It was an evening full of laughter, tears, and celebration as friends, family, and co-workers of Michael Flannery, MD, gathered at the USF Health Morsani College of Medicine and Heart Institute to celebrate his life.

Among those in attendance were Charles Lockwood, MD, MHCM, USF Health senior vice president and MCOM dean; Jose Lezama, MD, FACP, vice chair of the USF Health Department of Internal Medicine and MCOM professor, who made his decision to stay at USF for his residency because of Dr. Flannery’s advice and leadership.

Dr. Flannery’s relationship with the University of South Florida spanned more than 30 years.  He began his journey as an undergraduate student, continuing on as a medical student and later as a resident, and then joining MCOM’s faculty in the Department of Internal Medicine as associate program director.  He played a key role in increasing the residency class sizes and establishing a nationally recognized board review course.  He was hailed by many of his students as the best teacher they ever had.

Outside of the clinic, Dr. Flannery spent his life and career helping others.  He was recognized as a Tampa Bay Health Care Hero for his instrumental role in creating the Saint Andre Free Clinic in Dade City to improving the access and quality of care to underserved populations.

Dr. Flannery died December 6, 2020, after a difficult battle with COVID-19.

More images from the event:

Since the launch of the COVID Confirmed (COCO) Clinic in early April, over 4,700 patients with COVID-19 have been given virtual follow-up services after being discharged from the hospital. Not only has this virtual outpatient clinic helped patients on their road to full recovery and often kept them from being readmitted to the hospital, it also provided resident physicians and senior medical, nurse practitioner, physician assistant, PharmD, social work and behavioral health students, with a place to complete their clinical rotations. In mid-March, the Association of American Medical Colleges (AAMC) issued new guidance for medical student clinical rotations during the coronavirus which stated that it, “strongly supports medical schools pausing all student clinical rotations, effective immediately, until at least March 31,” due to concerns about the availability of personal protective equipment (PPE) and to give time for appropriate educational strategies and alternative clinical experiences to be developed and implemented.

Volunteers and trainees played vital roles within the clinic which included conducting regular welfare checks, offering support and discussing any symptoms that haven’t been resolved. Social work and behavioral health students were not originally part of the COCO Clinic when it first launched, but the team quickly realized that COVID-19 and quarantine could severely impact a patient’s mental health and so the interprofessional team expanded. The medical, social, and mental health assessments screened for depression, anxiety and substance abuse, and if a patient answered “yes” to any of the questions, they were offered resources or referrals to support. According to Asa Oxner, MD, FACP, COCO Clinic operations director, one patient agreed to being referred to the mental health team of COCO and a real suicide attempt was mitigated.

In addition to regular follow-up assessments, nurse practitioner students were in charge of monitoring the dashboard that displays the oxygen levels and heart rates of high-risk patients who were wearing a special device on their wrist.

A patient wearing one of the COCO Clinic’s monitors. Photo by CBS affiliate, 10 Tampa Bay, from their, “COVID-19 Telehealth Clinic Getting Overloaded with Tampa Bay Patients” video.

“Volunteering with the clinic has been a unique educational experience. The clinic administrators do a great job of turning every opportunity into a teaching moment,” said Joshua Mizels, Morsani College of Medicine fourth-year medical student and past clinic volunteer. “My classmates who all volunteer have had the opportunity to keep interacting with patients, giving us the opportunity to learn more about what they are going through during this pandemic.  The experience from this opportunity has been invaluable toward my medical education. ”

Lucy Guerra, MD, MPH, FACP, and Asa Oxner, MD, FACP, co-coordinators of the COCO Clinic, along with Elimarys Perez-Colon, MD, medical director, Christine Jennings, RN, nurse manager, and Rachelle Idziak, MD, data manager, led the effort to get the clinic up and running and play a pivotal role in helping the community. For their dedicated efforts, the doctors received a USF Health Culture Coin from Chief Medical Officer, Dr. Mark Mosely.

Dr. Asa Oxner (left) and Lucy Guerra (right), COCO Clinic co-coordinators, were presented with USF Health culture coins by Dr. Mark Moseley, USF Health chief medical officer, for leading efforts to get the virtual clinic up and running.

“We have been successful in offering close follow up to patients keeping them out of the hospital when able, monitor patient’s vital signs remotely to identify patients at higher risk, safely linking patients to care and offering education and reassurance to patients with COVID19 in the Hillsborough county,” said Dr. Elimarys Perez-Colon, assistant professor of medicine, vice chief of medicine at Tampa General Hospital, and medical director of the COVID-19 Confirmed Clinic. “The data collected will assist our department of health to better understand the distribution and epidemiology of COVID19 in our county. This effort wouldn’t have been successful without the assistance and compassionate care offered by our trainees.” In the first three months, over 150 trainees played a part in the care of patients.

The COCO Clinic has been the talk of the town, featured in news stories by ABC Action News, Baynews 9, 10 Tampa Bay, among others.

After the success of the virtual clinic for COVID-19 patients, clinic leaders began working with partners at Tampa General Hospital and the Florida Department of Health to make the clinic a permanent resource for the community. As of November 12th, the COCO Clinic transitioned management of the clinic to TGH and became the TGH Transitional Care Center. “This transition will allow the clinic to continue operating and provide excellent care to our patients impacted by COVID-19, while allowing USF Quality and Clinical Operations Department staff who have been assisting the COCO clinic to return to their normal non-COVID duties,” said Dr. Moseley. “The clinic will continue to provide hours to our medical, pharmacy, and nurse practitioner students and our teaching attendings will continue to support the clinic. TGH has also been able to hire several RNs and Mas, who have been training in the current clinic and will be able to facilitate a smooth transition.” An emphasis will be put on taking care of COVID-19 ‘long haulers,’ virus survivors who continue to have side effects weeks, or months, after surviving the coronavirus. Caring for these patients will also help conduct research into the little known long term effects of COVID-19. Beyond COVID-19, the clinic can continue to help patients using the same monitoring and staffing model, but for serious chronic diseases such as heart failure or chronic obstructive pulmonary disease (COPD).

