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Medicine

Professor Andrew Lotery MD, FRCOphth

Professor of Ophthalmology, Director, Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine,Honorary Consultant Ophthalmologist, University Hospital Southampton NHS Foundation Trust,Research Director for Gift of Sight Appeal (www.giftofsight.org.uk)

Professor Andrew Lotery's photo

Professor Andrew Lotery is Professor of Ophthalmology within Medicine at the University of Southampton. As a clinician scientist his research is driven by interactions with patients. He works from bench to bedside using laboratory techniques such as molecular genetics and cell biology to study common causes of blindness such as age related macular degeneration (AMD) and glaucoma. His laboratory work is complemented with clinical trials undertaken in Southampton Eye Unit.

Why do people go blind and how can we prevent this? Eye clinics are the busiest they’ve ever been

He is best known for his genetics research in retinal diseases. He has identified the genetic determinants of retinal diseases and helped to translate these into new therapies such as complement inhibitors for the commonest cause of blindness, age related macular degeneration (AMD). His innovative research in macular disease was recognised internationally by his 2004 election to the United States Macula Society. He is one of the top UK clinician scientists in eye disease as demonstrated by his election as an NIHR senior investigator in 2008 and The Times listing him in their 2010 Top 100 Doctors list. His influential research was recognised by the Royal College of Ophthalmology (RCOphth) who awarded him the Nettleship medal in 2009 for his Lancet paper on AMD genetics. He received the 2012 special award for excellence from the Macular Disease Society and the 2014 University Hospital Southampton Innovation Award and he is the former President of the of the Southern Ophthalmological Society.

In influencing policy to improve health and wealth, Andrew has beena member of the Department of Transport’s honorary medical advisory panel on driving and visual disorders since 2013. He has acted as a nominated clinical expert to The National Institute for Heath and Care Excellence (NICE) technology appraisal panels that have resulted in major changes in management of AMD and vitreo-macular traction.

As co-chair of the RCOphth academic committee, he initiated co-funded clinical training fellowships with the MRC. Andrew is specialty lead for the Wessex Clinical Research Network spearheading a major increase in clinical trials in Wessex over the last 5 years. He has contributed significant AMD samples to an international effort to find novel genetic determinants for AMD. This has resulted in over 20 novel genes been identified.

Research interests

Andrew is interested in understanding the molecular basis of ophthalmic diseases. His University laboratory identifies genetic determinants of eye disease and studies defined mutations in patient derived induced pluripotent stem cells. New therapeutic approaches are also being explored such as gene therapy and retinal cell transplantation. He also leads a dynamic clinical trials team which has participated in many landmark clinical trials developing new treatments for both common conditions such as age related macular degeneration and also rare conditions such as choroideremia. None of this would be possible without the financial support of the Gift of Sight Appeal.

Qualifications

MB BCh BAO, Medicine, Queen’s University, Belfast (1989)
FRCOphth, Ophthalmology, Royal College of Ophthalmology (1994)
MD, Molecular genetics, Queen’s University, Belfast (1997)

Appointments held

2002 - present Professor of Ophthalmology, University of Southampton

2000 – 2002 Assistant Professor of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA

1998 – 2000 Fellow in medical retina and molecular ophthalmology, University of Iowa Hospitals and Clinics, USA

1996 – 1998 Specialist Registrar in Ophthalmology, Royal Victoria Hospital, Belfast

1995 – 1996 Research Registrar (Ophthalmology and Medical Genetics), Belfast City Hospital

Research interests

Genetic studies and gene therapy trials

My MD research in Belfast successfully mapped a gene for Central Areolar Choroidal Dystrophy. At the University of Iowa I was part of the team which identified that mutation in Fibulin 3 is the genetic cause of Doyne’s Disease. This led to a simple test for this disease which is now freely available on the NHS and so allows rapid diagnosis and genetic counselling (figure 1).

Again as part of a team, I identified one of the commonest genes (CRB1) to cause Leber congenital amaurosis (LCA) and was one of the first to show that gene therapy is feasible in the macula . My work has therefore assisted in the choice of genes and vectors for human ocular gene therapy trials (which have now started). I am a co-investigator on an ocular clinical gene therapy trial on choroideraemia.

My research group in Southampton has identified several additional genetic risk factors for age related macular degeneration (AMD) (figure 2) and we identified the association of SERPING1 with AMD. For this contribution I was awarded the Nettleship Medal by the Royal College of Ophthalmology for the best research paper published by a British Ophthalmologist in the last four years.

As part of the UK multicentre IVAN study I co-ordinated the collection of DNA samples on participants in this trial so that pharmacogenomic evaluations could be made in AMD. My laboratory was one of the first to identify pharmacogenomic associations in AMD.

