Professor Nikki Robertson (MB ChB, FRCPCH, PhD)
Professor of Perinatal Neuroscience & Honorary Consultant Neonatologist
- Centre for Clinical Brain Sciences
- The Roslin Institute
Contact details
- Tel: 07779248235
- Email: n.robertson@ed.ac.uk
Address
- Street
-
The Roslin Institute
Midlothian EH25 9RG
- City
- The University of Edinburgh, Easter Bush Campus, Midlothian
- Post code
- EH25 9RG
- Street
-
Centre for Clinical Brain Sciences,
Chancellor's Building, - City
- Edinburgh BioQuarter, 47 Little France Crescent,
- Post code
- EH16 4TJ
Background
Professor Nikki Robertson trained in neonatal medicine in Melbourne and London after completing her medical training at the University of Edinburgh. Her interest in perinatal brain injury was kindled at the Hammersmith Hospital, Imperial College London in the late 1990s, a time of exponential increase in our understanding of the evolution of brain injury after birth asphyxia. Using MRI and MRS, the timing and evolution of brain injury in babies with neonatal encephalopathy (NE) could be followed, leading to the seminal finding that therapetuic hypothermia (HT) ameliorates the secondary wave of energy failure. HT is now standard care in babies with NE, however, not all babies benefit. Since 2003 at UCL, Professor Robertson has used pre-clinical models to assess the safety and efficacy of additional therapies that can complement and synergize with HT, eg melatonin and human umbilical mesenchymal stem cells. In 2020, Professor Robertson joined the University of Edinburgh as Professor in Perinatal Neuroscience and Honorary Consultant Neonatologist.
Qualifications
MB ChB University of Edinburgh 1983-1988
PhD University of London 2002
Fellow of the Royal College of Pediatrics and Child Health 1995
Responsibilities & affiliations
University College London
Open to PhD supervision enquiries?
Yes
Current PhD students supervised
PhD
Dr Kathryn Martinello 2018-2021 Inflammation-sensitized Brain Injury
Dr Raymand Pang 2019-2024 Repurposing Azithromycin as a Neuroprotective Therapy for NE
Past PhD students supervised
2003-2005 (completed) MD Primary supervisor Jeanie Cheong 4.7 Tesla MRI and MRS of NE
2005-2009 (completed) PhD Primary Supervisor Divyen Shah aEEG Reflects Cerebral Injury in the Newborn
2007-2010 (completed) PhD Second Supervisor Sudhin Thayyil Minimally Invasive Autopsy
2007-2012 (completed) PhD Primary Supervisor Cornelia Hagmann Qualitative and quantitative MR imaging in preterm infants: relation to neurodevelopmental outcome
2006-2011 (completed) MD Primary Supervisor Manigandan Chandrasekaran Cerebral MRS Biomarkers and Outcome in Perinatal Asphyxia
2010-2013 (completed) PhD Second Supervisor Gemma Williams Mapping Pain and Nociception in the Infant Brain
2007-2013 (completed) PhD Primary Supervisor Sachiko Iwata Safe and effective cooling using phase changing material
2007-2014 (completed) PhD Primary Supervisor Osuke Iwata Cerebral phosphocreatine overshoot after perinatal HI
2012-2014 (completed) PhD Second Supervisor Tharindi Hapuarachchi UCL CoMPLEX
2010-2013 (completed) PhD Primary Supervisor Alan Horn (University of Cape Town) Relation between aEEG and NE score
2010-2015 (completed) PhD Primary Supervisor Cally Tann (Wellcome Perinatal risk factors for NE in Uganda
2009-2017 (completed) PhD Primary Supervisor Mojgan Ezzati Ischaemic post conditioning as a neurpprotective therapy after perinatal HI
2014-2018 (completed) PhD Primary Supervisor Subha Mitra Near Infrared Spectroscopy biomarkers in NE
2015-2020 (completed) PhD Primary supervisor Ingran Lingam. Magnesium as a neuroprotective agent with cooling
Research summary
My clinical and research interest is neonatal brain injury and neuroprotection of the term and near-term baby, working both as a consultant neonatologist and research group lead at UCL over the past 20 years. The journey has been exciting and fast-moving, with therapeutic hypothermia (HT) for neonatal encephalopathy (NE) being a significant advance in newborn care. However, as HT is only partially protective, we are searching for adjunct therapies which can complement and synergize with HT. We study mechanisms of brain injury using MR techniques and NIRS. With the aim to move therapies along the translational pipeline, we have studied the following neuroprotective agents: melatonin, noble gases (xenon and argon), amiloride, erythropoeitin, remote ischemic post conditioning. We have shown that proton MRS is a robust marker of neurodevelopmental outcome in NE and we use this biomarker both in our pre-clinical models and for clinical prognosis.