Inside four bustling rooms at USF Health Center for Advanced Medical Learning and Simulation (CAMLS), emergency medicine residents from USF Health, emergency nurses from Tampa General Hospital, and paramedics from Tampa Fire and Rescue worked together in simulation exercises to improve how they work as a team during intense emergency situations. Over the course of the day, the residents rotated through four scenarios: a patient with undifferentiated chest pain, a 5-year-old with complications from a snakebite, an infant with an unstable abnormal heartbeat, and a patient in cardiac arrest.

Ryan McKenna, DO, director of the interprofessional simulation fellowship at USF Health CAMLS and director of simulation for Emergency Medicine, guides participants through the snakebite simulation.

A team of emergency medicine residents from USF Health work together to help a manikin with undifferentiated chest pain.

The interprofessional team involved in the cardiac arrest simulation, practiced the process and communication of the transition from the pre-hospital team to the emergency department. This scenario was intentionally cut short after the first five minutes as a part of its educational design, also called scaffolding, said Ryan McKenna, DO, director of the interprofessional simulation fellowship at USF Health CAMLS and director of simulation for Emergency Medicine. The goal of this kind of teaching method is to make the information more manageable to retain by breaking up the lesson into segments. Not only does scaffolding avoid students becoming overloaded, but it also allows learners to identify subtle ways to improve that might be missed in a larger scenario.

“When you have focused efforts, you have a chunk of a component of that training that can now be brought into clinical practice and everyone has the same mental model and is applying it in the same way,” said Yasuharu “Haru” Okuda, MD, FACEP, FSSH, executive director of CAMLS and executive director of interprofessional education simulation programming for USF Health.

Paramedics from Tampa Fire and Rescue helped to bring the cardiac arrest simulation to life.

During one of the run-throughs of the cardiac arrest simulation, an observing resident noticed that the nurse performing chest compressions on the manikin might benefit from standing on a nearby stool to improve her ability to perform compressions. He brought it over to her and placed it by her feet, but the message about the height-assistance was lost in the chaotic sounds of the emergency department and she did not notice the stool was there until the end of the simulation. That is just a simple example of the kind of communication gaps that can result in a missed opportunity or medical error in a hospital and it’s a small area for improvement that would have been missed in a more complex simulation. Many of the residents reported back to Dr. McKenna that they were already using the skills they learned to improve the hand-off in the subsequent days following the simulation-based training.

An interprofessional team including emergency medicine residents from USF Health, emergency nurses from Tampa General Hospital, and paramedics from Tampa Fire and Rescue, came together for simulation-based training.

In November 1999, the Quality of Health Care in America Committee of the Institute of Medicine (IOM) released a report called To Err is Hu­man: Building a Safer Health System that stated as many as 98,000 hospital deaths occur each year due to medical error. Communication error is described as the cause of 60% to 70% of those preventable hospital deaths.

“We’ve done a lot of amazing things in technology and medical knowledge and science, but I think one thing that we haven’t done well enough in health care is really learning to work together in teams,” Dr. Okuda said.

Twenty years after the IOM’s report, the statistics are still alarming. In an effort to make life better and combat medical errors, USF Health incorporates interprofessional education as a primary part of its curriculum.

“Especially in the ER, it’s a team discipline,” said Kelsey Hundley, MD, second-year emergency medicine resident with the USF Health Morsani College of Medicine. “Learning how to interact with people with different backgrounds and roles on the team is really important.”

Kelsey Hundley, MD, second-year emergency medicine resident with the USF Health Morsani College of Medicine, works with her team to help the infant with an unstable abnormal heartbeat.

Simulation exercises as a part of interprofessional education allows participants to practice in a realistic but safe environment, both for the learners and for the patients.

“It was a pretty enjoyable experience,” said Adam Koby, MD, second-year emergency medicine resident with the USF Health Morsani College of Medicine. “We see these scenarios all the time in real life, but there’s always the opportunity to improve and I feel the way that you would improve the most is to practice those situations. During these simulations, we learn about individual pathologies, but more importantly, about team building.”

Adam Koby, MD, second-year emergency medicine resident with the USF Health Morsani College of Medicine (right), listens to Dr. McKenna during the debrief of the snakebite simulation.

When the various medical professions came together and were working in a training environment, “I saw smiles, energy and enthusiasm and I’ll bet you, for many of these folks, they won’t forget this,” Dr. Okuda said. “They shared the passion and I think coming together outside the clinical environment often builds stronger teams. So beyond just the training, there are the personal connections and the bonds that were created through this environment and interaction.”

Participants shared laughs and smiles during the simulation-based training held at the USF Health Center for Advanced Medical Learning and Simulation.

Dr. Christian Bréchot will help elevate biomedical and health-related areas of research excellence to the international level

The former head of the world-renowned Pasteur Institute in Paris has joined USF Health to help university leaders strengthen biomedical and health-related areas of research excellence – and to elevate interdisciplinary signature programs to the international level.

Christian Bréchot, MD, PhD

Preeminent virologist Christian Bréchot, MD, PhD, joined the USF Health Morsani College of Medicine part time in October as senior associate dean for research in global affairs, associate vice president for international partnerships and innovation, and a professor in the Division of Infectious Disease, Department of Internal Medicine.  Dr. Bréchot is also executive director of the Tampa-based Romark Laboratories Institute for Medical Research. Since 2017, he has served as president of the Global Virus Network, a coalition of the world’s foremost medical virologists.

