Long COVID Research in Latin America with Carolina Hurtado Montoya, MD, PhD

• Growing up in a family of teachers, Montoya’s early interest in natural sciences, biology, and biochemistry led to her decision to pursue a career in medicine with the intention of also being a professor of medicine. 
• Influential mentors such as Dr. Gloria Vasquez at CES University and Dr. Iñaki Sans at Emory University, helped focus her research on immunology, autoimmune diseases, and now, long COVID.
• CES classmate, Dr. Gina Perez connected Montoya with Northwestern Medicine scientists who are pioneering long COVID research and treatment protocols to collaborate on research of long COVD patients in Colombia. .
• Initial findings from long COVID studies in Colombia showed significant cognitive impairment and persistent neurological symptoms in both hospitalized and non-hospitalized patients.
• In collaboration with Northwestern Medicine scientist  Dr. Igor Koralnik and the Shirley Ryan AbilityLab, a development of rehabilitation protocols, were created and tailored for Spanish-speaking long COVID patients in Colombia.
• The entire collaboration between Montoya and Kroalink has been virtual, aiding the affordability and function of this research.
•  Montoya advises young professionals to find their passion, enhance teamwork skills, and engage in global collaborations to make a larger impact.

[00:00:00] Dr. Rob Murphy: Welcome to the Explore Global Health Podcast. I'm Dr. Rob Murphy, executive director of the Havey Institute for Global Health here at Northwestern University Feinberg School of ---Medicine. Today's guest, Dr. Carolina Hertado Montoya, has led the first studies in Columbia and Latin America documenting the persistence of long COVID symptoms, and her work could help shape treatment and global understanding of long COVID. She's working closely with. Northwestern Medicines. Dr. Igor Koralnik, who is also director of the program for Global Neurology here at the Havey Institute for Global Health. This work is funded through our Global Health Research Catalyzer Fund, and aims to define the potential benefits of evidence-based cognitive rehabilitation for Spanish speaking, long COVID patients with cognitive dysfunction in a middle income country of Latin America. We welcome her to the show today to talk about this important work and her path to global health as a Colombian physician scientist. Welcome Carolina.

[00:01:10] Dr. Carolina Hurtado: Thank you. Thank you for having me.

[00:01:11] Dr. Rob Murphy: You're based at CES University in Medellin, Columbia as an assistant professor, and you also received your MD and PhD from that school, but you didn't always know that medicine would be your chosen career. I understand that you're from a family of teachers and thought you might go into that profession as well. What ultimately led you to choose medicine instead?

[00:01:33] Dr. Carolina Hurtado: Yeah, so at the beginning of my childhood, I had a close family member with an illness. So I was, I witnessed that process from a young age and I got curious about how the human body worked, how sickness, how treatments, how everything like in medicine worked. At the same time, I also had an interest in natural sciences, biology, and biochemistry. So in my last year of high school, I knew for sure that I wanted to work with people, like I knew for sure, either teaching or in medicine. I wanted to work, talking and interacting with people. So actually my mother gave me a wise piece of advice. She said, well, you like understanding the human body and you like science, why don't you study medicine? And if you still like teaching so much, you could be a professor in medicine. So basically that's what happened seven years later. And today that's basically what I am doing. Besides research, actually, I still see patients, which is very fulfilling for me. A research environment, but I am also teaching. So finally, everything came together.

[00:02:48] Dr. Rob Murphy: Well, your mother gave you some very good advice, it sounds like. , And I'm still seeing patients myself. I think it's really a good thing to keep that connection on the clinical side. During your medical school and research training, you worked with mentors like Dr. Gloria Vasquez in Columbia, and Dr. Inaki Sanz at Emory University. Can you tell me about those experiences and how they shaped your interest in immunology and your path toward researching autoimmune diseases and especially long COVID?

[00:03:18] Dr. Carolina Hurtado: Yeah, absolutely. So I've had. A very great fortune and honor of having excellent mentors throughout my medicine program and my doctorate program. So Dr. Gloria Vasquez, I have learned so much from her. She graduated from the first cohort of physicians from our university and later she studied internal medicine and rheumatology, and later on she did a PhD in immunology. So she has combined perfectly clinical, both clinical and basic research, and she's still seeing patients. Basically everything I know from research, I learned that from her. Not only like the operation, but she also taught me to be very patient and very empathetic with patients. Even in research. Like she said, those patients are suffering. Also, they're looking for answers for their illnesses that maybe they have not found in their regular treatments. So it was through Dr. Gloria, that I got two goals in a six month internship at Emory University with Dr. In. That's where I finalized my knowledge in biomarkers and multiparametric cytometry and some epigenetic experiments, and I finished my PhD. I had the training of both having some clinical research and some basic research like she did, so I think that was very fortunate for me to learn.

