Dr Moti Ramgopal shares the journey of becoming a leading Infectious Diseases Specialist

From Georgetown to Florida:

By Lakhram Bhagirat

The world of infectious diseases is vast and though it may seem as though much of it is explored, that may be far from the fact. The volatility of the world’s healthcare system was exposed late last year and early this year when COVID-19 began spreading like wildfire.

Currently, there are no signs that the spread of the potentially deadly disease is nearing containment.
COVID-19 does not discriminate and over the last few weeks, the world learned that one of the most powerful leaders – Donald Trump, President of the United States of America – contracted the disease. He was given an experimental drug treatment of antibodies and has since reportedly recovered.
That drug is currently undergoing clinical trials at several sites across the US and one of the leading sites is located in Fort Pierce, Florida. That site was founded and operated by Guyanese Dr Moti Ramgopal – one of the leading infectious diseases specialists in the USA.
He has played an integral part in the gathering of information about the drug so that Trump’s doctors could have made the informed choice to present him with the option.
Guyana Times recently sat down with Dr Ramgopal, who shared his story – from being raised in Station Street, Kitty, Georgetown, to establishing one of the leading Clinical Trial Sites for infectious diseases in the US.
Dr Ramgopal hails from a family of high achievers, with his father being Lalta Ramgopal – former General Secretary of the Guyana Rice Producers Association and an attorney. He has five siblings and his eldest brother and sister are also lawyers while his other brothers are into finance.
He was raised in Kitty and attended the Rama Krishna Primary School and wrote the Common Entrance Examination and gained a place at Queen’s College in 1976. In secondary school, he was well versed in sports and was a master at chess. He was the country’s junior champion for two years in a row and then represented Guyana at various levels in a number of tournaments.
He completed his secondary education in 1983 and began teaching mathematics and physics at the same institution. The then young teacher received a Government scholarship to study Medicine at the University of the West Indies, Mona Campus in Jamaica. After he received his medical degree from the University of the West Indies, he moved to the Bahamas where he spent three years.
When he moved to the Bahamas, the Human Immuno-Deficiency Virus (HIV) was wreaking havoc and it was there he was introduced to the world of infectious diseases. He began researching the field and became even more fascinated with his discoveries.
What amazed him the most was the fact that microscopic viruses and bacteria were being treated to lower or eliminate infections without ever being seen. He wanted to be a part of treating those diseases and coming up with plans to prevent those infections.
This led to him applying to be a part of the Internal Medicine Residency Programme at the Bon Secours Hospital in Detroit, Michigan. Upon completion of the Residency Programme, Dr Ramgopal completed a Fellowship in Infectious Diseases at Jackson Memorial and the University of Miami School of Medicine.
After he completed his two-year Fellowship, Dr Ramgopal returned home to Guyana and took up a post with the Georgetown Public Hospital and also began teaching at the University of Guyana’s School of Medicine. He stayed in Guyana for six months before he came to the realisation that he would be stuck in a cycle of just tending to patients and teaching. He knew that he wanted to do more so in order to do that, he needed to leave.
“Everybody had said why you want to do infectious disease but I saw it was the most complete form of medicine mentioning that infections can affect your brain, your sinuses, your heart, your lungs, your kidneys, your gastrointestinal system, your liver…There is a process whereby infections can get better or it can get worse. You can die from an infection very very quickly and it is the one disease state where you can actually make such a profound impact on somebody’s life.
“I think it became very important for me to recognise that I can make such a profound impact on people’s lives by treating them very quickly seeing their recovery and I felt drawn to infectious disease from that period of time,” Dr Ramgopal recounted.
He moved back to the United States and settled in Fort Pierce and started his private practice in 1999. His community was a small one but had a whole host of issues that ranged from a steady climbing HIV infection rate to low or no insurance. It meant that his services were needed and he answered the call.
To date, Dr Ramgopal has never turned away a patient because of a lack of finances. He noted that he is not in the profession for the money rather it is the results.

During his Fellowship days with the University of Miami, he was involved in clinical trials in fungal infections in transplant kidneys, so he decided that he wanted to continue in the line of clinical trials. However, he knew that he needed to work on something different and what affected his community.

HIV clinical trials
In an effort to address the needs of his community, Dr Ramgopal knew he needed to do something about the steady climbing HIV infection rate in Fort Pierce. He took the decision to begin clinical trials in HIV.
“I said I really want to get involved with clinical trial for HIV so I started my own clinical trial unit with 2-3 of us and I said that let’s start clinical trials in the new drugs. New drugs mean that a drug before it is being approved by the Government, the FDA (has to be tested). I wanted to be involved in these cutting-edge stuff, recognising that here is the virus, how does it attach, where the medication is going to work, what’s the mechanism,” he said.