“Dr. Bréchot has been at the forefront of catalyzing teams of top scientists to work together effectively on global solutions for emerging pathogens, malaria and microbial infections,” said Charles Lockwood, MD, senior vice president for USF Health and dean of the Morsani College of Medicine. “He is the ideal person to work with leadership across USF Health and USF in strategically identifying opportunities to take our infectious diseases, cardiovascular, neuroscience, and maternal-child health translational research to the next level, and to build upon the international networks he helped create at the Pasteur Institute and elsewhere to make that happen.”

Before serving as president of the Pasteur Institute from 2013 to 2017, Dr. Bréchot was vice president of medical and scientific affairs at Institut-Merieux, a company that develops new approaches to fight infectious diseases and cancers.  He also served as the general director of Inserm, the French national agency for biomedical research (analogous to the National Institutes of Health in the U.S.) from 2002 to 2007. As professor of hepatology and cell biology at Necker School of Medicine, Paris Descartes University, he headed the clinical department of liver diseases at Necker-Enfants Maldes Hospital from 1997 to 2001.

Dr. Bréchot has authored more than 400 articles in medical and scientific journals, and in 2005 was ranked by the Institute for Scientific Information as the 4^th most cited author on the topic hepatitis C. He has been recognized as an inventor on 18 patents, and helped to create three biotechnology companies.

With a prestigious career bridging basic science and medicine, Dr. Bréchot has combined research, clinical service and teaching with top administrative posts to enhance scientific understanding and better public health. His scholarly endeavors have included cultivating productive public-private partnerships between academia and industry.

During a recent interview in his office at USF Health, Dr. Bréchot talked about leading the Pasteur Institute, a preeminent global network of 33 institutes in 26 countries; his diverse background; and his new role at USF Health.  The interview has been edited for length.

What has been your area of research focus?

As an MD-PhD, I’ve always been convinced of the need to combine basic research with clinical practice — long before translational medicine became fashionable. My basic science research has combined cell biology and molecular virology, mostly focusing on hepatitis B (HBV) and hepatitis C (HCV) and how these viruses can induce liver cancer. I’ve also been very involved in developing diagnostic tests of HBV and HCV and evaluating new drugs to treat chronic forms of the infection.  More recently, I’ve worked on the mechanisms of liver regeneration and based on longstanding research activity in my laboratory, we discovered a new molecule (HIP/PAP, or hepatocarcinoma-intestine-pancreas/pancreatic associated protein), now being tested in clinical trials as a drug that may be useful for patients with a severe form of acute and chronic hepatitis. We’re contemplating organizing new phase 2 clinical trials in China, because China has so many people with chronic hepatitis B infection.

What were some major accomplishments at the Pasteur Institute under your leadership?

First, both at Inserm and the Pasteur Institute, I was very much focused on attracting and supporting young investigators. We created programs and special funding mechanisms to really give scientists at the early stages of their careers the means to develop interdisciplinary research and then get a grant. Second, at Pasteur, we reinforced research activities, especially in the fields of bioinformatics and integrative biology. We created a Center for Bioinformatics, Biostatistics and Integrative Biology (an international multidisciplinary center for processing, analyzing and modeling biological data) that included recruiting 40 high-level engineers and opening a new building.  Third, we merged the activities of different departments focused on the microbiota. For instance, we had a program called Brain and Microbes in which scientists working on infectious agents and those working in the neurosciences looked at how the bacteria of the intestine can modulate brain function, including disorders such as anxiety and depression.

What is the microbiome, and why is it such a hot area of research interest?

The microbiota is made up of populations of bacteria, fungi, certain viruses and other microorganisms present throughout the body.  It’s actually a very old topic:  The first microbiota intervention (to treat diarrhea) was done by a Chinese doctor 3,000 years before Christ (the ancient equivalent of a fecal microbiota transplant). What’s new is our technological progress – with the capacity for genome sequencing and advances in bioinformatics, we now have the possibility to investigate the human microbiota like never before… As a result, we’ve discovered very significant connections between dysbiosis — modifications of how microbe populations are distributed in the gut, the lungs, the skin — and metabolic disorders such as obesity and diabetes, cardiovascular diseases, neurological diseases like Parkinson’s and perhaps also Alzheimer’s, and some infectious diseases where disease severity correlates with what happens to intestinal bacteria. It’s a fascinating, challenging field with applications for cross-disciplinary research and translational medicine, and where international cooperation can be extremely interesting because the link between, say for example, the microbiota and diabetes may be very different in the U.S. and Africa due to the strong influence of environmental factors such as nutrition, as well as genetic variations… So, the science of microbiota as it affects certain diseases is a very good example of a collaboration which, if organized with centers in Africa, Southeast Asia and South America, could create a unique USF program very competitive with other universities.

What attracted you to the University of South Florida?

USF already has a lot of excellent ongoing research activities and in my discussions with senior leadership I found there’s real international ambition here, a desire and commitment to go further. I liked that.

What is your vision for helping advance research at USF Health?

I’m still in the stage where I need to listen and learn more about the research activities to see how I can best contribute. But, initially I want to work with Drs. Lockwood, (Paul) Sanberg, (Stephen) Liggett, (John) Sinnott and other leaders to delineate which strategic research areas need to be reinforced and then contribute to the high-level recruitment of scientists. Second, we’ll increase coordination among different departments working in research areas such as the intestinal microbiota and its impact on cardiovascular, neurodegenerative and infectious diseases. Third, I hope to contribute to the international expansion of USF, building upon the networks from my previous activities including work with industry partners.

I absolutely appreciate that I will only be efficient in helping to advance research activities at USF if I integrate into the team. It’s not always easy, but it works.

Dr. Bréchot will build on global networks from his previous activities, including work with industry partners.

