in immune-compromised patients (10, 43).Treatment with anti-RSV human immune globulin or anti-F glycoprotein neutralizing antibodies is effective in decreasing the titer of virus but does not appear to ameliorate the disease process, suggesting that a substantial portion of disease is associated with the host response to infection (27). The importance of the host response to infection is also suggested by the prominence of obstructed-airway disease and wheezing durin...