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Robert E MacLaren | |
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| Born | (1966-11-14)14 November 1966 (age 59) Surrey, England |
| Alma mater | University of Edinburgh |
| Awards | ARVO Camras Award (USA); RP Fighting Blindness Scientist of the Year Award (UK); Percival Hay, Richardson Cross and Jessie Mole Medals (UK) |
| Scientific career | |
| Fields | Ophthalmology |
| Institutions | University of Oxford |
| Thesis | Optic Nerve Regeneration (1995) |
| Website | ndcn |
Robert E. MacLaren (born 14 November 1966) is a Britishophthalmologist who has led pioneering work in the treatment of blindness caused by diseases of theretina. He is Professor ofOphthalmology at theUniversity of Oxford[1] and Honorary Professor of Ophthalmology at theUCL Institute of Ophthalmology. He is aConsultant Ophthalmologist at theOxford Eye Hospital. He is also an Honorary ConsultantVitreo-retinal Surgeon at theMoorfields Eye Hospital.[1] MacLaren is anNIHR Senior Investigator, or lead researcher, for the speciality of Ophthalmology.[2] In addition, he is a member of the research committee of Euretina: the European Society of Retina specialists,[3]Fellow ofMerton College, inOxford and a Fellow of theHigher Education Academy.[4]
Robert MacLaren was born on 14 November 1966, atEpsom in Surrey.[5] His father was a photographer, which prompted an early interest inoptics. MacLaren was educated and trained at theUniversity of Edinburgh Medical School, from 1985 to 1990, where hegraduated with a Bachelor of Medicine and a Bachelor of Surgery. MacLaren then earned an academicdoctorate, between 1992 and 1995, at theUniversity of Oxford. The doctorate was for his work on optic-nerve regeneration.[citation needed]
MacLaren was appointed Professor of Ophthalmology at the University of Oxford in March 2009.[1] In February of the same year, he was made Honorary Professor of Ophthalmology at theUCL Institute of Ophthalmology. He has been a Fellow of theRoyal College of Ophthalmologists (FRCOphth) since June 2003.
MacLaren is a professor in theNuffield Laboratory of Ophthalmology (NLO),[6] the academic ophthalmology outstation of Oxford University'sNuffield Department of Clinical Neurosciences, which is part of theMedical Sciences Division and based in theJohn Radcliffe Hospital.
MacLaren is described as 'one of the stars' of the developinginter-disciplinary field of ophthalmictranslational medicine (TM). This combines practical skills in eye surgery with clinical academic application in research, to investigate the diseases of the eye 'from bench to bedside': aiming to improve patient outcomes, at least by arresting or slowing the progress of a disease, or – ideally – by reversing the effects, partially or totally. Once the processes of the diseases are understood, new surgical technologies are furthering the options for a surgical solution and new ophthalmic technologies have created a variety of implants, such as electronic retinal devices for prosthesis. Furthermore, the enhanced precision of surgery allows additional interventions, with the application ofgene therapy andstem-cell therapy to retinal dystrophies (inherited conditions).[7]
MacLaren has been a Consultant Ophthalmic Surgeon for theOxford University Hospitals NHS Foundation Trust (OUH) since March 2009.[1] His surgical work is based largely at the Oxford Eye Hospital[8] and the Nuffield Laboratory of Ophthalmology [NLO], both located within theJohn Radcliffe Hospital, onHeadington Hill in Oxford. He has also been Honorary Consultant Vitreoretinal Surgeon atMoorfields Eye Hospital NHS Foundation Trust, in London, since May 2006.
He has been a Fellow of theRoyal College of Surgeons of Edinburgh (RCSEd) since July 1998 and was awarded their annual King James IV Professorship in 2007.
He is one of the first surgeons in the world to have made a successfulretinal implant forvisual prosthesis,[7] sometimes described as creating: a 'bionic eye'. He is also a pioneer inrobot-assisted surgery forophthalmic operations.[7] Key events of his work at the Moorfields and John Radcliffe hospitals include:
MacLaren was the assistant surgeon to James Bainbridge and helped perform the world's firstretinal gene therapy treatment. The operation was carried out at Moorfields in London. The patient was Robert Johnson, a young man withLeber's Congenital Amaurosis (LCA). A faulty gene in the pigment layer, RPE65, prevented his photoreceptor cells from working, so a valid copy of the gene was implanted in one eye to 'patch' the blind-spot and restore function.[9] The delicate operation required passing a needle through the eye, to lift the retina and insert the new gene-copy in the pigment layer.