You have said talent is key to research excellence. Is there one predominant quality you seek in selecting top talent?

You start by looking for bright minds. But, when you must choose among five scientists all with very bright minds, enthusiasm and the capacity to integrate are critically important. I’m a fan of soccer where you need to have very talented players, but you also very much need players with team spirit. Modern science needs researchers with an interdisciplinary mode of thinking who interact well with those from other disciplines.

Some things you may not know about Dr. Bréchot:

-Each generation of Dr. Bréchot’s family, dating back to King Louis XIV of France, had at least one medical doctor.

– As a student at Pasteur Institute, he helped set up the first diagnostic test to detect hepatitis B virus in blood; he also taught the first course in molecular biology in China in 1981.

-He met his wife Patrizia Paterlini Bréchot, MD, PhD, a professor of medicine at Necker School of Medicine and founder of a biotech company, when she came from Italy for a postdoctoral fellowship at Necker and Pasteur Institute in Paris. His five grown children include two MD-PhDs: a daughter who is a cancer immunologist at Pennsylvania State University, and a son who directs an intensive care unit at Pitié–Salpêtrière Hospital in Paris, one of Europe’s largest teaching hospitals. There are also six grandchildren, ranging from ages 1 to 11.

-Dr. Bréchot enjoys jogging, playing tennis and snow skiing. Currently, he’s reading about U.S. history, including biographies of George Washington and Abraham Lincoln.

-Photos by Eric Younghans, USF Health Communications and Marketing

USF Health’s Dr. Kami Kim probes the epigenetics of two global parasitic infections, malaria and toxoplasmosis

//www.youtube.com/watch?v=LWdihnsDl7U

While an undergraduate at Harvard University, Kami Kim, MD, participated in a research thesis project exploring leukemia’s resistance to chemotherapy and the effectiveness of combination drugs in combatting it.  While she was excited to help figure out (and publish) a mechanism, she recalls that she signed on for this laboratory research primarily “to help in get into medical school.”

Her interest in research intensified in medical school in early 1980s at the beginning of the domestic AIDS era, about the same time tuberculosis cases were exploding and malaria, once considered virtually eliminated as a major public health threat, began to re-emerge globally.

“It was clear that there was much to be done in infectious diseases research — a lot of interesting problems that needed to be solved,” said Dr. Kim, who joined the USF Health Morsani College of Medicine last year as a professor in the Department of Internal Medicine’s Division of Infectious Disease and International Medicine.

Kami Kim, MD, a USF Health professor of infectious disease, with her multidisciplinary laboratory research team, which includes expertise from the medicine, public health, mathematics and statistics

 Undergraduate laboratory work that sparked a lifelong passion for research

Basic science and clinical infectious diseases expertise

After clinical training as an infectious diseases fellow at the University of California San Francisco (UCSF) – and witnessing firsthand the devastating consequences of acquired immunodeficiency syndrome – Dr. Kim returned to laboratory research, with an emphasis on parasitic infectious diseases.  Meanwhile, she continued to see patients as an attending academic physician at some of the nation’s best hospitals in San Francisco and New York City.

That blend of rigorous clinical and basic science expertise makes Dr. Kim one of the first of several high-profile, energetic recruits who will help take USF Health’s global infectious disease research to the next level.

Dr. Kim came to USF Health in November 2017 from Albert Einstein College of Medicine in New York City, where she was a professor of medicine, microbiology and immunology, and pathology.  In addition to her laboratory research at USF, she consults monthly on infectious diseases cases at Tampa General Hospital. At Einstein, she directed the infectious diseases section of the Center for Epigenomics and helped launch and led the National Institutes of Health-funded Geographic Medicine and Emerging Infections Training Program, which supports interdisciplinary training in translational research for pre-doctoral students, post-doctoral research fellows and clinical fellows.

A plaque formation of the intracellular parasite Toxoplasma gondii

Seeking solutions to life-threatening global parasitic diseases

Dr. Kim’s USF Health research team, working out of a laboratory in the university’s research park, focuses on two major areas — malaria and toxoplasmosis.  The world’s most dangerous parasitic disease, malaria claims more than 2 million victims and 445,000 deaths yearly, primarily in sub-Saharan Africa. Toxoplasmosis, often asymptomatic, can be life-threatening to babies born to women infected during pregnancy and people with weakened immune systems.

• Toxoplasmosis project: Combining advanced techniques from genetics, cell biology and proteomics, the researchers investigate the ways that epigenetics – the interface of genetics and environmental factors – regulate development of chronic infection by the cat-borne gondii parasite. They seek to understand how this pervasive parasite switches back and forth between a rapidly dividing acute stage destructive to healthy tissue (tachyzoite) and a chronic, or dormant, stage, where bradyzoite forms within pseudocysts remain invisible to the immune system. Dr. Kim collaborates with other leading Toxoplasma experts: Distinguished USF Health Professor Michael White, PhD, a long-time colleague, as well as investigators at Indiana University, Pennsylvania State University and Albert Einstein College of Medicine.
• Malaria project: In the hot, wet regions of Africa, mosquitoes are ubiquitous and children exposed to malaria from birth may contract the infection several time a year. The overwhelming majority of clinical cases are uncomplicated, with flu-like symptoms of fever and malaise that typically resolve. Researchers are trying to determine why a small percentage of individuals, in particular certain children, are more likely to develop severe malaria with coma and death (cerebral malaria) or long-term neurological complications such as seizures and cognitive and behavioral problems. In particular, the USF team is assessing specific biomarkers, or genetic predispositions, and parasite or host factors that may help predict disease development or its outcomes.

 Dr. Kim discusses research correlating HIV co-infection with cerebral malaria.

