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. 2021 Jan 22;34(2):539–555. doi: 10.1007/s40620-020-00956-1

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© The Author(s) 2021

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 2 — Proposed mechanisms of neural toxicity due to calcineurin inhibitors (CNIs). Blood–brain barrier (BBB) permeability can be altered by CNI-induced damage to the capillary endothelium or by other concomitant disorders (e.g. infection and inflammation). CNI crossing of the damaged BBB may lead to altered neuronal excitability and could result in direct toxicity on glial cells (astrocytes and oligodendrocytes), which are particularly susceptible to these agents due to their high calcineurin content