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Severe Acute Respiratory Syndrome Coronavirus 2 Infection Reaches the Human Nervous System: How?

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blood–brain barrier, bloodcerebrospinal‐fluid‐barrier, blood–nerve barrier, blood–nervous system barrier, COVID‐19, double membrane vesicles cargo route, lymphatic brain drainage route, macrophage/monocytes cargo route, neurotropic virus, nicotinic acetylcholine receptor, olfactory route, peripheral nerve or neuronal retrograde route, SARS‐CoV‐2



Without protective and/or therapeutic agents the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection known as coronavirus disease 2019 is quickly spreading worldwide. It has surprising transmissibility potential, since it could infect all ages, gender, and human sectors. It attacks respiratory, gastrointestinal, urinary, hepatic, and endovascular systems and can reach the peripheral nervous system (PNS) and central nervous system (CNS) through known and unknown mechanisms. The reports on the neurological manifestations and complications of the SARS‐CoV‐2 infection are increasing exponentially. Herein, we enumerate seven candidate routes, which the mature or immature SARS‐CoV‐2 components could use to reach the CNS and PNS, utilizing the within‐body cross talk between organs. The majority of SARS‐CoV‐2–infected patients suffer from some neurological manifestations (e.g., confusion, anosmia, and ageusia). It seems that although the mature virus did not reach the CNS or PNS of the majority of patients, its unassembled components and/or the accompanying immune‐mediated responses may be responsible for the observed neurological symptoms. The viral particles and/or its components have been specifically documented in endothelial cells of lung, kidney, skin, and CNS. This means that the blood–endothelial barrier may be considered as the main route for SARS‐CoV‐2 entry into the nervous system, with the barrier disruption being more logical than barrier permeability, as evidenced by postmortem analyses.


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Journal of Neuroscience Research, v. 99, issue 3, p. 750-777