Research instructor Iset Vera

Both research initiatives harness the latest genomic technology to better understand how immunity works within the framework of host-parasite interactions – all with the aim of devising better or first-time treatments.

Valuable insights into cerebral malaria, future therapies

With collaborators from the Blantyre Malaria Project, based in Malawi, Africa, Dr. Kim published a high-profile paper in mBIO in 2015 reporting for the first time that children co-infected with HIV were much more likely than those who were not to die from severe malaria. Autopsies of the children who died from cerebral malaria indicated that those with HIV had brain blood vessels more clogged with white blood cells and platelets than those of children with malaria alone.  HIV appeared to rev up brain inflammation that could lead to death.

In another study, published in Cell Host & Microbe in 2017, Dr. Kim and colleagues used neuroimaging, parasite transcript profiling and laboratory blood profiles to develop machine-learning models of malarial retinopathy and brain swelling. The researchers found that the interaction of high parasite biomass, low platelet levels and certain parasite protein variants that bind to the endothelial protein C receptor (EPCR) play a pivotal role in fatal cases of malaria. Their findings added strength to the rationale that anti-inflammatory and anticoagulant treatments counteracting the breakdown of endothelium may benefit those with severe malaria.

“We still don’t entirely know why some of these kids get super sick and have complications requiring hospitalization,” Dr. Kim said. “If we could figure that out we could save lives, reduce complications and use limited healthcare dollars more effectively in these under-resourced countries.”

.

 The “Goldilocks” theory of immunity

When it comes to infectious diseases, too much of a good thing may make you sick.  Dr. Kim calls it the “Goldilocks” theory of immunity – not too much (overactive immune system) and not too little (under-responsive immune system).

For instance, “for someone with malaria the right amount of immunity might not be just the right amount if they already also have tuberculosis,” Dr. Kim said. “What we’re realizing now with the human immune response to parasites or other foreign invaders (pathogens) is that you have to get the balance just right, so you get rid of the pathogen without damaging the human host.”

Otherwise, she added, even after the pathogen is eliminated, long-term complications like a damaging autoimmune inflammatory condition may linger.

Rigorously studying the dynamics of host-parasite interaction – including how parasites hijack the epigenome, which adjusts specific genes in response to signals from the outside world such as diet and stress — is critical to bridging the gap between discovery and effective treatments for different subgroups of infected patients.

“Both the pathogen and the infected host are duking it out to see which one wins, so figuring out what’s happening on both sides is really important to understanding immunity – how our body fights off disease,” Dr. Kim said. “Using genomic information to tell us who’s most susceptible to certain conditions will likely help us to tailor therapies to the individual, or perhaps to know who needs to be vaccinated.”

Dr. Kim with Li-Min Ting, PhD, an assistant professor in the Department of Internal Medicine’s Division of Infectious Disease

 Striking the right balance of immunity

Potential applications for other diseases

Within their complex life cycles, both malaria and toxoplasma parasites have dormant forms that the human immune system can’t identify and kill, and antimicrobial drugs can’t touch.  For malaria, this silent form lurks in the liver. For Toxoplasma, cysts can settle quietly into the infected person’s brain and muscle tissue without replicating, sometimes for years, until weakened immunity reactivates the disease.

Dr. Kim and other researchers continue to look for new ways to combat chronic infection by parasites.

“Normally when treating a disease you think of killing the form that makes a person clinically symptomatic,” she said, “but with both malaria and Toxoplasma if you can kill the biologically silent form, which is absolutely essential for the disease to continue, you’re accomplishing the same thing.”

Although Dr. Kim’s group targets specific problems underlying malaria and toxoplasmosis, such immune research may have broad applications for understanding and treating other conditions.  For instance, atherosclerosis has been linked to the release of molecules from the immune system that can cause inflammation, blood vessel injury and plaque instability leading to heart attacks and stroke.

A T. gondii plaque assay

“Even though drug companies, because of financial return on investment, aren’t necessarily willing to invest in research on malaria host factors,” Dr. Kim said, “they are really interested in stroke and cardiovascular disease.  And the big players in the kind of inflammation seen in these two major diseases are platelets and monocytes” – the same inflammatory culprits implicated in cerebral malaria.

While more research is needed, perhaps statin and antiplatelet drugs already approved for another indication could be effective in helping combat malaria,” she said. “It’s entirely possible by better understanding what’s a good immune response to malaria in one situation and bad in another will lead to insights that can be used to develop treatments for other diseases, or insight into what’s protective in another disease.”

Pursuing new approaches to outsmart elusive pathogens

Dr. Kim received her MD degree from the Columbia College of Physicians and Surgeons in New York City. She completed her residency in medicine at Columbia-Presbyterian Medical Center, a clinical fellowship in infectious diseases at UC San Francisco, and two postdoctoral research fellowships – one in parasitology at San Francisco General Hospital and a second in microbiology and immunology at Stanford University.

Dr. Kim is a fellow of the Infectious Diseases Society of America and the American Academy of Microbiology. She is also an elected member of American Society for Clinical Investigation and the Association of American Physicians, national honor societies for physician-scientists. A recipient of the Burroughs Wellcome Fund (BWF) New Investigator Award in Molecular Parasitology early in her career, she has served on the BWF Postdoctoral Research Enrichment Program’s scientific advisory board since 2014.  She is a member of the NIH Pathogenic Eukaryotes Study Section.

The cutting-edge tools of computational genomics contribute to Dr. Kim’s work.

Throughout much of her career, Dr. Kim’s research has been funded by the National Institute of Allergy and Infectious Diseases.  She holds several patents, and was one of the first investigators to develop techniques to genetically manipulate T. gondii. She is the co-editor and currently preparing the third edition of Toxoplasma gondii, the Model Apicomplexan: Perspectives and Methods, a textbook widely considered the seminal source for scientists and physicians working with this parasite.