Current research interests
In October 2020, I was appointed as Professor of Perinatal Neuroscience at the University of Edinburgh and Honorary Consultant Neonatologist at the Royal Infimary of Edinburgh, returning to my Alma Mater after 30 years. The world-class laboratory facilities at the Roslin Institute and LARIF will facilitate the translation of therapies from bench to bedside and I am excited to have the opportunity to study human umbilical mesenchymal stem cells (huMSC) as a potential powerful neuroprotective therapy at the University of Edinburgh, funded by the MRC. I am committed to the delivery of optimal clinical neurocritical care as part of a neuroprotective bundle. In the next 5-10 years I am keen to set up and inspire clinical trials of the most promising adjunct therapies with HT, the development of biomarkers to assess inflammation sensitization, tailoring neuroprotection to specific babies. Our pre-clinical studies have shown that melatonin at therapeutic levels, given soon after injury, is a safe and effective therapeutic agent and early phase clinical trials are urgently needed.Past research interests
My interest in neuroprotection extends to low resource settings in particular sub-Saharan Africa. As inflammation-sensization is known to exacerbate injury, we have developed a model of LPS-sensitized hypoxia-ischemia, working with the Bill and Melinda Gates Foundation on therapies relevant to low resource settings (such the antibiotic Azithromycin, repurposed as a neuroprotective agent, acting by immunomodulation). In Uganda, our studies led to an important understanding of risk factors for NE and possible concerns of HT in this setting. As the main burden of NE is in low resource settings, my aim is to ensure we develop economical, practical, safe neuroprotective interventions relevant to both high and low resource settings.Knowledge exchange
Optimizing therapeutic hypothermia for babies with moderate to severe neonatal encephalopathy
Novel melatonin formulation (collaboration with Chiesi Pharmaceuticals) Int. pat. appl. PCT/EP2018/056423; https://patentscope.wipo.int/search/en/detail.jsf?docId=WO2018167162
Lac/NAA validation as a surrogate outcome marker for babies with NE
Project activity
INSTINCT Study: Intranasal Stem Cells for Improving Neurodevelopmental Outcomes in Neonatal Encephalopathy
Our primary aim is to assess neuroprotective effects of intranasal (IN) human umbilical cord stem cells (huMSC; clinical grade, manufactured at UCL) in a neonatal model with and without therapeutic hypothermia using aEEG, MRS and neurodevelopment as safety and outcome measures prior to early phase clinical trials.
The use of stem cells to successfully treat neonatal brain injury is emerging as a promising therapy. Human umbilical cord mesenchymal stem cells (huMSC) self renew and stimulate host brain cells to regenerate and repair, with superior anti-inflammatory properties than MSC from adult tissues. Importantly, although huMSC do not survive long term and replace damaged tissues themselves, they react to the needs of the ischemic cerebral environment by secretion of growth factors, cytokines and extracellular vesicles (EVs) to regulate damage and repair. These intrinsic adaptive properties of huMSC make them excellent candidates to treat the devastating effects of NE. The newborn brain is still in a developmentally active phase, leading to high efficiency of huMSC.
Current project grants
1. MRC UK
INSTINCT Study: Intranasal Stem Cells for Improving Neurodevelopmental Outcomes in Neonatal Encephalopathy. 2021-2024.
PI: Professor Nicola Robertson
Co-applicants: Professor Mark Lowdell, Dr Daniel Fullen, Professor Xavier Golay, Professor Boris Kramer
2. Bill and Melinda Gates Foundation. 2019-2022
PAINT: Piglet Asphyxia Inflammation Model for Neonatal Therapies
PI: Professor Nicola Robertson
3. Wellbeing of Women. 2020-2022
CAMELLIA Study: Cooling and Melatonin in LPS- sensitised Asphyxia
PI: Professor Nicola Robertson
Past project grants
Grants held over the last 5 years
Total Grant Funding ~£20 million
Grant Funding as Principal Investigator ~£16 million
1. MRC UK. 2018-2021. Development of a cot-side optical biomarker of brain tissue health following neonatal hypoxic-ischaemic brain injury. Co-applicant
2. MRC UK. 2017-2019 EMPATHY Study. Epo and Melatonin for Perinatal Asphyxia with Therapeutic Hypothermia PI.
3. Saving Lives at Birth. 2017-2020 RS-17-08196: Smart sclera screening of jaundiced newborns in Ghana. Co-applicant
4. MRC UK. 2015-2017. Reducing the Burden of Neonatal Brain Injury: Assessment of Hypothermic & Melatonin Neuroprotection in an Inflammation-Sensitised Piglet Asphyxia Model. PI
5. Action Medical Research. 2015-2017. Refining the potential use of magnesium in neonatal encephalopathy: safety, pharmacokinetics and neuroprotection of magnesium-augmented hypothermia compared to hypothermia alone. PI
6. Chiesi Farmaceutici S.p.A. 2014-2016. Melatonin for Birth Asphyxia (MELBA): optimizing dose and therapeutic window. PI
Invited speaker
April 9-12, 2018, 99nicu Meetup - advancing the management of newborns” Vienna, Austria. Precision Medicine in NE – is this possible?