This trial was funded by the Health Innovation Challenge Fund[10] and the Oxford (OUH) BRC. It addressed the progress of the diseasechoroideremia, or choroideraemia, in which a faulty gene, CHM, leads to a loss of REP1 protein, affecting theretinal pigment epithelium (RPE) and causing progressive loss of vision. On 24 November 2011, Jonathan Wyatt, a Bristol barrister, received a 'good copy' of the REP1 gene, administered through anadeno-associated virus (AAV) – serotype 2 (AAV2) – as a vector, in fluid under the retina. By 2016, the results of the trial appeared both 'promising and lasting' and further work was authorised, with a view to seeing whether the process could eventually be applied to more common conditions, such as age-related macular degeneration (AMD).
These trials, funded by the NIHR and the Oxford (OUH) BRC, tested the ability of an electronic retina to replace a retina that has become damaged, a development common in patients with the hereditary conditionretinitis pigmentosa (RP). The implants were developed by German company Retina Implant AG.[11] The devices also require a power-plant to be inserted behind the ear, in the manner of a cochlear implant.
The pilot-trial of 22 March 2012 tested the Alpha IMS device. The supporting power-plant procedure was carried out by surgeon James Ramsden with Markus Groppe. The main operation was undertaken, at Oxford, by MacLaren with Tim Jackson, consultant surgeon at Kings College Hospital.[12] The patient was Chris James, a council-worker from Wiltshire. MacLaren suggested that if the trial were successful, an electronic retina could become standard for patients with retinitis pigmentosa (RP). He warned that current devices were not suitable to treat age-related macular degeneration (AMD) or diseases of the optic-nerve, such as glaucoma.[13] The following week, Jackson, with MacLaren, operated on Robin Millar, a music-producer,in London; another four UK patients also received the device during that year.
On 8 June 2015, the improved Alpha AMS device was implanted in the first patient, again with MacLaren carrying out the procedure, in Oxford.[14]
In the past, retinal diseases of the eye could be monitored to microscopic level – using laser scanners and microscopes – but interventions were not possible because the delicate nature of the eye meant that surgical operations were beyond the physiological limits of the human hand. On 9 September 2016, operating at theJohn Radcliffe Hospital inOxford, MacLaren and Thomas Edwards[15] performed the world's first robot-assisted operationinside the eye. The patient was William Beaver, a local priest.
This operation was described as the 'R2D2 Trial', because it was testing the safety and efficacy of theRobotic Retinal-Dissection Device (R2D2), developed by Dutch firm Preceyes BV (pronounced:precise!).[16] The operation involved lifting off a damaged membrane, 100th millimetre thick, from the retina, at the back of the eye; the robot's tolerance, however, would have allowed work to 1000th millimetre.[17] The operation proved the efficacy of the new technologies available, allowing the possibility of exploiting their potential to new scientific and a medical ends: MacLaren said that with robotic systems, a whole new chapter of eye surgery had just begun.