Dr. Kim said she was attracted to USF because of the university’s upward national trajectory and USF Health leadership’s commitment to building translational research and pursuing innovative approaches and excellence in all its academic missions. She is a member of the USF-wide Genomics Program.

“I enjoy being part of a USF clinical community that excels in the treatment of infectious diseases and working with physicians and scientists who do parasitology research,” she said.  “You constantly have to think outside the box and come up with clever strategies – because we’re dealing with pathogens that do not behave like they are supposed to.”

 Toxplasma parasite strategy for survival

Dr. Kim, one of the first investigators to develop techniques to genetically manipulate Toxoplasma gondii, co-edits a textbook widely considered the seminal source for scientists and physicians working with this parasite.

Some things you might not know about Dr. Kim

• Korean was her first language, and she also speaks Spanish.
• She enjoys food, arts and crafts, and travel. Countries she has visited include Korea, Malawi, South Africa, France, Japan, and Brazil.
• Kim is married to Thomas McDonald, MD, USF Health professor of cardiovascular sciences and director of the new Cardiogenetics Clinic. They have two sons who are both mathematicians, one in a mathematics PhD program and the other in college. They met in the cardiac intensive care unit at Columbia Presbyterian Medical Center when Dr. McDonald was a resident and Dr. Kim was rounding as a medical student.

Dr. Kim’s career as an infectious disease physician-scientist bridges basic research and clinical practice.

-Video and photos by Torie M. Doll, USF Health Communications and Marketing

Dr. Jolan Walter, recruited by both institutions, leads first national genetic screening study for WHIM syndrome, a rare and potentially deadly primary immunodeficiency

From left: Krisztian Csomos, PhD; Jolan Walter, MD; Vicki and Fred Modell

USF Health immunologist Jolan Walter, MD, PhD, was recently visited by Vicki and Fred Modell, co-founders of the Jeffrey Modell Foundation, a global non-profit organization dedicated to diagnosis, treatments and, ultimately, cures for primary immunodeficiency diseases through research, advocacy, patient support and newborn screenings.

The Modells came to St. Petersburg May 24 to tour USF Children’s Research Institute laboratories of pediatrics faculty members Dr. Walter, Jennifer Leiding, MD, Larry Dishaw, PhD, and others. They also rededicated a space in the nearby Johns Hopkins All Children’s Hospital infusion center, naming the space the Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies. The new center is led by Dr. Walter, the Robert A. Good Endowed Chair and division chief of Pediatric Allergy and Immunology at the University of South Florida and Johns Hopkins All Children’s Hospital.

Like the Modells’ foundation, the new center honors the memory of the their son Jeffrey, who died at age 15 from complications of primary immunodeficiency – a genetic condition that is chronic, serious, and often fatal.

Dr. Walter, who holds the Robert A. Good Endowed Chair in Immunology, has spent her entire medical career seeking to better understand the genetic mechanisms that cause babies to be born without functioning immune systems or with severely impaired immunity.

Beginning in July, Dr. Walter will lead the first national genetic screening study to aid in diagnosis of patients with WHIM syndrome, a rare, chronic and potentially deadly primary immunodeficiency. Sponsored by the Jeffrey Modell Foundation and clinical stage biotechnology company X-4 Pharmaceuticals, the study will screen up to 300 patients, referred from private offices, community hospitals and academic medical centers, and link clinical signs of the syndrome with the targeted genetic testing needed to confirm a mutation in the set of genes (C-X-C chemokine receptor type 4) causing WHIM.

“The journey for patients with WHIM is long and winding, and can take them to numerous pediatric and adult specialists before specific genetic diagnosis and treatment may be offered. This study aims to establish a systematic approach for the early diagnosis of WHIM patients among physicians working in different fields,” said Dr. Walter, an associate professor of pediatrics at USF Health.  “Most importantly, if the disease is confirmed genetically, patients can begin targeted CXCR4 receptor agonist treatment promoting personalized medicine. We have ongoing clinical trials to help patients receive the medication.”

The Modells co-founded the Jeffrey Modell Foundation in 1987 in memory of their son who died at age 15 from complications of primary immunodeficiency. They recently toured the laboratory of Dr. Walter and other pediatric faculty members at the St. Petersburg-based USF Children’s Research Institute.

Dr. Walter was still a high school student in Hungary when the Jeffrey Modell Foundation was established in 1987. She was not even born when Dr Robert Good, the physician-scientist regarded as the “father of modern immunology” and whose endowed chair Dr. Walter now holds, performed the first successful human bone marrow transplant in 1968 between persons who were not identical twins.

But, her work has been inspired by both.

She has spent her entire medical career seeking to better understand the genetic mechanisms that cause babies to be born without functioning immune systems or with severely impaired immunity — all in pursuit of discovering more accurate diagnoses and better treatments that will allow children to grow into healthy adults.

Dr. Csomos, who promotes basic and translational immunology research in Dr. Walter’s laboratory, speaks with Fred Modell.

An expert in combined immunodeficiencies and immune dysregulation, Dr. Walter was recruited to USF Health Morsani College of Medicine and Johns Hopkins All Children’s Hospital from Harvard Medical School in 2016.  At the USF Children’s Research Institute, just a two-minute walk from the hospital, she continues to build a team to revive in-depth molecular research in primary immunodeficiencies, which affect one in every 2,000 people. These deficiencies can range from life-threatening as in the case of the “boy in the bubble” who suffered from severe combined immunodeficiency (SCID) to milder forms where patients experience frequent pulmonary, sinus or other chronic infections, but also may present atypically with treatment-resistant autoimmune disorders such as cytopenias.

Dr. Walter is a collaborator on a National Institute of Allergy and Infectious Diseases grant investigating immune repertoire and function in typical and atypical SCID.