I am Chief Investigator on a multi-centre genetic study of primary open angle glaucoma (POAG). Glaucoma is a progressive disease of the optic nerve, resulting in gradual but permanent loss to peripheral vision. We have collected approximately 1500 DNA samples so far (figure 2). Together with researchers at the Wessex Regional Genetics Laboratory in Salisbury, I have been able to establish a test for glaucoma, now available on the NHS. Most recently I have been part of multi-national collaborations seeking to identify novel glaucoma genes. This has resulted in a recent discovery which has been published online in Nature Genetics.

My laboratory has also been instrumental in the genetic understanding of a type of childhood Nystagmus where the eyes have involuntary to-and-fro movements. We have established the genetic cause in a large family with congenital infantile nystagmus (CIN), and are currently recruiting for a large paediatric genetics study.

We are also actively genotyping patients with cone dystrophies, glaucoma and retinitis pigmentosa.

Stem Cell studies

I am investigating the use of human iris pigment epithelium derived stem/progenitor cells and also corneal limbal epithelium derived stem cells, as potential cell sources for transplantation. This work aims to isolate stem cells from iris and corneal tissue, and to drive transdifferentiation towards retinal phenotypes including photoreceptor and RPE cells. From both tissues my team has sucessfully derived RPE and photoreceptor like cells. Our work is now focussing on assessing the functionality of these cells. Although we have been sucessful in deriving retinal lineage cell types, the efficiency of this process is relatively low. The next step for this work will therefore be to use viral gene modification with transcription factors, in an attempt to improve the efficiency of retinal specific differentiation.

Manufacture of artificial cell delivery scaffolds

In collaboration with Dr Grossel’s group in chemistry we have manufactured electrospun fibrous scaffolds using a non-biodegradable synthetic acrylic polymer, which is used clinically in the manufacture of intra-ocular lens (figure 3). The electrospun scaffolds mimic the structure of the inner fibrous layers of native Bruchs membrane. In order to improve cell adhesion, the surface of these fibrous scaffolds has been modified to facilitate attachment of extracellular matrix proteins and short cell adhesion motifs.

Using these scaffolds we are currently carrying out in vitro biocompatibility studies. We are assessing cell attachment, proliferation and viability on different types of fibres and also the effect of various surface modifications. We are also characterizing the phenotype and functionality of the cell monolayer formed on the surface of fibrous scaffolds. In collaboration with Dr Aly Hussain from the Institute of Ophthalmology (UCL), we are carrying out investigations to quantify the elasticity and permeability of the artificial fibrous scaffolds, in comparison to human Bruchs membrane.

Clinical Trials

I run a clinical trials group (figure 4) which is involved in a variety of commericial and NHS funded clinical trials. I have participated in over 10 clinical trials for AMD and diabetes. I have been the UK Chief Investigator for two of these studies. In recognition of my efforts in translational clinical trials I was one of the first 100 investigators in the United Kingdom to be made a National Institute of Health Senior Investigator.

I provide a tertiary referral service in medical retinal diseases including diabetic retinopathy, age-related macular degeneration, vascular diseases, hereditary and acquired macular diseases. I run a cataract operating list with an emphasis on training junior ophthalmologists in cataract surgery. I have responsibility for the delivery of photodynamic therapy (PDT) services for AMD in Hampshire and successfully both wrote and implemented the business case for PDT in Hampshire. I run a weekly special teaching session in fluorescein angiography. I have ongoing research programmes in age-related macular degeneration and ophthalmic genetics. I run a monthly ophthalmic genetics clinic with my colleagues in Clinical Genetics. I have established a medical retinal clinical research fellowship. I provide a national lead on AMD treatments in the NHS including submissions to NICE and the Hampshire Clinical Advisory Priorities Group. I have set up an NHS funded anti-VEGF service at Southampton Eye Unit. I have successfully developed a business plan for this which has resulted in the recruitment of two new consultants and additional staff grade doctors and nursing and imaging staff.

Link to Lotery group medline search

Electropherogram of mutation which causes Doyne Disease
Figure 1
Retinal appearance of AMD
Figure 2
Stem cells growing on polymers developed for eye delivery
Figure 3
Clinical Trials Group
Figure 4