June 7-9 2018 , Rostock, Germany, The Society of Neonatology and Pediatric Intensive Care (Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin GNPI) Neonatal Encephalopathy with special focus on current therapy concepts but also on future concepts from xenon to ischemic postconditioning.
June 11-13 2018, Neonatal conference Buenos Aires, 4 lectures: 1. Prognosis using MRI and MRS in Neonatal Encephalopathy; 2. Neonatal Seizures; 3. New Treatments for Neonatal Encephalopathy; 4. Therapeutic hypothermia: the journey over the last few decades
October 15-18 2018, Bill Gates Foundation. Grand Challenges Annual Meeting 2018: Berlin Germany, Invited speaker for Birth Asphyxia Consortium. Hypoxic Injury and Neonatal infection: do current treatments address this common combination?
November 22-24 2018, Cool topics in Neonatology, 2018, Melbourne, Australia. Invited Talks 1. Inflammation Sensitized Brain Injury: how do we detect and treat it? 2. Melatonin the Healing Hormone- is it ready for prime time? 3. Neonatal Seizures – an update from high and low resource settings
November 23-25, 2018. The Neonate, 2nd International Symposium for Asia -Shanghai, November 23-25, 2018. 1. Novel Therapies for Neonatal Encephalopathy; 2. Neuroprotective Bundle of Care for Preterm Babies
February 20-21, 2019. Bill Gates Birth Asphyxia Consortium, Seattle, USA
March 20-22, 2019 , Perinatal Asphyxia meeting, Modena (Italy), organized by Mariani Foundation. MR Spectroscopy Biomarkers
March 28-30, 2019, 7th International Meeting - from Fetal Life to Childhood maternal-infant nutrition congress, Istanbul, Turkey. Invited Talks. 1. New modalities in Neuroprotection; 2. Magnetic resonance biomarkers of neonatal brain injury
April 4th-6th, 2019. 2nd World Congress Maternal Fetal Neonatal Medicine, London. Term NE – how can we augment protection from therapeutic hypothermia?
April 15th-17th 2019. Ipokrates Clinical Seminar, Doha Qatar, Neonatal Pharmacology. 1. Neonatal Seizure Treatments – the new, the old and the useless; 2. Potential New Adjunct Therapies to Avoid Adverse Neurodevelopmental Outcome in Neonatal Encephalopathy
May 23 – 25, 2019 IPOKRATES Clinical Seminar. Protecting and Developing the Brain. Kagawa International Conference Hall, Takamatsu City, Kagawa, Japan. 1. MRI/MRS of the Neonatal Brain 2. Adjunct Therapies to include those for HIC and LMIC
17-21 September 2019 3rd Joint European Neonatal Society, Maastricht. Invited speaker. Pre-congress Course 3 – Basic Neuroscience Research Methods: Bringing Neuroscience into the Clinic. Parallel session: Translating neuroscience into clinical practice in low and mid income countries
24th September 2019 Neonatal and Children’s Brain Consortium Ireland, Dublin. Invited talk: Neuroprotection for Neonatal Encephalopathy – the old, the new and the unexpected.
4-5th October 2019. Sidra’s Inaugural Pediatric Neuroscience Conference, Doha, Qatar. Invited Talk: Neonatal Seizures – update on new treatments.
28th-31st October 2019. Qatar Critical Care Conference 2019, NEW Developments in the Care of the Newborn with HIE
23-26 November 2019. CUDOS-2019, Doha, Qatar, Invited Talk: Neonatal Hypoglycemia and Brain Injury
10-13 November 2019. 43rd “Miami Neonatology Conference”, Loews Hotel in Miami Beach. Invited Talks. 1. Brain protection therapies applicable to low resource settings; 2. The heart rules the brain – The impact of congenital heart disease on brain development and injury in the neonatal period
February 26-28th, 2020. International Neonatology Symposium: Bangkok 2020. Invited speaker: 1.Tailoring Brain Protection to Low Resource Settings; 2. Therapies for Neonatal Encephalopathy. What’s Next?
April 1-5, 2020. 28th National Neonatology Congress, Turkish Neonatal Society, Antalya, Turkey. 1. Therapies for NE: what’s next? 2. Predicting outcome and Imaging Markers in NE
June 20-24, 2020. Conference on Neonatology, Avignon, France, Invited talk
8-10 September, 2020. Best of IPOKRATES, Munich Germany. Invited talk and workshop: Pathway of investigation and management of NE
September 17-19, 2020. 12th International Newborn Brain Conference , Carton House, Kildare, Ireland. Invited talk: Is it time for MRS to enter clinical practice?