.

The Pediatric Allergy and Immunology team trains fellows on both sides of Tampa Bay working closely with the USF Department of Internal Medicine’s Allergy and Immunology Division led by Richard Lockey, MD.  Dr. Walter’s St. Petersburg-based team members include:

• Leiding, who has been instrumental in the clinical research and care of patients with a wide selection of primary immunodeficiencies.
• Mark Ballow, MD, nationally recognized in diagnosis and management of antibody deficiencies.
• Panida Sriaroon, MD, a clinical expert in primary immunodeficiencies and leader of the Allergy and Immunology Fellowship Program.
• Krisztian Csomos, PhD, recruited by Dr. Walter from Harvard, promotes basic and translational immunology research for Johns Hopkins All Children’s Hospital as part of the Walter’s laboratory.
• Mandel Sher, MD, and Nathan Tang, MD, community physicians specializing in allergy and immunology, also support the team.

The research collaboration between USF Health and Johns Hopkins All Children’s Hospital has promoted multidisciplinary connections with specialties in hematology/oncology (including bone marrow transplantation), cardiology, rheumatology and neonatology.

-Photos by Ryan Noone, University Communications and Marketing

Tampa, Fla.  (Oct. 17) — Back from last week’s trip to Puerto Rico, USF Health’s Dr. Asa Oxner discussed her recent experience treating patients and assessing critical medical needs in outlying rural areas of the hurricane-ravaged island.

Dr. Oxner spoke with local news media outside the USF Health Morsani Center for Advanced Healthcare.  She was joined by USF Health Director of Safety and Preparedness Don Mullins, who oversaw the Oct. 11 delivery to Puerto Rico of 1,500 pounds of USF Health-donated medications and supplies aboard a jet chartered by the Tampa Bay Rays for a medical humanitarian mission.

“We saw lots of devastation – power lines cut in half, laying across roads and homes, bridges down and roads full of debris,” Dr. Oxner said.

Dr. Asa Oxner of the USF Health Department of Internal Medicine speaks with local news media about ongoing USF Health disaster relief efforts in Puerto Rico following her return from the island.

Dr. Oxner and Dr. Elimarys Perez-Colon, both assistant professors in the Morsani College of Medicine’s Department of Internal Medicine, spent five days in Puerto Rico working out of hospitals and shelters in devastated rural areas of Puerto Rico.  They also assisted in sorting and delivering supplies and medicine, — including insulin, IV fluids and tubing, and specialized baby formula — donated by USF Health, Tampa General Hospital and other provider partners.

Hospitals in urban areas like San Juan and Ponce where power and water have been restored are rebounding, and most of those critically injured from the hurricane have been treated and are recovering, Dr. Oxner said.

“The long-term health concern is patients with chronic illnesses like heart disease, diabetes and respiratory disorders who cannot access care,” she said.

They live in the central mountainous region of the island hit hardest by the hurricane, and mudslides continue to make many roads difficult to navigate, she added. “They will continue to have shortages in medications for chronic conditions, because the supply chain has been disrupted.”

A dozen cases of leptospirosis, a waterborne bacterial disease, have been reported to the Puerto Rico Department of Health, Dr. Oxner said, adding that the island is also at high risk for diseases like cholera that can emerge after disasters in places with contaminated water.

Dr. Oxner, who spent a year in 2014 helping patients infected with Ebola in Sierra Leone, has always been interested in helping underserved populations impacted by disparities in health care. “Those are the patients I connect with,” she said.

Dr. Oxner is one of 12 Spanish-speaking USF Health doctors, many with disaster experience, who will travel to Puerto Rico over the next two months. She plans to return to Puerto Rico at the end of October.

You can help with USF Health’s relief efforts in Puerto Rico.  Go to the USF Herd Funder site to contribute.

-Photo by Sandra C. Roa, University Communications and Marketing

Dr Kapil Patel was recruited from Stanford University known for its preeminent center

Pulmonologist Kapil Patel, MD, arrived at USF Health full-time Sept. 1 with one overarching goal in mind: to help lead and strengthen the Lung Transplant Program at Tampa General Hospital while strategically working to create a Center of Excellence for Advanced Lung Disease.

He came from Stanford University Medical Center, home to one the few such specialty pulmonology centers in the United States, which is known for its exceptional patient outcomes and consistently ranked by U.S. News & World Report as one of the best in the nation.

Pulmonologist Dr. Kapil Patel was recruited to the USF Health Morsani College of Medicine from Stanford University Medical Center.

“Dr. Patel’s recruitment is significant for USF Internal Medicine, the patients of USF Health and Tampa General Hospital and the community at large. His move from Stanford University to head the lung transplantation program is a landmark, making this the first solid organ transplant program to be part of USF in 35 years,” said John Sinnott, MD, chair of the Department of Internal Medicine, USF Health Morsani College of Medicine. “Dr. Patel’s vision for a center for advanced lung disease will place USF and Tampa General at the forefront of caring for patients with lung diseases in the United States.”

A center like the one at Stanford promotes continuity of care, allowing patients to be conveniently treated in one place by physicians who subspecialize in complex lung disorders, while cohesively providing the latest advances in medical and surgical care, said Dr. Patel, assistant professor of medicine in the Morsani College of Medicine’s Division of Pulmonary, Critical Care and Sleep Medicine and medical director for lung transplant, interstitial lung disease and adult cystic fibrosis.

“As you bring academic research to the forefront, it also opens opportunities for patients to participate in clinical trials that can afford alternatives to treatment they may not otherwise receive elsewhere,” he said.

Dr. Patel most recently directed the Stanford’s Interstitial Lung Disease (ILD) Program, one of the arms of the medical school’s Center for Advanced Lung Disease. He helped build physician referrals to Stanford’s ILD program from 100 to more than 200 in just over two years.