Research group

Clinical and Experimental Sciences

Affiliate research group

Clinical Neuroscience Research group

Postgraduate student supervision

Principal supervisor for the following students

2014 Alasdair Warwick Academic Foundation Programme student
2013 Philip Alexander DM Student
2012 Gareth Ward Current PhD student
2011 Christina Lim MMedSci First class Hons
2010 Charles Pierce Current DM student
2009 Jenani Jegatheeswaran 4th year student study in depth
2009 Aruni Makuloluwa 4th year student study in depth
2009 Jocelyn Cherry Academic Clinical Fellow
2008 Dr Xiaoli Chen PhD graduated 2012
2008 Sam Khandhadia MBBS MRCOphth PhD graduated 2013
2008 Katherine Beeson Intercalated BSc 1st hons
2008 Thea Preston 4th year student study in depth
2007 Sebastian Foster 4th year student study in depth
2006 Aris Konstantopoulos MSc student graduated 2009
2006 Mahesan Murugavel 4th year student study in depth
2006 Thomas Marks Intercalated Bsc 2.2 hons
2005 James Self MRCOphth PhD graduated 2009
2005 Neda Bogari PhD graduated 2007
2005 Dildar Hussain 4th year student study in depth
2005 Matthew Cheung 4th year student study in depth
2004 Joy Okotcha Intercalated BSc 2:1 hons
2003 Srini Goverdhan FRCS PhD graduated 2008
2001 David Eliason M.D. Doris Duke Fellow

 

Co-supervisor for the following students

2014 Savannah Lynn Current PhD student
2014 Ahmed Salman Current PhD student
2013 Paul Ibbett Current PhD student
2010 Dr Salome Murinello  PhD graduated 2014
2008 Dr Andrew Treharne PhD graduated 2012

National and International responsibilities

01/07/2014 - to date. Member, E3 (European Eye Epidemiology) consortium.
01/04/2014 - to date. Clinical Specialty Lead for Ophthalmology, NIHR Clinical Research Network, Wessex.
01/01/2013 - to date. President Southern Ophthalmological Society
01/05/2012 - to date. Member International Glaucoma Genetics Consortium
01/04/2012 - to date. Grant Award Committee British Council for the Prevention of Blindness
01/01/2012 - to date. Chair of the UK Ophthalmology Steering Committee UK Biobank
01/10/2011 - to date. Director of Clinical Neuroscience Research Group University of Southampton
01/07/2010 - to date. Consultant Representative South Central Eye Care Advisory Group
01/06/2010 - to date. Member International AMD Genetics Consortium Phenotyping Committee
01/01/2010 - to date. Panel member, Integrated Academic Training review panel National Institute for Health Research
01/01/2010-01/12/2010 Biomedical Research Guest Panel Member Sir Jules Thorn Charitable Trust
01/01/2010-01/12/2010 Guest Panel Member, MRC–RCOphth clinical training fellowship Medical Research Council
01/01/2010 - to date. Chairman, Scientific Committee National Eye Research Centre, Bristol
01/09/2009 - to date. Chairman, Academic Ophthalmology Committee Royal College of Ophthalmologists (RCOphth)
01/04/2008 - 01/04/2014. Speciality Lead for Ophthalmology for HIOW CLRN Hampshire & IOW Comprehensive Local Research Network
01/04/2008-01/03/2011 Senior Investigator National Institute for Health Research
01/01/2008 - to date. Surgical training committee Wessex Deanery
01/01/2008 - to date. Editor-in-Chief, Eye Nature Publishing Group
01/01/2008 - to date. Honorary Member, Executive Council Royal College of Ophthalmologists (RCOphth)
01/04/2006-01/08/2008 Medical Advisor RNIB
01/04/2006-01/08/2008 Hampshire NHS commission Medical Advisor
01/04/2006-01/08/2008 Wessex Institute for Health Research and Development Medical Advisor
01/04/2006-01/08/2008 Expert Clinical Advisor National Institute of Clinical Excellence
01/01/2006-01/12/2011 Faculty Member Pfizer "Eyecampus" national educational initiative
01/01/2006-01/12/2009 Member, Scientific Committee National Eye Research Centre
01/09/2005-01/10/2008 Member, Panel of Experts Medical Research Council
01/01/2005-01/01/2008 Assistant Editor, Eye Nature Publishing Group
01/01/2005-01/09/2011 Member, Examination Committee Royal College of Ophthalmologists (RCOphth)
01/01/2004 - to date. Research Director Gift of Sight Appeal, University of Southampton
01/01/2004 - to date. Member, Eye Research UK Group Vision 2020
01/01/2003 - to date. Elected Member Macula Society (USA)
01/09/2002 - to date. Chair of Ophthalmology University of Southampton

 

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Postgraduate Supervisor for PhD/DM/MSc laboratory based projects for both clinical and basic visual science students

Undergraduate Supervisor offering one MMedSci and one Academic Foundation Programme laboratory based vision science project per year. Postgraduate supervisor offering Integrated PhD rotation projects in both the Immunity and Infection and Stem Cell pathways.

Co-ordinator of weekly Retinal teaching program

Professor Andrew Lotery
University of Southampton Southampton General Hospital LD 70 MP 806 Tremona Road Southampton SO16 6YD Tel: +44 (0)23 8120 5049

Room Number: SGH/LD75/MP806

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