Although SARS-CoV-2 has been detected in the brain tissue of patients, its entry pathways and resulting consequences are not well understood. In this study, the researchers demonstrate a distinct upregulation of interferon signalling pathways in the neurovascular unit in lethal COVID-19. Examined the susceptibility of human induced pluripotent stem cell (hiPSC)-derived brain capillary endothelial-like cells (BCECs) to SARS-CoV-2 infection and found that BCECs were infected and recapitulated the transcriptional changes detected in vivo. While BCECs were unaffected in their paracellular tightness, SARS-CoV-2 was found in the basolateral compartment in transwell assays after apical infection, suggesting active replication and transcellular transport of the virus across the blood-brain barrier (BBB) in vitro. Moreover, entry of SARS-CoV-2 into BCECs could be reduced by anti-spike, anti-angiotensin-converting enzyme 2 (ACE2)-, and anti-neuropilin-1 (NRP1)-specific antibodies or the transmembrane protease serine subtype 2 (TMPRSS2) inhibitor nafamostat. Taken together, the data demonstrate that SARS-CoV-2 enters the brain via the BBB and leads to increased interferon signalling.
The blood-brain barrier is dysregulated in COVID-19 and serves as a CNS entry route for SARS-CoV-2
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