Providing integrated subspecialty care for complex lung diseases

Dr. Patel says he was attracted to USF Health by the opportunity to serve as medical director of an academic-affiliated lung transplant program and to build upon the solid foundation laid by Tampa General’s transplant team to create what could be Florida’s first center for advanced lung disease.

He plans to work with colleagues in USF Health Internal Medicine and Tampa General over the next several years to develop a center of excellence serving as the umbrella for four interconnected programs:

• Lung Transplantation: Tampa General already has an active program accredited by the United Network of Organ Sharing – one of five in Florida – and has performed more than 480 total adult lung transplants (single and double) since 2002. The program’s one-year patient survival rate of more than 91 percent and three-year survival rate of more than 71 percent both exceed national survival rate statistics. Dr. Patel plans to selectively grow a larger program.

“Selective is the way to go to do the right thing for patients. It is critical to identify appropriate candidates in need of transplant and to understand the limitations to transplant, so you do not push the limits too far,” he said. “We want to be confident that the surgery will go well, so the patient leaves the hospital with a new life.”

Since arriving here, Dr. Patel has worked closely with USF Health-affiliated cardiothoracic surgeon Christiano Caldeira, MD, of Florida Advanced Cardiothoracic Surgery, who serves as surgical director of the heart and lung transplant programs at TGH. They take donor calls together, jointly decide which donor organs are the healthiest for recipients, and co-manage lung transplant patients in the intensive care unit (ICU).

Dr. Patel with Nicole Davis, RN, a lung transplant coordinator at Tampa General Hospital.

• Interstitial Lung Disease, or ILD (also known as pulmonary fibrosis): This new program would manage the care of patients with a group of lung disorders causing tissue deep in the lungs to progressively stiffen and scar, which affects the ability to get enough oxygen into the bloodstream. Currently, Dr. Patel said, Florida has no ILD program certified by the Pulmonary Fibrosis Foundation (PFF) Care Center Network. Dr. Patel will lead an initiative by USF and TGH to establish the first.

• Cystic Fibrosis: Cystic fibrosis is an inherited disease that causes thick mucus to build up in the lungs, leading to repeated, serious lung infections. The Cystic Fibrosis Program at TGH is the largest adult program in the state certified and supported by the Cystic Fibrosis Foundation.

• Pulmonary Hypertension: USF Health pulmonologist Ricardo Restrepo-Jaramillo,MD, assistant professor of medicine, specializes in pulmonary hypertension – high blood pressure that occurs in the arteries that go from the heart to the lungs and may eventually lead to heart failure. He will become director of the new USF pulmonary hypertension program at TGH, Dr. Patel said.

Lung transplants are typically performed for people likely to die from lung disease within one to two years, when other treatments like medications or breathing devices no longer work, according to the National Heart, Lung and Blood Institute. ILD and cystic fibrosis are both conditions accounting for the most lung transplants nationwide, Dr. Patel said, with pulmonary hypertension affecting a smaller population of patients needing transplants.

Collaborating with community physicians

To create an integrated center, Dr. Patel plans to bring several pulmonologists with research as well as clinical expertise into the lung transplant program he directs, as well as recruit subspecialty directors for the ILD and cystic fibrosis programs. He will also add nurse practitioners to a team already supported by TGH nurse coordinators, respiratory therapists, social workers, dietitians and a pharmacist.

“When you manage patients with advanced lung disease, it takes a multidisciplinary team of professionals skilled in pre and post-transplant,” he said. “These are patients with complex conditions who need a lot of support and coordination,”

Dr. Patel sees patients at the Cardiac and Lung Transplant Clinic based at Harbourside Medical Tower.

More immediately, though, he is focusing on selectively increasing the referral base of patients by meeting with community physicians across the Tampa Bay region and seeing established pre-transplant patients in the clinic at Harbourside Medical Tower, Tampa General campus.

“I want doctors in the community to know that we are here to collaborate in the care of patients with advanced lung diseases,” Dr. Patel said. “Our availability is a priority, and ensuring the shortening of turn-around times for initial clinic visits is crucial, so that patients referred to the USF-TGH program are evaluated for medical care or transplant within weeks, not months. When someone needs a transplant, they need to be seen yesterday, and we work to intervene early.”

Advances in pulmonary transplant treatment

Over the last decade, advances in surgical techniques and significant improvements in post-operative care have contributed to improved survival of pulmonary transplant patients.

“We’ve gotten better at understanding what it takes to get these patients through transplants with fewer complications,” Dr. Patel said. “Once you get patients through the ICU following transplant, their chances of recovery and surviving a year or more out are much better.”

Medical therapy has also improved. For example, in 2014 the FDA approved the first medications (pirfenidone and nintedanib) to treat the most common type of pulmonary fibrosis, known as idiopathic pulmonary fibrosis (IPF). Until then, lung transplant was the only option for these patients, said Dr. Patel, who at Stanford led several site clinical trials testing the effectiveness of drugs for IPF.

Dr. Patel received his MD degree from the Medical University of Lublin in Poland. He completed a fellowship in pulmonary and critical care medicine at the University of Vermont and a dual heart-lung and lung fellowship at Stanford University Medical Center. He worked in private practice in Baltimore as well as holding faculty positions at the University of Vermont College of Medicine, the University of Maryland Medical Center, and Stanford.

Dr. Patel is a member of the American College of Chest Physicians and the International Society for Heart and Lung Transplantation.

A USF-TGH Center for Advanced Lung Disease won’t happen overnight. But Dr. Patel is confident that the vision can become a reality one purposeful step at a time.

“That’s why I came here,” he said. “We have a strong foundation and the pieces to grow.”

Photos by Eric Younghans, USF Health Communications and Marketing