[00:04:50] Dr. Rob Murphy: A few years ago we had a CES classmate of yours on this podcast, Dr. Gina Perez. She was a neuroimmunology fellow here at Northwestern at the time, and I understand it was Gina who introduced you to the long COVID research taking place here at Northwestern Medicine with Igor Koralnik.. Can you tell me about that connection?

[00:05:12] Dr. Carolina Hurtado: It is actually very funny because Gina and I met when we were 17 years old in our first semester in medicine, like in our biochemistry class. Then she went to the States, she did neurology. I stayed here, I did my PhD. And in 2022 we reconnected because she came to Columbia, to the university. Actually, I didn't know she was working long COVID. I just heard she was coming to university and I wanted to say hi. We were drinking a cup of coffee and she started telling me about her. Research in long COVID and that she was looking for uh, research collaboration at CES University at Columbia. And she told me that she was a bit worried because she wasn't sure if they could find a way to process the blood samples. They weren't sure about that. So I asked her, what are you going to do with the blood samples? What is, is it a very complicated experiment? What are you going to do? So she showed me, like in her cell phone, she showed me this is the protocol. So when I read it, I said, Oh my God. This is what I, this…

[00:06:16] Dr. Rob Murphy: this is what I'm doing anyway.

[00:06:18] Dr. Carolina Hurtado: Yeah. I'm teaching this to my students, so. I could help you if you want to. So initially I was only going to participate in the processing of the blood samples. Yeah, the laboratory

[00:06:27] Dr. Rob Murphy: component, right?

[00:06:28] Dr. Carolina Hurtado: Yeah, exactly. But then the other researcher from the university who was working with her in all the other administrative tasks, she left the university. Then Gina asked me, well, you have a PhD. I mean, can you step up? And I said, sure.

[00:06:45] Dr. Rob Murphy: Good collaboration, old friendship. Now in collaboration with a global research team that includes Northwestern and Columbia and scientists, you've led the first study in Columbia and Latin America to analyze persistent neurologic symptoms in long COVID patients. Tell me about these symptoms, your research, and what were your initial findings?

[00:07:07] Dr. Carolina Hurtado: The evidence about non COVID in Columbia is variously scarce. The few studies available beside. Our, our study, they only described the most frequent symptoms, but our study went a bit further evaluating patients both cognitively in an objective and subjective way. And we also evaluated quality of life in those patients. So our findings were that more than 60% of our patients had brain fog. Over 70% of our patients had cognitive impairment in either one of the four cognitive objective tests that we're doing with the NIH toolbox program. This is very interesting because our study evaluated both patients, which were hospitalized and had a severe or moderate COVID infection. And we also had a group of 50 patients with a mild or even a symptomatic COVID-19 infection. And it was interesting because you would think that patients who were hospitalized would have more sequela but we found sequela in both groups and it was actually very shocking because the mean age of our non hospitalized patients was 36 years old, so they are people in their most productive years. And the mean age of our hospitalized group was 15 years older. But we are seeing people like, we have patients 23 years old with sequela, and we also found that the percentage of anxiety and depression, both exacerbated or new Anxiety and depression were also a higher number in both groups. And it was interesting because when we talked with the patients in the non hospitalized group, the hardest thing for them to understand was in their own words, they were saying like, I only had a cold, like. COVID for me was a cold, a win, a one week cold. And I have been with Long COVID for two or three years. So that was the other part of our study that described patients who had long COVID for two or three years after the COVID infection. So the other, uh, studies reported in Latin America. They only reported long COVID six months later after the, the, the infection in Brazil, Ecuador, Argentina. But this was the first time that we were saying in Latin America, we have patients with two or three years of long COVID. And only one week of COVID.

[00:10:01] Dr. Rob Murphy: Can you tell me about the treatment that you gave these patients and what it might mean for long COVID patients in Columbia and potentially other Spanish speaking countries?

