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. 2022 Sep 11;11:40. doi: 10.1186/s40035-022-00316-y

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© The Author(s) 2022

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/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 2 — SARS-CoV-2 infects the brain via the haematogenous route. a SARS-CoV-2 is a respiratory virus that spreads primarily through airborne droplets, causing infection of the lungs. Left panel: SARS-CoV-2 infection of the lungs may lead to endothelial damage and increased capillary permeability, which allow the transfer of SARS-CoV-2 from the lungs to the pulmonary microcirculation. Right panel: SARS-CoV-2 in the blood can enter the cerebral circulation, where the slow blood flow may allow the virus to damage the BBB. b Viruses in the cerebral circulation may infect and destroy microvascular endothelial cells, resulting in increased BBB permeability and facilitating viral entry into brain tissues. c SARS-CoV-2 infects brain cells via the interaction of S protein with ACE2, NRP1 and other potential receptors on microvascular endothelial cells after the S protein is primed by TMPRSS2. Once SARS-CoV-2 enters the cell, the viral life cycle begins, including genome replication, protein synthesis, virus assembly, maturation and release, ultimately leading to brain parenchyma infection and tissue damage