Rising to the challenge of COVID-19
The University of Florida College of Pharmacy adapted to new conditions brought on by the COVID-19 pandemic.
When the spring semester began in January, no one in the UF College of Pharmacy could have predicted how it would end in May, but the college successfully moved its curriculum online, identified innovative ways for fourth-year students to complete their advanced clinical rotations and fulfilled a commitment to provide a high-quality pharmacy education. Additionally, researchers in the college contributed to the growing literature of understanding COVID-19, and clinical pharmacy faculty expanded their roles to better serve patients and the UF Health system.
Scientists pivot to COVID-19 research
The COVID-19 pandemic sidelined scientists across the University of Florida, as labs closed and experimental research halted for several months. But some scientists in the College of Pharmacy saw an opportunity to pivot their existing research to join the fight against COVID-19.
“It was either stay at home and fight the disease like everyone else or use our expertise to contribute to society by trying to develop a new wave of antiviral drugs,” said Hendrik Luesch, Ph.D., a professor of medicinal chemistry and the Debbie and Sylvia DeSantis Chair in Natural Products Drug Discovery and Development in the UF College of Pharmacy.
Luesch and his research team in the Center for Natural Products, Drug Discovery and Development began screening their existing and unique compound libraries to identify natural products from novel marine organisms that could work against the virus. They identified several ways to attack SARS-CoV-2 — the virus that causes COVID-19 — at the level of infection, viral replication and downstream inflammation.
“We hypothesized that several of our compounds might be effective at these different levels and generated a focused, mechanism-based marine natural product library that we are screening against the virus within a nationwide network of COVID-19 researchers,” Luesch said. “We focused on compounds that do not act on the RNA-dependent RNA polymerase, but in a totally different, complementary fashion.”
Out of the first 20 selected candidates, Luesch’s team already identified two compounds that completely eradicated the virus in a cell culture through a novel mechanism. The compounds are now being analyzed in validation studies, as well as more mechanism and in vivo efficacy studies and are subject to medicinal chemistry campaigns.
Meanwhile, at the UF Research and Academic Center at Lake Nona, Jürgen Bulitta, Ph.D., a professor of pharmacotherapy and translational research in the UF College of Pharmacy, Ashley Brown, Ph.D., an associate professor in the UF College of Medicine and affiliated associate professor in the UF College of Pharmacy, and George Drusano, M.D., a professor in the UF College of Medicine, are leading research efforts to identify and optimize antiviral therapy against SARS-CoV-2.
The Lake Nona scientists are studying an existing class of antiviral drugs called Nucleoside Polymerase Inhibitors, or NUCS, which have shown broad spectrum antivirus activity. The three NUCS they identified for study include the intravenous therapy drugs galidesivir and remdesivir and the oral antiviral drug favipiravir.
Juergen Bulitta, Associate Professor, UF College of Pharmacy along with his research team are working on COVID-19 research with several College of Medicine partners at Lake Nona.
“What makes these drugs special is that the parent compound is inactive and has to enter the cells to be converted within the cells into its active form,” Brown said. “There are several NUCS in development in vitro against a wide variety of viruses, and we found promising activity for several of them against other viruses in our prior work. We thought this would be the most promising place to start our research against SARS-CoV-2.”
Using translational antiviral pharmacology methods, human lung and colon cell lines were infected with the virus. After an hour of the virus attaching to the cells, it was washed away and replaced with varying concentrations of the drugs. Both galidesivir and remdesivir showed considerable activity at relatively low and clinically relevant concentrations, indicating the drugs’ potential in suppressing the virus. Remdesivir has further emerged as a COVID-19 treatment option, as the U.S. Food and Drug Administration issued an emergency use authorization in May. Meanwhile, favipiravir yielded some viral suppression but not at the same level as the other two drugs.
Identifying an effective antiviral therapy is only part one of the equation. The research team still needs to determine the optimal dose of the drug and how often it should be given to maximize viral suppression. Different modeling systems are being used to study the pharmacokinetic profile of the drugs, with the goal of predicting how the medicines will work in a patient population over time.
“We want to determine the dosing regimen that produces the fastest recovery and least toxicity for the patient,” said Bulitta, who also serves as the Perry A. Foote Eminent Scholar Chair in the UF College of Pharmacy. “Fortunately, UF has state-of-the-art technology and experts in experimental and mathematical modeling approaches here in Lake Nona. These capabilities enable us to come up with a scientifically sound and mechanistically informed dosage regimen in a very rapid basis to combat the crisis.”
Future clinical trials will be necessary for prospective validation. Brown, Bulitta and Drusano expect a clinically relevant dosage regimen for favipiravir to be available by fall. Work is already under way writing clinical protocols to support a clinical trial.
“It is really amazing how our research teams could come together and execute these drug studies in such a short time frame,” Bulitta said. “With Doctor Brown’s work on the antiviral efficacy studies, my team’s involvement in developing novel assays for intracellular concentration measurements and the combined effort of Dr. Drusano and myself working on the mathematical modeling, we’ve made it our collaborative mission to develop an effective therapy against SARS-CoV-2.”
Brown and Bulitta received a UF Clinical and Translational Science Institute, or CTSI, grant to support their research. The CTSI set up a $2 million pilot research fund for scientific teams with translational projects that could be rapidly mobilized during the pandemic.
COVID-19 shifts classes online
When Clinical Assistant Professor Stacey Curtis, Pharm.D., walked into the skills lab classroom on March 16, she was greeted by an eerie silence. The 30-40 first-year pharmacy students, who would typically gather for her Monday morning session, were nowhere to be found. Instead of welcoming her students to another week of classes in person, Curtis pulled out her laptop and opened a Zoom video conferencing meeting. Greeting her on the computer screen were dozens of those same, familiar faces ready for their first online skills lab. The same virtual learning routine would be repeated day after day across the college for the next eight weeks, as the University of Florida moved all its spring semester courses online.
