Skip to main content
. 2022 Jul 28;1:100013. doi: 10.1016/j.jmccpl.2022.100013

Fig. 1.

Fig. 1

Interplay between SARS-CoV-2 infection, neurological and cardiovascular complications. 1) Underlying neurological and cardiovascular comorbidities are associated with high mortality in patients with COVID-19. 2) Multiple molecules at the cell surface are involved in the entry of SARS-CoV-2, including the major receptor ACE2, the membrane protease TMPRSS2, and other potential alternative/auxiliary receptors or cofactors such as cathepsin L, a transmembrane glycoprotein CD147, high-density lipoprotein (HDL) scavenger receptor B type 1 (SR-B1) and neuropilin-1. The initial step of SARS-CoV-2 infection involves specific binding of spike protein (S) to the cellular entry receptor ACE2 and priming of S protein by TMPRSS2 at the cell surface or by cathepsin L in the endosomal compartment following ACE2-mediated endocytosis. After activation of the S2 domain on the spike, the virus enters the cell via membrane fusion. 3) Although the main presentation of COVID-19 is viral pneumonia, SARS-CoV-2 infection can also induce neurological and cardiovascular complications. Since the expression and tissue distribution of ACE2 dictates viral tropism and pathogenicity, ACE2 may facilitate direct invasion of neurons or myocardial cells leading to apoptosis and necrosis of neurons/cardiac and neighbouring cells. On the other hand, cytokine storm can damage an intact blood–brain barrier and disrupt the homeostasis of the central nervous system without the virus crossing the blood–brain barrier from the systemic circulation. In the cardiovascular system, an acute coronary syndrome can occur because of plaque rupture, coronary spasm or micro-thrombi owing to systemic inflammation or cytokine storm. In addition, the SARS-CoV-2 infection is associated with a pro-thrombotic state, which may lead to occlusion of blood vessels leading to injuries of both the heart and the brain. A part of this figure was created using “Mechanism of “SARS-CoV-2 Viral Entry” and “Cytokine storm” templates by BioRender.com (2020). Retrieved from https://app.biorender.com/biorender-templates.