Mutations in theX-linked RPGR gene are the most common cause of severe sight loss inretinitis pigmentosa. The RPGR gene contains a highly repetitive sequence ofpurine bases in theDNA with a large section comprising almost exclusivelyGuanine orAdeninenucleotides, which made it very difficult to clone it forgene therapy. Using a form of gene editing known ascodon-optimisation, MacLaren and members of his research team were able to engineer a stable version of RPGR that was expressed highly efficiently in anAAV vector.[18] This led to the first gene therapy trial for X-linkedretinitis pigmentosa sponsored by Nightstar and with MacLaren as the surgeon.[19]
TheOxford NIHR Biomedical Research Centre (OxBRC)[20] is, as evidenced by NIHR funding allocation, one of England and the UK's leading centres for medical research. It is sometimes styled 'Oxford (OUH) NIHR BRC' since the establishment of a second BRC in Oxford: the Oxford Health NIHR BRC. The OxBRC'sNHS Host is theOxford University Hospitals NHS Trust, where MacLaren is a Consultant Ophthalmologist and itsAcademic Partner is the University of Oxford, where MacLaren is also Professor of Ophthalmology. Additionally, in 2016, the NIHR appointed MacLaren to be a senior investigator, or lead researcher, for the speciality of ophthalmology.[2]
Between March 2001 and April 2006, MacLaren was a Resident Clinical Research Fellow at theMoorfields Eye HospitalNHS Trust, in London. He was then a faculty member and a founding research-theme leader in theMoorfields – UCL Institute of Ophthalmology Biomedical Research Centre, which was then the specialist BRC for Ophthalmology.[21]
His currentclinical andlaboratory research efforts focus on the forms ofblindness which are to date incurable. By understanding the causes ofretinal degeneration, it may be possible to slow, arrest or ameliorate the processes. The ultimate aim is then to reverse such effects and to restore working vision.[7] Theresearch efforts concentrate on two areas of the eye in particular: theretinal pigment epithelium (RPE), and thephotoreceptors. The NLO Clinical Ophthalmology Research Group ('the MacLaren Group')[22] is looking at replacement methods for each, and for both, to improve patient outcomes.[7] Electronic retinal implants have already been trialled to treat retinitis pigmentosa, and trials are now being conducted to treat choroideremia through gene-therapy: implanting missing or faulty genes to correct retinal dystrophies (inherited conditions).
As well as retinal issues, research is undertaken to improve outcomes for conditions relating to the lens and to the optic nerve, such as improved intra-ocular lenses (IOL) for cataract operations and therapies for glaucoma.
In addition to his other duties, MacLaren has a full programme of teaching and tutoring. He is formally qualified, with a Postgraduate Diploma in Learning and Teaching in Higher Education (PGDipLATHE) from 2006.[23] He has been a Fellow of the Higher Education Academy since June 2003.
As a Bodley Fellow – the active staff of the college – at Merton, since October 2007, he is a stipendiary lecturer in human anatomy.[24] He has held weekly tutorials in medical sciences for undergraduates since 1992: anatomy, genetics and cell biology for Year 1, and neuroanatomy and visual neuroscience for year 2; third year FHS topics relate to gene therapy, stem cells or visual neuroscience.
As a mentor at the Academy of Medical Sciences, he supervises clinical academics. He also supervises junior doctors training in ophthalmic surgery and DPhil research students.[4]
In 2014, with Oxford University, he co-founded the privatebio-technology companyNightstaRx Ltd.,[25] also knownNightstar, in which he remains a director, and which is based at the offices of theWellcome Trust in London.
The technology spin-out was developed withOxford Innovation, Ltd. and Syncona Ltd. and the clinical-stage company now is backed by Syncona,NEA venture capital and Oxford Science Equity-Management (OSEM).[26][27] The company has received four rounds of funding, including its IPO on NASDAQ in September 2017.[28][29][30]
MacLaren was also acommissioned officer inGroup A – the units intended for operational service – of theTerritorial Army, now Army Reserve, of theBritish Army.[31] As a qualified doctor, he served as aMedical Officer (MO) in theRoyal Army Medical Corps.[31] He achieved the rank of major before retiring from military service in 2012.[31]
MacLaren was posted to theHonourable Artillery Company (HAC) and, in due course, became the Surgeon-Major: the Regimental Medical Officer (RMO). The term Surgeon-Major applied to all the unit's RMOs, most of whom were inGeneral Practice (GP), and it was coincidental that Major MacLaren was primarily an occupational surgeon. Major MacLaren also served as locum RMO to theHousehold Cavalry Mounted Regiment, at Knightsbridge in London.[21]
In addition to serving as an RMO, Major MacLaren volunteered for an operational tour, in the formerYugoslavia, engaged in the field ofmilitary medicine, as part of 1st Mechanised Brigade,[21] with case-work based more on occupational injury andtrauma medicine, rather than disease and genetics.
Having served as a member of theVolunteer Reserves for more than a decade, Major MacLaren, RAMC qualified for thepost-nominals:VR.[32]
Robert MacLaren is married with three children: two boys and a girl.[33] He is the grandson of the lawyerRobert Edwin NewberyMC, great-great grandson of the Victorian actor/playwrightJames Roland MacLaren and great-great-great grandson of the engineerSampson Moore.[34]
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