“In many ways, the college was well prepared for the sudden transition to online learning,” said Shauna Buring, Pharm.D., associate dean for professional education. “Our Pharm.D. curriculum is set up in a way that faculty deliver lectures online and students come together for active-learning sessions, skills lab and tests. We determined quickly how to transition those in-person components to Zoom and use an online proctoring service for the exams.”
Clinical Assistant Professors Eric Egelund, Ph.D., Pharm.D., and Stacey Curtis, Pharm.D., led the first online skills lab for first-year pharmacy students on March 16.
The UF College of Pharmacy has been offering online education for more than 25 years and has successfully graduated thousands of students through its Working Professional Pharm.D. and online master’s programs. With video production and information technology teams, as well as the instructional designers and academic coordinators assisting the effort, the transition online was much easier than many students expected.
“Everyone in the College of Pharmacy was cooperative and understanding with the transition to virtual classes,” said Wendy Caba Piloto, a third-year pharmacy student. “They made sure all of us received the same quality education. Seeing how everything happened so smoothly makes me proud to be part of such a great institution.”
COVID-19 presented a different set of challenges for fourth-year pharmacy students on their final year of rotations. When COVID-19 cases increased in certain parts of the state, some Advanced Pharmacy Practice Experience, or APPE, sites decided they could not prioritize training health professions students. The Office of Experiential Programs quickly pivoted to find other opportunities for experiential learning.
Preceptors at sites minimally impacted by COVID-19 volunteered to train additional students, while other displaced pharmacy students took part in virtual APPE rotations, where they participated in simulation and patient case activities. Faculty in the College of Pharmacy also stepped up to fill other APPE needs to ensure every fourth-year student graduated on time.
50,000 tubes of viral transport media prepared for COVID-19 testing
Faculty, staff and students in the UF College of Pharmacy are supporting COVID-19 testing efforts at the University of Florida by labeling test tubes and making media for transporting viral samples. Each tube contains three milliliters of solution that preserves a COVID-19 test sample until it arrives at the lab. More than 50,000 test tubes have been labeled and filled since the work began in April.
Siobhan Malany, Ph.D., and associate professor of pharmacodynamics, fills test tubes with viral media to support UF's COVID-19 testing efforts.
Answering the Call: UF College of Pharmacy responds with call center support during pandemic
The battle against COVID-19 took place on many fronts, including a sprawling four-story office building on the east side of Gainesville and the UF Research and Academic Center in Lake Nona, which house the University of Florida College of Pharmacy’s Center for Quality Medication Management, or CQM. Inside the call centers, licensed pharmacists, technicians and pharmacy residents supported UF Health’s COVID-19 phone lines early in the pandemic by triaging patients and scheduling telehealth appointments with physicians.
CQM began its COVID-19 operations on March 30, and in the first month, 1,150 patients concerned about whether they had COVID-19 were screened by phone. Pharmacists and staff used a series of questions to determine whether a patient needed to be evaluated by a UF Health physician via telehealth. They also collected patient information and entered it into UF Health’s electronic medical record system. The physician considered the patient’s symptoms, travel history and other factors to determine whether a COVID-19 test was needed.
Clinical pharmacist Carolina De Los Ríos, Pharm.D., R.Ph., was among a team of pharmacists and staff in the Center for Quality Medication Management who supported UF Health’s COVID-19 phone lines.
When the University of Florida began reopening campus, health system leadership also turned to the CQM to support its Screen, Test and Protect program. CQM staff reached out to UF employees to schedule a voluntary COVID-19 test appointment. If the employee agreed, the CQM ordered the test and entered it into the employee’s electronic health record.
Responding to the need for PPE
Gowns, gloves, masks and shoe covers are all pieces of personal protective equipment, or PPE, that UF Health Physicians were able to order amidst the COVID-19 pandemic, but face shields were another story.
Scott Martin Vouri, Pharm.D., Ph.D., an assistant professor in the UF College of Pharmacy and assistant director of pharmacy services at UF Health Physicians, found another way: assembling them out of materials from three different sources. He found the protective plastic covering from an industrial supplier, the elastic straps from local retailers and weather stripping from local hardware stores.
Helping him were Pharm.D. students from the UF College of Pharmacy and colleagues from Vouri’s home department, pharmaceutical outcomes and policy. These volunteers assembled over 500 reusable face shields during a couple weeks in April, which have gone to COVID-19 testing sites, various UF Health Physicians practices and the UF Health emergency rooms. “The pharmacy students have stepped up, and they really understand the need,” Vouri said. “I think they’ll certainly look back at this time and know that they made a contribution.”
UF pharmacy student Katarina Lambertson helps assemble face shields.
New COVID-19 website launches for health care professionals
A COVID-19 website developed by the University of Florida College of Pharmacy Office of Continuing Pharmacy Education, or CPE, launched in late March to provide practical, relevant and timely information about the global pandemic. The website featured video updates from experts explaining foundational science and epidemiological concepts about COVID-19, as well as practical issues affecting pharmacists on a day-to-day basis. More than 50 Advanced Pharmacy Practice Experience students and 13 preceptors helped to build a library of brief COVID-19 drug information summaries.
The website registered more than 30,000 page views from nearly 10,000 users in its first month. In addition, the Office of Continuing Pharmacy Education provided more than 1,000 contact hours of CPE credit to Florida pharmacists at no charge through the website and discounted CPE offers for UF faculty, preceptors and alumni.