He started his first clinical trial in 2006-07.
In order to be able to successfully market a new drug, there are three steps the clinical trial must undergo. The first phase is where a small number of patients are placed on the drug and observations for side effects and dosage are made. Phase two increases the patient number and investigates the drug more in-depth. The last phase is the compilation of the data and presentation of it to the Food and Drug Administration.
When he commenced his first clinical trial, Dr Ramgopal was still working at the hospital and running his private practice all while travelling back and forth between Guyana and the US as part of the PepFar Project which was initiated by President George Bush.
He would leave the PepFar project in 2012 to focus more on his trials and clinical research as well as further develop his Clinical Trial Site.
“When you look at every HIV medication that we have studied for the last 15 years, I have been involved in either phase 2 or phase 3 of the study. I haven’t developed a medication per se but I bring it to the market, meaning I will enrol patients, I will study the drug in patients, the effects, the side effects and then I will publish (articles) on those studies with other people,” he said.
Dr Ramgopal has been published in all of the major scientific journals. In fact, he is one of the few physicians that has been published in such an extensive way. That is so because of how he approaches his writing. He not only looks at and discusses the results of his studies and trials, rather he goes in-depth – explaining the data and how the findings are arrived at. He looks at the scientific data and is also part of a team of physicians that would present the drug findings to the FDA for approval so that they can market it.
Currently, he is involved in three clinical trials for the cure of HIV which is very unusual because there are not a lot of clinical trial sites in the world involved in such work. He is excited to be a part of what he foresees as the solution to the HIV disease. However, he is also cognisant of the fact that most of the drugs that he is presently working on would not be heard about for the next five years since the process to get them to customers is such a long and gruelling one.
“In the future, take HIV for example, people are taking pills every day and in about three to five years they will be taking an injection. Actually three months from now they will be releasing an injection to give one a month or every two months. So pills will be replaced by injectables and in time instead of taking the pills every day, we will take the pills once a week or once a month and these are the studies that I am involved in from very early,” the Infectious Disease Specialist said.

The cure for HIV
The cure for HIV is interesting because, here is a virus that has been around for over 25 years and scientists have not really developed a vaccine for it as yet. When one looks at the amount of information about the virus that is available, it is puzzling as to why the cure has not yet come about. But Dr Ramgopal explained that it is not as easy as it seems on the surface.
He noted that while he does not aid in the creation of the drug, he has baseline knowledge of how the process works and extensive knowledge of how the HIV virus operates. The drug needs to be created to address the way the virus operates but doctors are still determining how that is.
“We understand that here is a virus that now attaches to a certain site on the CD4 cell and the virus now enters into the cytoplasm of the human cell and then the virus ultimately integrates into our DNA and then the virus goes into hiding and it stays forever. So we developed medications which can actually stop the virus from replicating in the blood, but the million-dollar question is the virus hides, we know where it hides and we know it hides in reservoirs, but the problem now is these reservoirs are cells that are slowly multiplying or stays dormant for many years. So the moment you stop the medication, the virus starts replicating and coming to the forefront.
“So the strategy for curing a person with HIV who have been on the treatment for years and have suppressed the virus, is to determine how do you now stimulate the reservoir to produce the virus and completely kill it. The clinical research I am doing for the cure for HIV has to do with using medications called toll-like receptors (TLRs) to stimulate these reservoirs to multiply so we can kill it. It is called kick or kill strategy,” he explained.
Dr Ramgopal and other researchers have found that with the antibodies and other medication, they can actually stimulate the immune system to kick this virus out.
“So I think in a long time we actually have a mechanism that we are working on that we do believe we can cure it. We are now in the phase one studies of most of these medications.”
His role as the investigator is important since he is needed to deliver the drugs to the patients and to track the patients, understand the data, track their vitals and then release that data to the FDA for drug approval.

COVID-19
Currently, Dr Ramgopal is running about 7 clinical trials with COVID-19 patients. The antibody cocktail that President Trump received is one of them that he has been working on for over three months now.
“The coronavirus is one of the many coronaviruses so when you look at a virus you ask many questions. So like how does this virus replicate, where does it replicate and how does it affects someone’s immune system and what really happens. So we call this coronavirus a novel virus because we have never seen it before, we have never seen any virus behave like this.
“So there is a lot of steps in the process of how we stop this virus from replicating so that is how the remdesivir story came about because it was developed against Ebola virus and it really didn’t have a good activity…When we look at a drug like remdesivir it will attack the virus but still even though we give patients the remdesivir we still see they have pulmonary complications and the question is why? And then we start to look at the immune system.
“We produce antibodies naturally and over the last 10-15 years, we have genetically manipulated antibodies where we can produce antibodies against certain parts of the virus. The medication President Trump received is called Regeron COV2 and this medication has 2 components – it has 2 antibodies that was developed against the virus – one against the spike protein that penetrates to the lung and attaches and develops a replicative cycle whereby it pushes the immune system to the point where it becomes hyperactive…the next part is an antibody against the virus itself,” he explained.
Dr Ramgopal said he has not gotten involved with the COVID-19 vaccines because of the fact that he feels the need to find treatment methods that work so they can bring the infection rate down.

Small country boy
For Dr Ramgopal, he never really left Guyana because he will always consider here home. While he is able to do exciting things in the US, he is taking steps to bring those same services to Guyana. He intends to open an International Centre for Research here in Guyana.
He already has the Midway Centre on Carmichael Street and is gearing to move the operation to Kingston at a new location. He is hopeful in a few years’ time to be able to bring clinical trials to Guyana.
“I go to meetings and at the table are the top guys in infectious diseases in the county and around the table, I am the only one that is not at the university and I feel honoured and privileged that here is a guy from Guyana sitting at the table with the leading infectious diseases doctors around and making these decisions and having discussions.”
Dr Ramgopal with his father Lalta Ramgopal
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