[00:10:11] Dr. Carolina Hurtado: Yeah, so for our current research collaboration, we joined with the experience of Shirley Ryan Rehabilitation Center and also with DR. Team. So. Both teams joined and then exchanged experiences and instruments and protocols, and after that, our team designed the protocol, so they decided we should have six rehab sessions and also two evaluations. What we saw was that our patients had problems in attention, executive function, memory, fatigue, anxiety, depression. And taking those results, they took that and created and designed the protocol. So they have attention sessions, executive function sessions, and memory. We have preliminary results. They're very encouraging. We now have nine patients that have completed the protocol, and most of them have improved at least one standard deviation in attention, at least in one of the cognitive functions. So they're very encouraging and we are seeing patients getting better both objectively and subjectively. We've had pretty moving comments from our patients. I'm just going to read one which is about a 42-year-old male. He said after having had COVID-19 infection, I began to experience difficulties with attention and concentration. One of the most valuable aspects was understanding what was happening in my body and mind, and discovering that with effort and dedication, it is possible to recover skills that had been affected so far. Our patients have had good feedback, very positive feedback about the rehab protocols. We are aiming to have 40 pretreated patients. We currently have 25 patients under rehab, and so we hope we can really help them. And also after we publish, we hope this can also help to create rehab protocols, both in Colombia and others, Spanish speaking countries, because actually we're not really doing anything new. I mean the rehab therapy they're applying to also applies to other problems like head trauma. They are not new techniques. They're just organized and they're applying them to these patients, but they're not actually new.

[00:12:34] Dr. Rob Murphy: Part of your current project involves collecting blood samples and analyzing biomarkers of mitochondrial dysfunction in these long COVID patients. Can you tell me anything about what these biomarkers reveal about the disease and how they could inform future treatments?

[00:12:52] Dr. Carolina Hurtado: For now, we are taking the samples, but our aim with Dr. Koralnik will be in the long run trying to describe which biomarkers associate with having a good rehab performance and which biomarkers could perhaps or are related with patients that do not respond as well for cognitive therapy. That would be interesting and maybe it would be also interesting in the future having some sort of help in the diagnosis because so far long COVID is very new, so it would be very helpful having something that can support diagnosis. Besides here at Columbia, at the beginning of the pandemic, they were performing, performing many tests, COVID-19 tests. But two, three years ago, nobody's getting any tests. Um, I mean, people are still getting infected with COVID, but the testing is very low, so it is very hard for those patients because they don't have a test to support they had COVID, but they have all the symptoms of long covid, so, it is especially challenging for those patients to get diagnosis and treatment for long COVID.

[00:14:08] Dr. Rob Murphy: Despite your work with our Institute, you have not actually met personally with Dr. Koralnik, a completely virtual relationship. All of your communication is virtual. Everything is just electronic. How common is this type of virtual international research collaboration now in Columbia? What are some of the challenges and pros and cons of the arrangement?

[00:14:32] Dr. Carolina Hurtado: I think Zoom callings have no issues with that, and I think it actually makes things easier for projects to work because. I think it would take more time and effort and funding if everything depended on personal communication. I really liked it.

[00:14:49] Dr. Rob Murphy: It's good to get together in person every once in a while, but I don't think it certainly has to be like it used to be before the pandemic. I mean, we found that with all our international partners, we can keep a lot of projects really alive. All right. I have one last question for you. What advice do you have for young people who are just now embarking or wanting to embark on a career in global health?

[00:15:11] Dr. Carolina Hurtado: Finding a passion within the field. I am very fortunate to have. Teaching as a passion, having that very clear in my mind makes me want to, in all my research projects, I want to work with students, master students, residents, and undergrad students. And having a team, working in a team makes things work better and have more impact, and also get better results. Global medicine, you need to work in a team, you need to work with people from different backgrounds, different languages. So I would say work on those skills and have your passion clear.

[00:15:53] Dr. Rob Murphy: One characteristic that everybody brings up on this podcast involves passion. There's so many different ways that passion can affect your career development and it's good to hear it again and good to talk to you about how you managed to do all this virtually. You have a grant from the Institute for Global Health, the Havey Institute working with some big leaders in the field and. Been able to translate all this, uh, into your own country and, probably the region as well. So congratulations and thank you so much for joining us today. We really loved hearing your story.

[00:16:29] Dr. Carolina Hurtado: Thank you.

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